H.R. 10177: Competition in State Healthcare Markets Act

This bill would require the Department of Health and Human Services (through the Assistant Secretary for Planning and Evaluation) to conduct a yearly study for 10 years on how competitive or concentrated health care markets are in each state.

What the study would look at

• Licensing rules for health care workers, including initial licensing, renewal, training, continuing education, residency supervision, and board certification.
• Mergers and acquisitions involving hospitals, outpatient practices, ambulatory surgical centers, health insurers, habilitative service providers like physical or occupational therapy providers, and telehealth companies.
• State laws that allow states to approve hospital mergers, often called certificates of public advantage, and laws that regulate building or expanding health care facilities, often called certificates of need.
• Alternative health insurance options such as short-term limited-duration insurance and association health plans.
• The number of providers operating at the start and end of each year, including hospitals, medical practices, outpatient practices, ambulatory surgical centers, insurers, and habilitative service providers.
• Market concentration measures for certain services, using a standard economic measure called the Herfindahl-Hirschman Index, for:
  • general acute care hospital services,
  • outpatient medical services by specialty, and
  • habilitative services.

How the study would be carried out

• The Assistant Secretary would have to consult with the Federal Trade Commission and the DOJ Antitrust Division.
• HHS could request relevant information from the FTC to help with the study.
• Each year, HHS would submit a report to House and Senate committees.
• The report would also have to be posted online, and the underlying data would need to be made publicly available in an interactive format.

What the bill would not do

• It does not directly change licensing laws, merger rules, insurance rules, or state health care regulations.
• It does not impose new penalties or taxes.
• It mainly requires data collection, reporting, and public disclosure about health care competition and consolidation.

Relevant Companies

• HCA — Large hospital operator that could be affected by increased public attention to hospital concentration and merger activity.
• THC — Tenet Healthcare, a hospital and outpatient services company that could be included in merger and market-concentration analysis.
• UHS — Universal Health Services, a hospital operator that could be affected by state-level competition studies.
• CYH — Community Health Systems, a hospital chain that could be affected by analysis of hospital consolidation.
• RCM — R1 RCM, a health services company that may be indirectly affected by broader scrutiny of provider consolidation.
• CI — Cigna, including health insurance operations, which could be covered in the study’s insurance market analysis.
• UNH — UnitedHealth Group, whose insurance and provider businesses could be relevant to consolidation and competition analysis.
• ELV — Elevance Health, a major insurer that could be part of the study’s review of insurance market concentration.
• HUM — Humana, another large insurer likely to be included in market-competition analysis.
• CVS — CVS Health, which has insurance and health services businesses that could be affected by the bill’s reporting focus.
• OSCR — Oscar Health, a smaller insurer that could appear in state-level market studies.