Healthcare Markets and Acquisitions Health Insurance After Corporatization —What Next? New England Journal of Medicine Perspective Leemore Dafny, Ph.D. The author explores whether the corporatization of the U.S. health insurance industry (i.e., the consolidation of insurers within and across markets) contributes to the industry’s poor performance among the commercially insured population. The answer is maybe. One key driver of such consolidation is the “technology of insurance.” Economies of scale drive insurance consolidation by lowering costs and stabilizing risk for larger insurers, but beyond a certain size, these advantages fade, and […]

On January 22, the House Committee on Energy & Commerce held a hearing titled “Lowering Health Care Costs for All Americans: An Examination of Health Insurance Affordability.” The discussion centered on health care costs, patient access, and affordability across the entire health insurance marketplace, and focused on the role insurers play in care delivery. Meaningful Congressional action on rising healthcare prices has been limited in recent years. The purpose of Congressional hearings is often to gather information about a specific topic likely to be used to shape future legislation. For […]

Healthcare Costs Growth In National Health Expenditures: It’s Not The Prices, Stupid Health Affairs Michael Chernew The article seeks to identify the causes of rising healthcare costs by assessing trends across sectors, including coding intensity, AI medical services, product costs, and healthcare consolidation and administrative shifts. Chernew reports that coding intensity has increased and explores the possible relationship to AI medical services, though notes it may be too early to identify any trends. Broad healthcare infrastructure changes show conflicting trends in prices, and the author advocates for more focus on […]

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 […]

Antitrust Enforcement Fixing a Broken System: Policy Responses to Hospital Acquisitions of Physician Practices That Limit Health Care Access for U.S. Consumers Progressive Policy Institute Diana Moss, Alix Ware, Lief Lin By 2023, more than half of all independent physician practices (IPPs) were no longer independent, but owned by hospitals, health systems, or corporate entities, meaning 78% of all U.S. physicians were employed by large provider organizations. Loss of IPPs through vertical consolidation leads to higher prices, reduced access, loss of physician autonomy, and reduced patient choice. This study highlights […]

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 […]

Healthcare Prices and Payments UnitedHealthcare Pays Optum Providers More Than Non-Optum Providers Health Affairs Daniel R. Arnold, Brent D. Fulton Optum has a history of increasing market power through aggressive acquisitions of healthcare services and has been accused of using that market power to impede provider competition for financial gain.  UnitedHealthcare and Optum are parts of the same company, with UnitedHealthcare serving as the insurance arm, and Optum providing healthcare services.  In 2024, Optum, which includes a variety of smaller entities such as a pharmacy benefit manager (PBM) and software […]

The Source’s executive editor Katie Gudiksen, working with Arnold Analytics, co-authored a report on hospital market competition in Monterey County. The report was released today by California’s Office of Health Care Affordability (OHCA). The study examines why prices at CHOMP, Natividad, and Salinas Valley Memorial are among the highest in the state and finds that limited competition—not higher costs or better quality—is the main driver. It also outlines the impact on local families and employers and offers policy options for the state to consider. Read the full report here: https://hcai.ca.gov/wp-content/uploads/2025/11/OHCA-Investigative-Study-of-Hospital-Market-Competition-in-Monterey-County.pdf.

Health Care Consolidation and System Reform Health Care Consolidation: Published Estimates of the Extent and Effects of Physician Consolidation Government Accountability Office In 2023, Congress directed the Government Accountability Office to study the extent of healthcare consolidation, the potential role of private equity, and the effects on healthcare quality, access, spending, and costs. The GAO reviewed peer-reviewed empirical studies and reports from January 2021 through July 2025, and interviewed stakeholders, including physicians, hospitals, insurers, private equity firms, retail companies, and employees. The article cited available data sources, including PECOS, insurer […]

In 2025, the Oregon Health Authority (“OHA”) invited the public to weigh in on its Health Care Market Oversight (“HCMO”) Program.  The Oregon Health Policy Board is seeking comments on the program’s guiding principles and framework.  This move follows growing criticism and scrutiny of the program, as well as a lawsuit in which a federal appeals court upheld the program’s authority.  These public comment opportunities offer a rare chance for residents, providers, and stakeholders to directly influence how healthcare mergers, acquisitions, and affiliations are reviewed, or potentially restricted, by the […]