Across the healthcare system, companies that once occupied a single layer of the supply chain increasingly own the layers above and below them, and that vertical consolidation can raise costs, narrow patient choice, and create conflicts of interest when one firm both sets prices and competes in the market it is pricing.  Pharmacy benefit managers (PBMs) are a prime example of the potential for harms created by vertical consolidation.  A PBM sits between health plans and pharmacies and determines how much the pharmacy is reimbursed when it dispenses a drug, […]

As state legislative sessions wind down, notable healthcare policy themes are emerging across the country.  It is important to note which states introduced ambitious legislation, and even more so, which enacted it.  State policy activity often builds on one another, with legislative changes in one state influencing those in another.  In some instances, states can act as trendsetters by adopting new approaches not yet considered elsewhere, and whether these initiatives will influence legislative activity in other states remains to be seen.  The following paragraphs highlight a few of the topics […]

On May 14, California Governor Gavin Newsom released the May Revise to his initial January proposal for California’s 2026-2027 fiscal year.  The revised budgetary proposal totals $246 billion in total general fund spending, a reduction of $1.8 billion from his initial January proposal.  The bill prioritizes reducing the state’s long-term deficit through 2028 by cutting general fund spending, despite higher-than-anticipated tax revenues in anticipation of a volatile market, federal budget cuts, and rising costs from the Iran conflict. The initial proposed budget was shaped by federal funding cuts to Medicaid […]

On Tuesday, April 7, 2026, the 9th U.S. Circuit Court of Appeals struck down key provisions of California’s Assembly Bill 290 (2019), a law that capped the reimbursement rates dialysis providers could collect from private insurers for patients receiving premium assistance from charitable organizations and required related patient disclosures. The court held that the reimbursement cap and disclosure provisions violated the First Amendment by burdening the American Kidney Fund’s right to associate with dialysis providers DaVita and Fresenius, and that California had not narrowly tailored the law to its asserted […]

On February 10, 2026, California Governor Gavin Newsom signed SB 25 into effect, enacting the California Uniform Antitrust Premerger Notification Act.  Introduced by Senator Tom Umberg, the new law mandates that companies required to file federal premerger notifications under the federal Hart-Scott-Rodino (HSR) Act also file the information with the California Attorney General.  California is following Washington and Colorado in enacting a version of the Uniform Antitrust Premerger Notification Act, model legislation proposed by the Uniform Law Commission.  Although the new law gives no new enforcement powers, it expands the […]

On March 9, 2026, Jennifer L. Rochon, United States District Judge for the Southern District of New York, partially granted and partially denied a motion to dismiss a case against JPMorgan Chase.  The original suit, filed by JPMorgan employees, claimed that their employer mismanaged health benefit plan funds, allowing excessive payments to CVS Caremark, resulting in higher healthcare premiums, higher drug costs, and lower wages, thereby constituting a violation of the Employee Retirement Income Security Act of 1974 (ERISA).  JP Morgan had moved to dismiss the case, but the judge’s […]

In mid-March 2026, Sutter Health and Allina Health announced the signing of a Letter of Intent to merge the healthcare systems.  Sacramento-based Sutter Health has more than 600 locations and 27 hospitals, and reported $19.8 billion in total revenue and $509 million in operating income in 2025.  Sutter Health has come under fire in recent years with claims that it has improperly used its market power to impose anticompetitive contract terms, restricting competition and driving up the cost of care.  Minneapolis-based Allina Health has 12 hospitals and 100 additional care […]

On March 6, 2026, New Mexico enacted HB306, the “Fair Pricing for Routine Medical Care Act”, to prohibit charging of healthcare facility fees for certain services, to require the disclosure of facility fees to patients, and to require the reporting of facility fees to the all-payer claims database.  The bill prohibits hospitals and clinics from charging outpatient facility fees, which many hospital systems add to bills for healthcare services at facilities they own.  The bill imposes special requirements for uninsured patients, as well as for rural clinics and emergency departments […]

Antitrust and Market Competition Playing Favorites — State Protection of Academic Medical Centers from Antitrust Oversight New England Journal of Medicine Jaime S. King, Katherine L. Gudiksen, Anna D. Sinaiko The authors explore a new trend with U.S. academic medical centers (AMCs) merging with nonacademic hospitals and health care systems.  These mergers pose risks of price increases and other competitive harms.  Regulators should review all transactions involving an AMC and ensure that any promised benefits from consolidation do not harm the public.  Notably, at least four states have laws explicitly […]

On March 26, 2026, the Department of Justice (DOJ) sued New York-Presbyterian Hospital (NYP), claiming NYP used illegal anticompetitive terms in their contracts with payors.  In the related press release, the DOJ stated that “New York-Presbyterian uses its market power to protect its margins, impede competition from rival hospitals, and prevent employers and unions from creating [budget-conscious health plans].”  According to the complaint, NYP imposes restrictions in its contracts that prevent payors from offering plans that do not place NYP in the plan’s most-favored tier.  Additionally, payors are required to […]