As states like Nevada, Colorado, and Washington push forward with their state public option efforts, a new article in New England Journal of Medicine, co-authored by Erin Fuse Brown and The Source’s Katie Gudiksen and Jaime King, takes a closer look at the key provisions of each of the plans. The article discusses potential challenges to these state public option plans and most importantly, whether they can effectively improve healthcare coverage and affordability. Listen to Erin Fuse Brown discuss lessons from these states in a podcast for NEJM.

Breaking: A class action lawsuit has been filed in North Carolina state court against HCA Healthcare and Mission Health, alleging anticompetitive practices in violation of the North Carolina Constitution and antitrust and consumer protection laws. The lawsuit follows HCA’s 2019 acquisition of Mission Health in North Carolina, which was approved with conditions by the North Carolina AG, although none of which were competitive impact conditions. Plaintiffs, who are North Carolina patients, claim that Tennessee-based HCA used market power garnered from the cross-market merger to demand anticompetitive terms in contracts with …

In the most recent legislative session, Indiana enacted a new certificate of public advantage (COPA) law (SB 416) that allows mergers of certain hospitals to receive immunity from claims of state antitrust laws for the duration of the certificate. Specifically, hospitals eligible for the COPA must be located in a predominately rural county with a specific population cap and has no more than two hospitals in the statewide comprehensive trauma care system. Indiana joins 17 other states with existing COPA laws and 1 states with limited COPA laws, mostly enacted …

In an encouraging boost to efforts to promote healthcare competition and price transparency, President Biden signed a sweeping executive order that targets consolidation and lack of competition in the healthcare industry, among others. As part of the Executive Order on Promoting Competition in the American Economy released on July 9th, the President targeted specific market players in the healthcare sector, including hospitals, health insurers, and prescription drug manufacturers. The Executive Order affirms the policy of the Biden Administration “to enforce the antitrust laws to combat the excessive concentration of industry, …

On December 10, 2020, the Supreme Court overturned a decision by the Eighth Circuit and upheld an Arkansas Law to regulate pharmacy benefit managers (PBMs).  In a unanimous decision (8-0, Justice Barrett did not participate in the case), the court reaffirmed that state regulation of prices is not preempted by the Employee Retirement Income Security Act of 1974 (ERISA). The ruling in this case found that Arkansas’ law was a price regulation.  In effect, the law required PBMs to reimburse pharmacies at a rate above the price the pharmacy paid …

A new article published in the Milbank Quarterly Opinion proposes the new Biden administration should help states develop capitated public options as part of its health policy agenda, which could lay the groundwork for a federal public option. Authored by Source Advisory Board Member Richard Scheffler and Thomas Rice, the article examines the recent efforts of Washington and Colorado in developing quasi-public options in their states. The authors identify specific states, including California, Massachusetts, and Rhode Island, as being most ready for such a risk-based capitation program. Finally, they call …

After much anticipation and a round of public comments on the draft guidelines released in January, the Department of Justice (DOJ), along with the Federal Trade Commission (FTC), officially issued the final Vertical Merger Review Guidelines, replacing the Non-Horizontal Merger Guidelines originally issued in 1984. The updated guidelines govern how federal antitrust agencies evaluate vertical, as well as other non-horizontal mergers. The guidelines outline three main sources of evidence for potential adverse competitive effects from vertical mergers: 1) Foreclosure and Raising Rivals’ Costs, 2) Access to Competitively Sensitive Information, and …

On January 10, the Department of Justice (DOJ), along with the Federal Trade Commission (FTC), released a new draft guideline for vertical merger review. As opposed to horizontal mergers, vertical mergers generally combine entities that operate at different levels in the same supply chain. As vertical mergers become more commonplace in the healthcare industry, they are increasingly raising antitrust concerns as they often times don’t trigger the same level of scrutiny as do horizontal mergers. The much needed new guidelines specifically targeting vertical mergers serve to withdraw and update the …

On January 10, California Governor Gavin Newsom released his 2020-2021 State Budget proposal. While the state budget process will not begin in earnest until after the Governor’s May Revise, the state budget provides a glimpse of likely California health care reforms. The Governor’s January Budget Proposal proposes the following: Proposal Goals Office of Health Care Affordability Increase price and quality transparency Develop cost targets for health care industry Address hospital cost trends by region, with focus on cost increases driven by delivery system consolidation Establish standards for advance evidence-based and …

On Thursday, December 12, 2019, the House passed H.R. 3, the Elijah Cummings Lower Drug Costs Now Act, with unanimous support of House Democrats, but only 2 Republican votes. While the primary provisions of the bill and the conclusions drawn in our original blog post remain unchanged, we highlight two changes made to the bill as described in our post before it was passed. First, the original bill required drug manufacturers that increase the price of a drug faster than the rate of inflation (benchmarked to prices in 2016) to …