GRAND RAPIDS (WZZM) - America's 49 million uninsured, and the hospitals that treat them, will be paying especially close attention to the court's decision on the individual mandate.

The vote is expected to come down Thursday morning. The mandate would require that the majority of uninsured Americans get coverage.

Right now, local hospitals treat thousands of these folks a year and eat the costs. After all, the emergency room often becomes an option of last resort for those who don't have insurance to go to a doctor regularly. At Metro Health Hospital, the number of uninsured patients is up for each of the past three years.

The hospital system is seeing more uninsured people ages 18 to 64 years old. However, the number of kids 0 to 17 without coverage has stayed the same over the past three years, and fewer seniors 65 and older are coming in uninsured.

In 2010, Metro Health served 16,875 patients without insurance.

In 2011, that increased by more than 11 percent, to 18,781 people. While the 2012 fiscal year is not yet finished, the hospital estimates it will serve 19,754 uninsured patients. That would be afive percent increase from 2011.

The fastest growing uninsured population Metro Health is serving is the 56 to 64 age group. Cases jumped 35 percent last year. The 27 to 55 age group has the largest number of people without coverage; 11,018 walked through the doors last year, a nearly 13 percent increase.

Metro Health Hospital spokeswoman Ellen Bristol attributes the increases to the economy. Most who lost their jobs qualified for COBRA and could stay on the insurance plan for 18 months. But now, more and more people are coming off the COBRA benefits and not getting other insurance, and hospitals are feeling the impact.

Bristol says the hospital has seen an increase in bad debt and charity care, and says the hospital is working more efficiently to keep costs down.

Spectrum Health did not have their information readily available.