Oregon Invites Public Comments on the Healthcare Market Oversight Program
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 state.
HCMO is one of the most Comprehensive State Merger Review Programs
The Oregon Legislature created the HCMO program in 2021 to prevent anticompetitive consolidation in healthcare and maintain the affordability of care. Recognizing that increasing mergers, acquisitions, and affiliations among hospitals, clinics, and insurers were driving up healthcare costs, reducing competition, and threatening community-based care delivery, the Oregon Legislature authorized HCMO to review significant healthcare transactions. These include mergers, acquisitions, and affiliations involving healthcare entities (including hospitals, insurers, and provider groups) across four domains–cost, access, equity, and quality–to ensure they do not harm Oregon residents. The legislature also authorized HCMO to block or place conditions on any healthcare entity transaction, making it the first state with such authority.
The scope of this authority, however, has raised significant concern among industry stakeholders, leading to resistance and litigation. For example, in 2023, SB 476 would have repealed the entire HCMO program, though the bill ultimately died in committee in 2023. Also in 2023, HCMO survived a legal challenge from the Oregon Association of Hospitals and Health Systems alleging that it violated due process because the basis for denying or dictating conditions on proposed transactions was too vague.
Effects of the Program So Far
Since the creation of the program, HCMO has reviewed 33 transactions. Six or more have been approved outright, and seven have been approved with conditions. OHA is still reviewing four other transactions, and the rest either withdrew or received special emergency status. Only two of 20 transactions triggered a comprehensive review. Each of these transactions will be reviewed one, two, and five years afterwards to continue to ensure that the transaction is adequately meeting OHA’s goals.
Current Call for Public Feedback
On September 9, 2025, the Oregon Health Policy Board (“OHPB”) invited the public to submit comments on the HCMO's guiding principles and administrative rules and to attend a public listening session. According to the OHA, “HCMO staff use public comments to inform transaction reviews, identify emerging issues, and understand potential impacts of a transaction on people and communities in Oregon.” The comment period for the 2025 rulemaking remains open through early 2026, tentatively closing when the rulemaking cycle ends.
So far, public feedback has surrounded three themes: 1) calls for independent review and greater accountability of HCMO; 2) criticisms of emergency and exempt transaction rules; and 3) community impacts of the Optum/Corvallis Clinic Acquisition. First, there are concerns that HCMO lacks transparency, accountability, and meaningful public input. The feedback includes repeated calls for an independent, comprehensive public review of the HCMO program. Citizens have made requests for more community oversight, independent evaluation, and better enforcement mechanisms.
Second, critics have raised strong concerns about loopholes in the “Emergency Exemption” clause in HCMO. For a transaction to qualify for an “Emergency Exemption,” there must be an emergency that threatens healthcare services (e.g., the COVID-19 pandemic) and the proposed transaction must be urgently needed to protect consumers' or patients' interests. Critics note that these provisions allow large corporations to bypass regulatory review. Commentators have recommended several reforms: including defining “emergency” using measurable financial criteria, requiring public disclosure and a mandatory comment period before granting exemptions, mandating post-acquisition follow-up reviews on provider retention and patient outcomes, and ensuring local and community consultation before approval of such transactions.
Lastly, concerns have emerged regarding the community impacts of Optum's acquisition of the Corvallis Clinic. Residents have reported declining care quality, physician departures, and longer wait times since the takeover. Many community members have expressed frustration over the lack of transparency and loss of local control, arguing that the Health Care Market Oversight (HCMO) program failed to protect the community's interests. These concerns have fueled calls for rule changes to prevent similar corporate consolidations from proceeding without meaningful public oversight.
Conclusion
Oregon's HCMO program remains one of the most ambitious and closely watched state efforts to confront healthcare consolidation. Its broad authority, transparent review process, and focus on protecting affordability and access have set it apart from programs in other states. While it has the potential to serve as a model for other states, the legal challenges, legislative attempts to repeal the law, and public criticism are revealing. By inviting public feedback in 2025, the OHPB appears to be responding to pressures by listening to feedback and creating a responsive and accountable model. However, if HCMO is significantly weakened, or fails entirely, it could be discouraging to other states that are trying to pursue similar oversight efforts. Oregon's program is still in its early stages, and its long-term influence will depend on how it reacts to the political and legal pressure.