The Federal Push for Transparency Since the Affordable Care Act (ACA) was enacted in 2010, there has been a push for comprehensive healthcare reform, including early efforts to create price transparency. The ACA requires health plans to provide a summary of benefits and coverage, along with a list of definitions to facilitate consumer comprehension. In 2019, President Trump issued Executive Order (EO) 13877, which directed federal agencies to give patients access to real prices rather than estimates and to make pricing information comparable across health plans. Following that Executive Order, […]

The final California state budget bill, SB 101, passed in June 2025, allocates more than $321 billion in state spending.  Lawmakers worked to close a $12 billion deficit through a mix of solutions, including delays, sunsets, and fund transfers.  While the budget was heavily debated, the Governor’s administration defended the approach as necessary to maintain critical services in the face of federal funding cuts under the Trump Administration.  Following the enactment of SB 101, attention quickly turned to the accompanying trailer bills, which also carry consequential policy changes through modifications […]

Steering methods, where health plans are able to incentivize patients to choose high-value, cost-effective care can be critical to the financial health of these plans.  New York–Presbyterian Hospital is facing mounting legal and regulatory challenges over allegations that it sought to limit competition and prevent insurers from steering patients to lower-cost options.  On July 25, 2025, the Cement and Concrete Workers DC Benefit Fund, a self-funded union health plan, filed suit against The New York and Presbyterian Hospital, claiming that New York Presbyterian (NYP) engaged in various anti-steering efforts in […]

Update: On Monday, July 28, 2025, U.S. District Court Judge Brian Miller issued a preliminary injunction blocking the law (which would have taken effect on January 1, 2026) until the federal court issues final judgement. In April 2025, Arkansas passed legislation prohibiting pharmacy benefit managers (PBMs) from acquiring or holding a direct or indirect interest in pharmacies.  This law makes Arkansas the first state to enact a structural approach to address concerns about PBM business practices.  To date, three separate lawsuits have been filed challenging the law.  This article looks […]

In January, Governor Newsom released his proposed budget for the 2025-2026 fiscal year with hopes of a strong fiscal position and a surplus for California that has not been seen in recent years.  However, in the face of multiple federal and state spending decisions, the final budget bill signed on June 27, 2025, although balanced, as required in California, is comprised of several solutions to close a $12 billion deficit.  Governor Newsom cited the Trump Administration’s funding cuts as the main culprit for this deficit, also noting significant financial drawbacks […]

On May 14, Governor Newsom released the May revision to the initial 2025-2026 California budget proposal that was released in January.  The May Revise proposes a total expenditure of $321.9 billion, representing a $300 million decrease from the January estimate.  Despite a projected surplus in the January budget, changing national economic conditions and increased expenditure growth (especially in Medi-Cal) have resulted in a $12 billion deficit in the updated budget. In 2024, the budget’s $45 billion deficit was anticipated to take two years to balance, but in January, following hopeful […]

Healthcare Consolidation Partnerships Between Pharmaceutical and Telehealth Companies – Increasing Access or Driving Inappropriate Prescribing? (The New England Journal of Medicine) Erin C. Fuse Brown, Oliver J. Wouters, Attev Mehrotra As technology has progressed, so too have health care delivery mechanisms for Americans. However, an emerging collaboration between pharmaceutical companies, like Pfizer and Eli Lilly, and telehealth companies is leaving many divided. Pharmaceutical companies have evolved their marketing and disbursement practices by increasingly using social media marketing to now directly link to telehealth providers who connect healthcare consumers with a […]

On April 1, 2025, the Federal Trade Commission (FTC) filed for a stay in a case against three Pharmacy Benefit Managers (PBMs), not because of any lack of evidence, but rather because there was no one left at the FTC to pursue the case due to recent firings by the current administration. When the suit was filed, it was supported by the three Democrat Commissioners, and the two Republican Commissioners recused themselves. A last-minute reversal of a previous recusal may have put the suit back into motion, but the entire […]

Market Consolidation and Merger Review The Forgotten Anti-Monopoly Law: The Second Half of Clayton Act Section 7 (Texas Law Review) Robert H Lande, John M Newman, Rebecca Kelly Slaughter The authors of this article analyze the second prong of Section 7 of the Clayton Act, which prohibits mergers that “tend to create a monopoly.” In comparison to the well-known first prong that seeks to “substantially lessen competition,” the second prong is posited to wield more statutory power as it does not contain a requirement for a certain degree of harm […]

The California State Legislature kicked off the first year of its 2025-2026 biennial Legislative Session on December 2, 2024. This year, the legislature got off to a sprinting start as it raced to meet the February 21, 2025 deadline to introduce new bills. Compared to last year, this year’s legislature proposed a wider swath of bills aimed at healthcare-related concerns, including enhanced merger review, the use of artificial intelligence (AI) in healthcare, and expanding access to both provider and coverage options for consumers. In this month’s California Legislative Beat, we […]