Illustration: Gabriella Turrisi/Axios
It may not have been a fruitful year legislatively, but one growing trend has emerged in health care: No one in Washington is happy with the business decisions of much of the health care industry.
Why it matters: The new focus on anti-competitive actions has already trickled into some pending legislation and, in the case of the Biden administration, regulatory action.
- So far, the industry has mostly avoided any drastic changes. But if this year's attention was only the tip of the iceberg, the industry could be in trouble.
Driving the news: President Biden's health care announcement last week received a lot of attention for opening the door to the use of march-in rights, but a second piece included measures targeting "anticompetitive mergers and anticompetitive practices by dominant corporations in health care markets."
- The DOJ, FTC and HHS will jointly issue a request for information to "identify areas for future regulation and enforcement prioritization," which the White House labeled "a cross-government public inquiry into corporate greed in health care."
- The agencies also said they will share data to better identify "roll ups" of individual acquisitions that evade antitrust review on their own but end up consolidating a market.
The big picture: Congress has expressed similar interests all year, and it's hard to find a sector of the health care industry that hasn't come under fire at some point.
- Senate Budget Committee Chair Sheldon Whitehouse and Ranking Member Chuck Grassley announced an investigation into the impacts of private equity ownership on hospitals, sending letters to multiple companies "demanding answers regarding questionable financial transactions that may have impacted quality of care for patients in hospitals under private equity ownership."
- Both the Senate Finance and Ways and Means committees have held hearings with titles like "Consolidation and Corporate Ownership in Health Care" and "Why Health Care is Unaffordable: Anticompetitive and Consolidated Markets."
- The House price transparency bill — the biggest piece of health legislation to move through committee this year — targets PBMs and hospital billing practices.
- And Sens. Elizabeth Warren and Mike Braun recently questioned insurance companies about potentially evading the Affordable Care Act's limit on premium dollars that go to profits and administration through their ownership of different parts of the drug supply chain.
What they're saying: "Going after anti-competitive practices in health care is something both Democrats and Republicans can get behind. It both supports market forces, which appeals to Republicans, and highlights industry abuses, which appeals to Democrats," said KFF's Larry Levitt.
Between the lines: Consolidation and anti-competitive practices may be easy bipartisan targets, but another reason they're increasingly in the spotlight is that the industry is becoming more consolidated, which in turn opens the door to more anti-competitive behavior.
What we're watching: All of this may provide a great opportunity for oversight, and the Biden administration has been signaling a crackdown on future mergers.
- But the bigger question is what, if anything, can be done to address the consolidation resulting from past mergers and acquisitions.
- "It's very hard to put the genie back in the bottle since so much consolidation has already happened in health care," Levitt said. "Focusing on anti-competitive practices is a concession that you can't easily reverse the consolidation."
