Sign up for our daily briefing

Make your busy days simpler with the Axios AM and PM newsletters. Catch up on what's new and why it matters in just 5 minutes.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Catch up on the day's biggest business stories

Subscribe to the Axios Closer newsletter for insights into the day’s business news and trends and why they matter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Sign up for Axios Pro Rata

Dive into the world of dealmakers across VC, PE and M&A with Axios Pro Rata. Delivered daily to your inbox by Dan Primack and Kia Kokalitcheva.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Sports news worthy of your time

Binge on the stats and stories that drive the sports world with the Axios Sports newsletter. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Tech news worthy of your time

Get our smart take on technology from the Valley and D.C. with Axios Login. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Get the inside stories

Get an insider's guide to the new White House with Axios Sneak Peek. Sign up for free.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Catch up on coronavirus stories and special reports, curated by Mike Allen everyday

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Denver news?

Get a daily digest of the most important stories affecting your hometown with Axios Denver

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Des Moines news?

Get a daily digest of the most important stories affecting your hometown with the Axios Des Moines newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Twin Cities news?

Get a daily digest of the most important stories affecting your hometown with Axios Twin Cities

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Tampa Bay news?

Get a daily digest of the most important stories affecting your hometown with the Axios Tampa Bay newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Charlotte news?

Get a daily digest of the most important stories affecting your hometown with Axios Charlotte

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Nashville news?

Get a daily digest of the most important stories affecting your hometown with the Axios Nashville newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Columbus news?

Get a daily digest of the most important stories affecting your hometown with the Axios Columbus newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Dallas news?

Get a daily digest of the most important stories affecting your hometown with the Axios Dallas newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Austin news?

Get a daily digest of the most important stories affecting your hometown with the Axios Austin newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Atlanta news?

Get a daily digest of the most important stories affecting your hometown with the Axios Atlanta newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Philadelphia news?

Get a daily digest of the most important stories affecting your hometown with the Axios Philadelphia newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top Chicago news?

Get a daily digest of the most important stories affecting your hometown with the Axios Chicago newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Sign up for Axios NW Arkansas

Stay up-to-date on the most important and interesting stories affecting NW Arkansas, authored by local reporters

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Want a daily digest of the top DC news?

Get a daily digest of the most important stories affecting your hometown with the Axios DC newsletter.

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Please enter a valid email.

Please enter a valid email.

Subscription failed
Thank you for subscribing!

Rebecca Zisser / Axios

The hospital industry is participating in a massive flea market, with large chains buying and selling hospitals like Pokémon cards or Monopoly properties. Buyers want to bulk up their market power, while sellers want to reduce huge loads of debt or focus their attention elsewhere.

What's happening: The main action this week is coming from three large for-profit companies: HCA, Tenet Healthcare and Community Health Systems. There also have been a bevy of deals among not-for-profit health systems. These transactions can be easily overlooked, but they are important because they alter the pricing power in local markets.

Here's the latest deal-making from this week:

HCA: Bought three acute-care hospitals in Houston from Tenet and two hospitals, also in Texas, from Community Health Systems. HCA missed Wall Street's profitability expectations in the first quarter, so the easiest way to make investors happy is by acquiring high-margin assets. Brian Tanquilut, an analyst at Jefferies, said HCA now has the most inpatient hospital beds in Houston and should "see improved commercial payer pricing" because of the deals.

Tenet Healthcare: Sold the Houston hospitals to HCA for $725 million. Those facilities had high profit margins — 14% — but Tenet didn't have a lot of market share in the area and wanted money to invest in its outpatient surgery centers. CEO Trevor Fetter has made it clear Tenet will only own hospitals if they have a dominant negotiating position in the local market to extract better prices from health insurers. Tenet sold its Atlanta hospitals last year for the same reason.

Community Health Systems: The most active seller right now. In the past week, CHS has announced or closed on the sales of 14 hospitals. CHS is hemorrhaging money and has $14.6 billion of debt that needs to be paid off, so it has set a goal of divesting 30 hospitals. Steward Health Care, Curae Health and Christus Health are some of the health systems that are buying from CHS.

Not-for-profit deals: Hackensack Meridian Health is acquiring JFK Health, which will give Hackensack an even stronger grip on the New Jersey hospital market. Baptist Memorial Health Care and Mississippi Baptist Health Systems merged, creating a powerful hospital giant around Arkansas, Mississippi and Tennessee.

The systems say the deals are about enhancing quality care, but look past that. Hospitals are recording fewer admissions as more people seek care in outpatient settings, and that inevitably leads to lower revenue. Acquiring more hospitals builds up a bigger revenue base and creates more leverage to milk higher prices out of commercial health insurers.

"The evidence and the impact of these mergers is becoming clearer and clearer, which basically shows...an increase in price and in some instances a reduction in quality," said Zack Cooper, a Yale University professor who has studied hospital consolidation.

Go deeper

Big Tech lobbies hard against looming antitrust bill

Illustration: Sarah Grillo/Axios

Big Tech CEOs, including Apple's Tim Cook and Google's Sundar Pichai, have been jawboning lawmakers as a Senate committee takes up a key antitrust bill Thursday.

Why it matters: The bill prompting this lobbying frenzy could upend how tech's giants do business, and tech's critics see this as a "now or never" moment for Congress to check the industry's power.

Biden stock market gets Trumped

Data: Yahoo Finance; Chart: Jared Whalen/Axios

U.S. stocks markets performed worse during the first year of Joe Biden's presidency than during the first year of Donald Trump's presidency.

By the numbers: The S&P 500 rose 19.3% between the market close before Biden's inauguration and yesterday's market close, compared to a 24.1% increase for Trump during the similar period.

First look: Biden's Year One turnover

Expand chart
Data: Brookings Institution; Chart: Thomas Oide/Axios

Low first-year turnover among President Biden's senior staff marks a "return to normalcy" and a sign of stability after the Trump years, says a new Brookings Institution report reviewed by Axios.

Driving the news: The departure of five out of 66 "A-Team" officials puts Biden's departure rate as the third lowest since Ronald Reagan's presidency, above only George H.W. Bush and son George W. Bush, the report found.