WASHINGTON, September 14 — The American Hospital Association wants federal antitrust regulators to widen the lens on hospital mergers, and it brought a commissioned report to make the case. The bottom line: the AHA argues that current merger reviews lean too heavily on commercial insurance prices and market-wide concentration, and not enough on who the merging hospitals actually treat. The country’s largest hospital lobby released a new analysis Monday commissioned from healthcare advisory firm Kaufman Hall.
AHA General Counsel and Secretary Chad Golder, writing in a blog post highlighting the report, said “hospital mergers receive careful antitrust review. But careful review is not the same thing as a narrow review.”
The figure that matters
Kaufman Hall’s report states that antitrust agencies evaluating proposed deals “primarily focus on the price increases following the transaction.” But it notes prices would not move for Medicare, Medicaid, Medicare Advantage and Medicaid managed care, which the government controls. Nearly 60% of patient days at an acute care hospital are among patients under the Medicare and Medicaid programs, according to the report.
The AHA said that undercuts what it called the “outsized attention to only one potential effect on one segment of patients—higher negotiated rates paid by commercial insurers.” Golder framed the relevant question as broader than prices commercial insurers negotiate. He argued regulators should weigh what a transaction—or its failure—means for patients, including whether healthcare services remain available, whether hospitals can invest in their workforce and facilities, and whether local communities retain access to care.
What happens when deals die
The report also examined 88 proposed-but-cancelled deals within the past decade. It found that potential acquirees experienced a median 50% reduction in operating profit margin, a 38% reduction of days cash on hand and a 10% dip in labor compensation ratio a year after the cancellation. “While some of these hospitals were already facing financial headwinds, our analysis suggests that a failed partnership may accelerate decline by removing access to capital or operational expertise that could stabilize performance,” the report reads.
Kaufman Hall also highlighted that the 12 hospital transactions since 2015 that the Federal Trade Commission has sued to block involved, on average, acquirees with higher percentages of governmentally insured patients (64%). A separate review of Kaufman Hall’s proprietary data on 88 deals since 2006 showed acquirees typically served communities more vulnerable than the national average.
The AHA’s push lands as hospital consolidation faces increasing scrutiny, with research tying consolidation to higher healthcare prices. The association and the report recommend regulators place more weight on the types of patients merging hospitals serve, what could happen to care delivery if a deal falls through, and how hospitals within a shared market compete at the service-line level. Investors will note the timing.
The AHA is asking for a change in how deals are judged, not a change in the law—and the report’s own numbers suggest the acquirees most often in regulators’ crosshairs are the ones leaning hardest on government payers. Watch whether the FTC signals any shift in how it weighs patient mix and deal failure against commercial price effects.
