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 […]

The Source’s founder Jaime S. King, and executive editor Katherine L. Gudiksen, working with Harvard’s Anna D. Sinaiko, have authored a report on state antitrust exemptions for academic medical centers (AMCs) published recently by the New England Journal of Medicine.  There is a recent history of AMCs merging with nonacademic systems, with states creating “carve-outs” to exempt AMCs from antitrust oversight.  The research indicates that such exemptions are unwise and that states should engage in reviews of AMC transactions to ensure they actually deliver public benefits while minimizing consumer harm.  Read the full paper here: https://www.nejm.org/doi/full/10.1056/NEJMp2514565

Background In August of last year, The Source shared information about the California Law Revision Committee’s (CLRC) antitrust study, spurred by the 2022 Assembly Concurrent Resolution No. 95. At its outset, the study aimed to address the U.S. monopoly problem and the “threat of market concentration” in California.  The legislature tasked the CLRC with determining the following: Whether California antitrust law should align itself with Section 2 of the Sherman Act, outlawing monopolies by single corporations in California? Whether California antitrust law should be specifically modified with respect to technology […]

Antitrust scrutiny of anticompetitive healthcare contract terms is on the rise, and the use of anticompetitive contract terms are increasingly in the crosshairs of both regulators and courts. When healthcare systems acquire a dominant market share, one method of capitalizing on this dominance is to impose anticompetitive terms on entities they contract with for financial gain and to forestall competition.  The use of anti-steering, anti-tiering, all-or-nothing, gag clauses, etc., can result in higher costs and reduced options for healthcare consumers.  In recent years, Indiana, Connecticut, Nevada, and Texas have enacted […]

Healthcare Markets and Acquisitions Health Insurance After Corporatization —What Next? New England Journal of Medicine Perspective Leemore Dafny, Ph.D. The author explores whether the corporatization of the U.S. health insurance industry (i.e., the consolidation of insurers within and across markets) contributes to the industry’s poor performance among the commercially insured population. The answer is maybe. One key driver of such consolidation is the “technology of insurance.” Economies of scale drive insurance consolidation by lowering costs and stabilizing risk for larger insurers, but beyond a certain size, these advantages fade, and […]

For 2026, California is in the second year of a two-year legislative session.  And while a significant number of bills have carried over from last year, we are seeing the introduction of new bills for 2026.  With economic uncertainty and reduced federal funds, the state is facing challenges.  However, lawmakers are still pursuing some ambitious goals for this year, with a focus on expanding and protecting coverage, Medi-Cal payments, provider professional practice, and drug regulations.  Below, we look at some of the new legislation introduced in California for 2026 that […]

On February 17, 2026, California Hospital Association (CHA) and Office of Health Care Affordability (OHCA) representatives were before the Superior Court of San Francisco as CHA contested the court’s tentative ruling sustaining OHCA’s demurrer. A demurrer is a motion that does not address factual allegations in a case, but rather challenges a plaintiff’s legal basis for a suit.  In December, the OHCA filed a demurrer to the petition for writ of mandate filed by the CHA. OHCA’s filing argued that CHA’s petition (1) lacked “a concrete and particularized injury” to […]

On January 22, the House Committee on Energy & Commerce held a hearing titled “Lowering Health Care Costs for All Americans: An Examination of Health Insurance Affordability.” The discussion centered on health care costs, patient access, and affordability across the entire health insurance marketplace, and focused on the role insurers play in care delivery. Meaningful Congressional action on rising healthcare prices has been limited in recent years. The purpose of Congressional hearings is often to gather information about a specific topic likely to be used to shape future legislation. For […]