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, […]

Primary Care Impact of primary care market mergers on quality: Evidence from the English NHS (Journal of Health Economics) Yuan Lyu, Zhaocheng Zhang This article examines the growing trend of market consolidation among primary care providers and assesses the impact of mergers and acquisitions on the English primary care market. The authors first look at the reasons behind primary care mergers.  They identify the three most significant issues as practitioners retiring (causing a small practice to merge with another), offices consolidating functions to practice more efficiently, and failing practices merging with […]

Impact of Federal Hospital Policies Sharp Rise In Urban Hospitals With Rural Status In Medicare (Health Affairs) Yang Wang, Jared Perkins, Christopher Whaley, Ge Bai This article aims to quantify the impacts of Geisinger Community Medical Center v. Secretary, United States Department of Health and Human Services, and Lawrence Memorial Hospital v. Burwell, which began allowing hospitals to qualify for both urban wage indexes for calculating Medicare reimbursements and Medicaid rural health policies designed to support rural healthcare.  The authors assess changes by tracking the proportions of administratively and geographically rural and […]

The 2025–2026 legislative session has produced two major regulatory oversight bills regarding private equity in healthcare. SB 351, introduced by Senator Christopher Cabaldon (D) on February 12, 2025, and currently set for its second hearing, focuses on strengthening California’s ban on the corporate practice of medicine. Similarly, AB 1415, authored by Assemblymember Mia Bonta (D), seeks to expand the authority granted to the Office of Health Care Affordability (OHCA) in monitoring healthcare transactions. Below we discuss the intricacies of each bill, the potential impact on the state’s healthcare market, and […]

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 […]

Healthcare Pricing Can Public Option Plans Improve Affordability? Insights From Colorado (Health Affairs Forefront) Roslyn Murray, Christopher M. Whaley In the face of individuals and families unable to afford increasing insurance premiums due to lack of healthcare insurance competition, a variety of states are considering offering public option plans, commonly for ACA Exchange plans. These plans seek to provide coverage with low premiums by means of capped prices for those who do not meet Medicare or Medicaid requirements nor receive private coverage through employment. The article describes Colorado’s effective public […]

New laws and rules requiring greater transparency into the behaviors and reimbursements of insurers have given employees and employers a clearer picture of where their healthcare dollars are going.  For example, the “Transparency in Coverage” rule, implemented in October 2020, required health plans and insurers to post rates they negotiate with providers and develop price transparency tools related to cost-sharing.  The “Consolidated Appropriations Act”, passed in 2021, requires Third Party Administrators (TPAs) to provide notice of other compensation they receive to plan sponsors and restricts “gag clauses” that would otherwise […]

Healthcare Competition and Consolidation Vertical Integration and Market Consolidation in Healthcare: Policy Drivers and Impact on Physicians and Patient Care (Seminars in Colon and Rectal Surgery) Rachel Ekaireb, Anna Yap, and Robert Kucejko Over the past several decades, the healthcare market has become increasingly consolidated. For instance, in the last twelve years alone, the percentage of physicians employed by hospitals or healthcare systems has more than doubled from 26% to 55%. While proponents for vertical integration have touted its potential to improve the efficiency and quality of care delivery, empirical […]

Healthcare Competition and Consolidation Medicare Advantage and Consolidation’s New Frontier — The Danger of UnitedHealthcare for All (New England Journal of Medicine) Hayden Rooke-Ley, Soleil Shah, and Erin C. Fuse Brown This article describes the recent ransomware attack on Change Healthcare and the ownership structure of UnitedHealth Group, including how much market power it has with medical claims, data analytics, insurance, physicians, PBMs, pharmacies and a bank.  The authors note the risks involved in these types of conglomerations, including market abuses that raise costs, erode quality of care, and harm […]

Mergers, Acquisitions and Healthcare Competition Is There Too Little Antitrust Enforcement in the U.S. Hospital Sector? (American Economic Association) Zarek Brot-Goldberg, Zack Cooper, Stuart Craig, Lev Klarnet From 2002 to 2020, there were more than 1,100 hospital mergers with a 1% enforcement rate by the FTC resulting in only 13 blocked transactions. The authors of this study speculate low rates of enforcement could be due to factors including budgetary issues and jurisprudence that favors mergers. It is estimated these mergers resulted in a high concentration of hospital markets in “90% […]