Six major hospital associations have filed an amicus brief in support of the federal government in the case brought by the state of Virginia to repeal the healthcare reform law.

The reform law's mandate that all Americans carry health insurance is lawful because, whether they purchase health insurance or not, everyone participates in the healthcare system, argue the American Hospital Association, National Association of Public Hospitals and Health Systems, Association of American Medical Colleges, Catholic Health Association, Federation of American Hospitals and National Association of Children's Hospitals.

“By forgoing health insurance, individuals simply shift the burden of their healthcare payments to others,” the hospital groups wrote in the brief. “The healthcare market is unique in this respect.”

In December, a federal judge agreed with Virginia Attorney General Ken Cuccinelli in finding the insurance mandate in the health reform law unconstitutional. The case is now on appeal.

Along with the hospital groups, the main lobbying group for insurers, America's Health Insurance Plans, also defended the individual mandate, in a separate brief filed with the court.

“Market reforms that are not coupled with an individual mandate are likely to lead to disruption and instability in the health insurance market,” AHIP wrote in its brief in support of neither party.