In February of this legislative session, California Assemblymember Jim Wood introduced AB 1130, titled the California Health Care Quality and Affordability Act. Wood was prompted to draft AB 1130 when a 2020 California Health Care Foundation poll found that 84% of Californians surveyed cited health care affordability as an extremely or very important issue to them.[1] The bill would establish the Office of Healthcare Affordability (the “office”) within the Office of Statewide Health Planning and Development (OSHPD) and be tasked with analyzing health care markets for cost trends and drivers …

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, …

In this mid-year issue of Litigation and Enforcement Highlights, we provide updates on  several pending healthcare transactions. As much of the country recovers from COVID-19, healthcare entities continue to actively pursue proposed mergers and affiliations that could further change the landscape of the healthcare market. In the last update, federal enforcement agencies saw a mixed bag of results to their enforcement efforts, with an FTC loss against Jefferson-Albert Einstein, a DOJ settlement with Geisinger-Evangelical, and several proposed mergers that buckled under antitrust scrutiny (see case reference table below). Since then, …

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 …

By: Gregory Curfman, MD   On October 20, 2020, the U.S. Department of Justice joined by 11 state attorneys general filed a stunning civil antitrust lawsuit in the United States District Court for the District of Columbia against Google.[1] What will this antitrust case mean for health information, and what other questions are health policy makers asking about Google’s control of health information? The complaint in this high-profile case is that Google engages in anticompetitive practices in the two principal components of its business, general internet search and advertising related …

This month’s roundup covers academic articles and reports that examined: 1) early results and challenges of the new federal price transparency rule; 2) how to address increasing market consolidation and competition during the COVID-19 pandemic; 3) rising healthcare costs; and 4) how much patients pay and physicians receive when patients receive out-of-network emergency care.   Price Transparency In response to policymakers calling for greater price transparency of healthcare services for patients and other payers of healthcare, a federal rule from the Department of Health and Human Services took effect on …

This month in Litigation and Enforcement Highlights, we dive into a pair of healthcare antitrust lawsuits that is making the headlines. In late March, a group of doctors sued United Healthcare Insurance in Colorado and Texas in state courts, alleging the insurance giant violated state antitrust laws. Plaintiffs U.S. Anesthesia Partners (USAP) is a physician practice group made of anesthesiologists who practice in nine states. In the complaints, they claimed that United Healthcare used its market power to “squeeze” the group out of its insurance network and the marketplace for …

As an extension of the Source’s research and work on provider market consolidation, the Milbank Memorial Fund commissioned the Source team to conduct an in-depth policy analysis of health system consolidation in Rhode Island and provide legal and regulatory options for Rhode Island state officials to address the impacts of consolidation. Executive Director Jaime King, Senior Health Policy Researchers Robert Murray and Katie Gudiksen, and Source Advisory Board Member Bob Berenson of the Urban Institute created a detailed presentation that first provides an overview of Rhode Island’s provider markets and …

February 19th was the deadline for California legislators to introduce their proposed bills this session.  In a two-part series, we highlight some of the notable healthcare bills on the table in 2021.  In this post, we focus on a few ambitious reform efforts to the healthcare market and delivery system.  Next month, we’ll turn our attention to proposed bills that aim to regulate the prescription drug market and bills that promote price and quality transparency. Healthcare system reform measures are those that change the structure of health care in a …

In this month’s Litigation and Enforcement Highlights, we provide the latest updates on several proposed provider mergers, many of which were fueled by the continued pandemic. With the increased consolidation came increased antitrust scrutiny. So far this year, we’ve seen a mixed bag of wins and losses for federal and state enforcement agencies that seek to block the mergers.   FTC Concedes in Failed Challenge of Jefferson-Albert Einstein Merger In its first major loss in a healthcare merger challenge in recent years, the Federal Trade Commission (FTC) officially dropped its …