This month, a long-standing private antitrust lawsuit against Blue Shield/Blue Cross came to a conclusion after a decade of litigation. After a favorable court ruling for the class plaintiffs on a key legal issue, the final settlement agreement received approval in federal court and provides both monetary and injunctive relief that is intended to boost competition in the insurance market. Filed in 2012 by employers and individual policyholders with Blue Cross/Blue Shield (BCBS) coverage, the putative class action alleges that BCBS entities conspired to divvy up insurance markets all over …

On June 30, California Governor Gavin Newsom signed the 2022-2023 state budget, which includes a trailer bill (SB 184) that provides funding to establish the highly anticipated Office of Healthcare Affordability (OHCA) within the Department of Health Care Access and Information (HCAI). California joins a number of other states including Massachusetts, Oregon, and Rhode Island, as it becomes the latest state to establish a healthcare cost commission. This is a promising step forward in California’s efforts to control health care costs while ensuring high quality and broad accessibility. The main …

As federal agencies including the FTC and DOJ step up antitrust enforcement efforts in response to Biden’s executive order to revamp competition in the healthcare market, more and more healthcare entities are turning to less traditional consolidation that did not previously trigger antitrust scrutiny, such as “cross-market” mergers, which involve providers that do not directly compete in the same geographic market.[1] This month in Litigation and Enforcement Highlights, we take a look at the latest merger review and conditional approval of a proposed cross-market transaction in California, the third of …

It’s been a busy month in healthcare antitrust land, both for federal regulators and private plaintiffs, as we saw an explosion of enforcement actions challenging both proposed mergers and anticompetitive conduct that stemmed from previous mergers. From New Jersey to Utah, large health systems such as HCA are being increasingly scrutinized and coming under fire for garnering and using their market power in anticompetitive ways.   Merger Challenges Fresh from its appeals court win in the Hackensack Meridian and Englewood merger challenge, the Federal Trade Commission (FTC) is continuing its …

This month’s Roundup highlights articles and reports discussing the need for improved, adequate monitoring of healthcare consolidation, including 1) vertical integration and joint contracting between physicians and hospital and 2) pharmaceutical mergers. We also examine articles studying healthcare cost affordability, specifically 3) the significant disparities in prices paid to hospitals by private plans and Medicare and 4) California’s improvements in healthcare affordability and access. Finally, we look at some proposed cost containment strategies such as 5) key areas to improve competition to reduce costs and 6) price caps on out-of-network …

See case page: Sidibe v. Sutter Health   The antitrust action against Northern California hospital giant Sutter Health is a saga that continues to give and capture the attention of antitrust regulators and stakeholders around the country. After Sutter’s landmark settlement with the California attorney general in state court in 2019 and a jury verdict in March 2022 clearing Sutter of anticompetitive allegations in a decade-long federal class action, many thought the Sutter chapter had finally closed, albeit somewhat anti-climatically. Not so fast. In late April, plaintiffs in the federal action …

Consistent research has shown that consolidation in the health industry leads to an increase in healthcare costs without improved quality of care. Though many healthcare mergers have previously gone unchecked, antitrust enforcers are increasingly using their statutory and regulatory authority and the court system to address healthcare consolidation concerns.[1] In California, the attorney general has had the statutory authority to review non-profit hospital mergers for decades but the limited oversight does not extend over all anticompetitive transactions and behavior. This session, the legislature introduced AB 2080 aimed to broaden existing …

In the latest healthcare antitrust action, Hackensack Meridian and Englewood Healthcare officially terminated their merger plans after the Third Circuit Court of Appeals handed down a big win for federal regulators in the merger challenge. Last month, after multiple amicus briefs filed by various stakeholders in the appeals court, a three-judge panel affirmed the lower court’s preliminary injunction to block the merger, holding that the Federal Trade Commission (FTC) established a prima facie case showing that the proposed merger is likely to substantially lessen competition and that the hospitals’ procompetitive …

This month, we are pleased to highlight new publications co-authored by The Source-affiliated health policy researchers and scholars, discussing 1) the potential benefits of all-payer hospital global budgets, and 2) the legal viability and policy effects of state public option health plans. Additionally, we examine articles covering research on 3) hospital service offerings based on ownership type, 4) the correlation between hospital prices and patient outcomes, 5) data sources within California’s physician practice landscape, and 6) the labor market impact of hospital mergers.   Healthcare Reform and Cost Containment High …

See case page: Sidibe v. Sutter Health   After nearly ten years of litigation and a month-long trial in Sidibe v. Sutter Health in the federal district court in San Francisco, a nine-person jury delivered a unanimous verdict finding that Sutter Health did not engage in anticompetitive conduct and did not cause consumers to pay higher prices or premiums as alleged by the class plaintiffs. The jury answered no on two key questions to plaintiffs’ case, that 1) Sutter Health did not use tying practices in its insurer contracts; and 2) …