States’ Merger Review Authority Is Associated With States Challenging Hospital Mergers, But Prices Continue To Increase

Fulton, Brent D.; King, Jaime S.; Arnold, Daniel; Montague, Alexandra D.; Chang, Samuel M; Greaney, Thomas L.; Scheffler, Richard M.

doi:10.1377/hlthaff.2021.00781

Cited by 5 publications

(7 citation statements)

References 19 publications

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“…We have also shown that prices paid by those with employer‐sponsored insurance vary across health care settings, with the same service costing more than double in hospital outpatient departments than it does in physician offices 10,11 . Other studies have brought new attention to the impacts of private equity, out‐of‐network care, state merger review, and vertical integration on health care prices 12–22 …”

Section: High and Rising Prices In The Employer‐sponsored Insurance M...mentioning

confidence: 78%

“…10,11 Other studies have brought new attention to the impacts of private equity, out-ofnetwork care, state merger review, and vertical integration on health care prices. [12][13][14][15][16][17][18][19][20][21][22] Still, there remain numerous questions to answer regarding private health care prices. For example, understanding the role of changes in treatment in price trends is critical as we work to improve affordability without sacrificing quality of care.…”

Section: High and Rising Prices In The Employer-sponsored Insurance M...mentioning

confidence: 99%

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Research and policy to strengthen the employer‐sponsored health insurance market

Sen

2022

Health Services Research

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In 2020, over 163 million Americans -50% of the US populationwere covered by health insurance provided by an employer, either through their own job or as a dependent. 1 Close to 60% of firms offer health insurance to at least some of their employees. 2 The population covered by employer-sponsored insurance is bigger than that covered by any other form of health insurance in the United States and heterogenous in terms of age, ranging from children of employees to midcareer adults to those nearing retirement.Whether and how this market works impacts the cost and generosity of health insurance and prices paid out-of-pocket for health services, as well as labor market outcomes such as wages, ultimately affecting access to care and financial well-being for over half of the US population. Yet, despite its significance to a wide swath of Americans, there remains surprisingly little evidence on the effects of market structure and policy in employer-sponsored health insurance markets on individuals. In this commentary, I highlight the importance of an in-depth, evidence-based understanding of this market, including identifying key questions health services researchers are wellsuited to address.

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Section: High and Rising Prices In The Employer‐sponsored Insurance M...mentioning

confidence: 78%

Section: High and Rising Prices In The Employer-sponsored Insurance M...mentioning

confidence: 99%

Research and policy to strengthen the employer‐sponsored health insurance market

Sen

2022

Health Services Research

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“…The statutory authority to review and subsequently approve, conditionally approve, or deny healthcare transactions varies notably among the states ( 11 ). The actions state officials take and the types of conditions they impose will often depend largely on the kind of legal authority they have to review various types of transactions.…”

Section: Overview Of State Healthcare Transaction Conditional Approva...mentioning

confidence: 99%

“…Furthermore, federal antitrust enforcement tends to focus on horizontal merger challenges rather than vertical, cross-market, or other types of consolidation, which commonly occur in healthcare ( 4 ). State entities tasked with overseeing healthcare transactions, including state attorneys general, state health agencies, and certificate of need (CON) programs, face similar resource limitations and are also constrained by the boundaries of their varying legal authorities to receive notice of, thoroughly review, and potentially block transactions ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

“…When it comes to challenging problematic transactions, federal antitrust enforcers have expressed a preference for blocking anticompetitive transactions or imposing structural remedies, such as divestiture of any entities that create competition concerns, instead of relying on what are called conduct remedies, which permit the transaction to go through but include conditions that seek to prevent anticompetitive behavior ( 12 ). While various state entities have also successfully blocked healthcare provider transactions, we have found that state enforcers and regulators more often utilize conditions to manage, rather than trying to block, transactions that raise concerns ( 11 ). While the use of conditions can provide guardrails to ensure that healthcare providers behave in the public interest, the fact that these conditions are most often time-limited and only apply to the providers involved in the transaction suggests that their use cannot be relied upon as a long-term regulatory solution in most situations.…”

Section: Introductionmentioning

confidence: 99%

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Considerations for state-imposed conditions on healthcare provider transactions

Montague,

Davison,

Gudiksen

et al. 2023

Front. Public Health

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The widespread consolidation of health systems, hospitals, and physicians has contributed to the high price of healthcare across the United States. While federal antitrust enforcers continue to play an important role in overseeing large mergers, acquisitions, and other consolidating transactions of major healthcare providers, state oversight over healthcare markets is essential to slow consolidation more broadly and address market failures across the country. State laws govern the scope of authority held by state attorneys general and other state agencies to receive notice of, review, and approve, conditionally approve, or block healthcare provider transactions, which can significantly impact the breadth and content of oversight. While blocking potentially anticompetitive transactions can help states maintain any competitive forces that remain in the market, in some situations, approving a transaction with conditions may be the best path forward. Applying conditions to transactions may allow state officials to oversee and govern the behavior of providers post-transaction while states pursue other legislative fixes. Although the use of conditions is a relatively common practice at the state level, little research has been done to explore their use among states. Following a search in all 50 states, this paper examines decisions from state officials imposing conditions intended to address the impacts of transactions on healthcare price, access, and quality and provides recommendations for the effective use of conditions moving forward.

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Market landscape and insurer–provider integration: the case of ambulatory surgery centers

Zhao,

Richards,

Damberg

et al. 2024

Health Affairs Scholar

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Insurer–provider integration is a new form of vertical integration, with increasing prominence in health care markets. While there are potential benefits from tighter alignment between providers and payers, risks of perverse impacts on health care markets loom large. Yet, little is known about this new wave of consolidation, which limits options for policy or regulatory responses. We focus on a dominant insurer's acquisitions of ambulatory surgery centers (ASCs) to document the growth and geographic spread of these ownership events. We found that a diverse swathe of the United States has experienced an insurer-led ASC takeover. The acquisitions are also more frequently in areas where the insurer holds a higher enrollee market share at baseline, although a linear prediction of the likelihood of ASC acquisition shows a more nuanced picture.

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States’ Merger Review Authority Is Associated With States Challenging Hospital Mergers, But Prices Continue To Increase

Cited by 5 publications

References 19 publications

Research and policy to strengthen the employer‐sponsored health insurance market

Research and policy to strengthen the employer‐sponsored health insurance market

Considerations for state-imposed conditions on healthcare provider transactions

Market landscape and insurer–provider integration: the case of ambulatory surgery centers

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