Overview In April 2024, the Health Care Affordability Board at California’s Office of Health Care Affordability (OHCA) approved a statewide health care spending target, setting an annual per capita growth rate that health plans and providers are expected to meet in order to slow the rise in health care costs. Starting January 1, 2026, OHCA intended to begin to enforce spending targets, limiting annual increases in healthcare expenditures for most California hospitals to 3.5% and 1.8% for seven high-cost hospitals. By 2029, these targets drop to 3% and 1.6%, respectively. […]

On February 20, 2026, the Department of Justice (DOJ) and the Ohio Attorney General’s office filed suit against OhioHealth, a 16-hospital nonprofit health system, claiming that OhioHealth’s use of all-or-nothing terms (requiring insurers to include all of its providers in their networks) inflates costs for policyholders and disadvantages competitors.  The suit also claimed that OhioHealth’s contracts included terms requiring OhioHealth to be at the most-favored level of benefits in each network, and that payors were prevented from providing patients with price information about healthcare services.  The Source published an analysis of this case in March. […]

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, […]

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 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 […]

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 […]

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 […]

On Thursday, February 5, a federal jury ordered Medtronic to pay $381.7 million to Applied Medical for antitrust violations, finding that Medtronic used its market power to illegally stifle competition through bundling and exclusive-dealing contract terms. Parties to the Case Both Medtronic and Applied Medical produce a surgical instrument called an advanced bipolar device (ABD), which uses electrical current to cut tissue and seal blood vessels during surgery.  Medtronic is the largest medical device supplier in the world.  Medtronic has a dominant market share in the ABD market while Applied […]

Discussions of health care consolidation often center on providers and insurers, but growing concentration among the companies that operate behind the scenes poses equally serious risks.  For example, the Change Healthcare data breach in early 2024 caused significant disruptions in healthcare because Change processes approximately half of all U.S. medical claims, and a single cyberattack disrupted large swaths of the health care system.  Similar dynamics are playing out in other sectors of the health care system.  More than 305 million patients have electronic health records controlled by Epic.  At the […]

On November 9, the Indiana Department of Health issued a Certificate of Public Advantage (COPA) to allow Union Hospital to acquire Terre Haute Regional Hospital. The proposed merger would effectively combine the two only acute care hospitals in Vigo County and create a near‐monopoly for inpatient hospital services in the Terre Haute, Indiana area. The proposed acquisition drew opposition from the Federal Trade Commission (FTC) (under both the Biden and Trump administrations) and the state’s own Attorney General (AG). The COPA prevents state enforcement to challenge the merger as an […]