See case page: Sidibe v. Sutter Health   As all eyes were fixated on UFCW & Employers Benefit Trust v. Sutter Health (UEBT), the landmark state antitrust lawsuit that the California attorney general brought against Sutter Health, another long-standing litigation against Sutter in federal court for similar claims has largely gone under the radar. With the final judgment in the state action set to be approved in state court this July, we turn our attention to Sidibe v. Sutter Health, the other case to watch in the ongoing antitrust challenge against …

The ongoing COVID-19 pandemic has exacerbated the issue of health care affordability in the United States. According to a Pew Research Center study, since the pandemic began, 25% of adults have had trouble paying bills, with 11% having particular difficulty in affording medical care.  Lower income Americans face an even more dire situation, with 46% having had trouble paying bills and 19% unable to afford medical care.  Already stretched thin by the pandemic, the last thing Americans across the country need is to open their mailboxes to find an unexpected …

Editor’s Note: An abbreviated summary of this case appears in the research report “Preventing Anticompetitive Contracting Practices in Healthcare Markets”, which provides a detailed analysis of anti-tiering/anti-steering clauses, including economic justification and procompetitive use and states that have restricted its use in healthcare contracts.   The antitrust case against Sutter Health in California has drawn the attention of state regulators and policymakers across the country, spawning legislative reform efforts to curb dominant hospitals’ market power. Prior to this, an enforcement action against Atrium Health, a large health system on the …

The COVID-19 pandemic necessitated the rapid expansion of telehealth services.  This has led the federal government and many states to expand insurance coverage for telehealth services through emergency waivers of certain requirements.  Implemented ideally, widespread telehealth use could lower the overall cost of health care in commercial markets by lowering per-patient and per-visit costs for specialty and primary care providers, while increasing patient satisfaction and quality of care.  However, if done poorly, telehealth expansion could increase healthcare costs by providing easy access to care that is unlikely to improve health …

As unrelenting consolidation in healthcare provider and insurer markets continues, policymakers need additional options to protect the public from escalating healthcare prices and low-quality care. High healthcare prices result from multiple factors, including third-party payers dampening consumers’ price sensitivity, patients and providers demanding expensive healthcare technologies, and healthcare markets consolidating. While these factors are visible, dominant insurers and healthcare providers can also use terms in their insurer-provider contracts in anticompetitive ways that thwart competition and lead to higher prices or lower quality but remain hidden from public view. With support …

Recent evidence demonstrates that provider and insurer markets in the United States have been highly concentrated for years and have led to increased healthcare prices and insurance premiums without a commensurate increase in quality. The coronavirus pandemic is placing additional financial strain on many physician practices and small, rural hospitals, elevating the risk of unchecked consolidation. State governments can play a critical role in improving oversight of anticompetitive mergers and other affiliations, especially in this time. With support from Arnold Ventures and in collaboration with the Nicholas C. Petris Center on Health …

As states increase legislative efforts to rein in prescription drug prices, an increased number of laws have been passed to regulate pharmacy benefit managers, price gouging, and price transparency in the pharmaceutical industry. However, industry groups have also stepped up legal challenges against these laws, using specifically the Dormant Commerce Clause, ERISA, and federal patent and trade secret laws. With support from the National Academy for State Health Policy (NASHP), The Source’s Katie Gudiksen, Sammy Chang, and Jaime King examine these state laws and ensuing legal challenges in the newly …

Many health care providers and payers seek to maintain the confidentiality of amounts paid for services as trade secrets, claiming their secrecy provides a competitive advantage. With support from the California Health Care Foundation (CHCF), The Source’s Katie Gudiksen, Sammy Chang, and Jaime King examine the legal and economic implications of collecting and releasing this data in the newly published report, The Secret of Health Care Prices: Why Transparency Is in the Public Interest.  Part I of this report reviews trade secret statutes and case law regarding the protection of negotiated …

Medicaid serves nearly one in five Americans, including many with chronic conditions, and purchases about 10% of total prescription medications dispensed in the U.S.[1] From 2013 to 2016, Medicaid’s nationwide drug spending increased almost 50%, from $22.4 billion to $33.4 billion.[2] Medicaid programs consume an increasing percentage of state budgets and threaten to overtake funding for other programs like education and infrastructure.[3] In 2018, the National Association of State Budget Officers (NASBO) estimated that Medicaid accounted for nearly 30% of total state spending and is the fastest growing component of …

Since 2005, Americans have identified the availability and cost of health care as one of their top concerns.  Health care costs have risen due to various factors, such as reliance on fee-for-service payment systems, lack of patient engagement, and lack of coordination and management.  In recent years, state legislatures have focused on increasing price transparency in the hopes that it will drive down health care costs by encouraging consumer price shopping.  One means of promoting price transparency is through the use of database tools, such as state-mandated all-payer claims databases …