In November of 2024, three lawsuits were filed by pharmaceutical manufacturers against the Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA), challenging how HRSA oversees the Federal 340B Drug Pricing Program.  (HRSA is the sub-agency within HHS that administers the 340B Program). The potential impact of the lawsuits on the 340B Program is significant in its own right, but the outcome of the lawsuits could also have an indirect effect on merger and acquisition activity.  Research has indicated that the merger and acquisition […]

The California legislation concluded the 2024 legislative session when it adjourned on August 21, 2024. Overall, the legislature introduced a variety of health care bills spanning a list of hot-topic issues from Medi-Cal eligibility to health care worker minimum wage increases. Below we recap noteworthy bills from the 2024 legislative session impacting California’s health care market that were not enacted (to learn what bills were enacted please see Recapping the 2024 California Legislative Session: Artificial Intelligence, Debt, and More). The bills covered are arranged by issue relating to Pharmaceuticals, Health […]

Price Transparency Hospital Payment Caps Could Save State Employee Health Plans Millions While Keeping Hospital Operating Margins Healthy (Health Affairs) Roslyn C. Murray, Christopher M. Whaley, Erin C. Fuse Brown, Andrew M. Ryan As health insurance premiums continue to rise, state employee health plans are occupying an increasing portion of state budgets. State employers are often the largest purchaser or commercial health insurance in each state, given the volume of employees that they employ. As such, state governments are placed in a unique negotiating position to implement cost containment strategies. […]

Healthcare market oversight at the federal level is primarily done through litigation brought by the Federal Trade Commission (FTC) or the Department of Justice (DOJ).  Any change in administration in Washington will change the focus and priority of these agencies.  Nonetheless, the second Trump administration has indicated that it will make wholesale changes to federal agencies, including the FTC and DOJ, that exceed those that are typical during a change in administration.  These indications raise many questions about the new role of the FTC and DOJ in healthcare markets: How […]

On August 31, the California Legislature ended the second year of the 2023-2024 legislative session. Lawmakers worked arduously until midnight of the last day of the session to decide on the future of more than 1300 bills but ultimately ran out of time to get through them all. Through their efforts, they passed approximately 990 of these measures which were presented to Governor Newsom for signing this fall. Keeping in line with recent years, the Governor vetoed 183 of the bills (a roughly 18% veto rate). Nevertheless, California successfully passed […]

On November 7, California Governor Gavin Newsom called for a special session of the California Legislature to take steps to protect California from anticipated changes driven by the new Trump administration.  While many of the Governor’s areas of concern are not directly related to healthcare (including protecting civil rights, climate action, and immigrant families), there is a focus on reproductive rights, women’s rights and LGBTQ+ rights. The special session convened on December 2.  The primary goal of the session is to provide additional resources to the state Department of Justice […]

Healthcare Competition and Consolidation Chang(ing) Health Care: Bigger May Not Be Better, Just Necessary (Health Affairs Forefront) Atul Grover, Jonathan B. Jaffery As the health care market increasingly trends towards consolidation, many have been left wondering whether the trend towards amalgamated efficiency truly is better. The authors of a new Health Affairs article are arguing that the answer is no. Specifically, they state that the trend towards larger, more consolidated entities is resulting in higher health care costs without marked improvements to quality. As health systems become larger, their power […]

On October 18, 2024, the North Carolina Supreme Court unanimously ruled to send a case challenging the states Certificate of Need (CON) law back to a lower court.  Certificate of Need laws require healthcare providers and facilities to get permission from the state government before adding or expanding healthcare services, equipment, or facilities.  To get this permission, the provider must show that the new service is needed, hence the name. The case in North Carolina originated in April 2020 when Dr. Jay Singleton, an eye surgeon, filed suit against legislative […]

On September 28, 2024, Governor Newsom approved Assembly Bill 2063. The provisions of the bill were originally enacted as AB 1124 in 2020, amends section 1343.3 of the Health and Safety Code regarding risk-bearing arrangement pilot programs. These programs, according to the bill’s author, Assemblyman Brian Maienschein, are a solution to increasing health care costs through shared financial risks.  Background The California Department of Managed Health Care (DMHC) regulates the licensure process in the state under the Knox-Keene Health Care Service Act of 1975 (KKA). Entities required to obtain a […]

Healthcare Competition and Consolidation Are “All or Nothing” Contracts by Hospital Systems Anti-Competitive? – Evidence from a Recent Antitrust Lawsuit (Journal of Hospital Management and Health Policy) Glenn Melnick, Katya Fonkych Research has consistently shown that hospital prices are a major driver of increasing healthcare costs in the United States, with the expansion of multi-hospital systems contributing highly to this trend. While contracts between hospitals and health plans have been suspected to contribute to increasing prices, these assertions could not be confirmed until recently since many of these contracts have […]