Our healthcare system is supposed to work for patients, families, employers, and communities. But across the country, a growing number of federal antitrust lawsuits tell a troubling story. When large hospital systems gain too much market power and use restrictive contracts to block competition, health insurance premiums and out-of-pocket costs rise, and ordinary people pay the bill.
Four major cases from New York, Wisconsin, Connecticut, and Ohio point to the same pattern. Dominant hospital systems are accused of using their leverage to prevent insurers and self-funded employers from building lower-cost networks. These lawsuits should serve as a wake-up call for Congress and federal regulators. The problem is not local. It is national.
In New York, the UFCW Local 1500 Welfare Fund, which provides health benefits to thousands of grocery workers and their families, sued NewYork Presbyterian Hospital under federal antitrust law. The complaint alleges that the hospital system used its strong position in New York City to impose contract terms that block real competition. According to the filing, those terms include anti-steering provisions that stop insurers from encouraging patients to use lower-cost providers, all-or-nothing clauses that require plans to include all of the system’s facilities, and restrictions that limit transparency about prices. The fund argues that these tactics make it nearly impossible to design more affordable networks for working families.
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A similar story is playing out in Wisconsin. Two self-insured employers filed suit against Aspirus, a dominant regional health system. The complaint alleges that Aspirus controlled roughly 65% of inpatient hospital services and more than 75% of outpatient services in its region. With that level of control, insurers allegedly could not build a commercially viable network without including Aspirus. The lawsuit claims the system used exclusive arrangements and network strategies that shut out competitors and allowed it to charge artificially high rates.
In Connecticut, the Estuary Transit District and the Teamsters 671 Health Service and Insurance Plan sued Hartford HealthCare and related entities. Their complaint describes all-or-nothing contract terms, anti-steering and anti-tiering provisions, and referral practices that allegedly lock in market share and suppress competition. The plaintiffs argue that these tactics prevent insurers from steering patients to higher-value providers and lead to higher premiums and out-of-pocket costs.
This issue has also drawn direct federal enforcement. In February 2026, the Justice Department joined the Ohio attorney general in filing a civil antitrust lawsuit against OhioHealth, one of central Ohio’s largest hospital systems. Government officials allege that OhioHealth required insurers to include all of its hospitals in their commercial plans and used contract provisions that limited insurers’ ability to offer lower cost options. According to the complaint, when dominant hospital systems use these restrictive terms, employers and consumers ultimately pay more.
These cases share a common theme. Healthcare prices are not set by patients’ comparison shopping. They are negotiated between insurers and hospital systems. If an insurer can credibly threaten to exclude a provider, it can push for better rates. But when a system becomes a must-have provider, that leverage disappears. Without competitive pressure, prices tend to rise.
The consequences are real. Employers that self-insure their workers face higher claims costs. Insurance premiums increase. Families see rising deductibles and copays. Independent doctors and clinics struggle to compete unless they join the dominant system. Choice shrinks even if the hospital buildings remain the same.
Federal antitrust law provides tools to address harmful mergers and exclusionary conduct, but these cases suggest that more clarity and stronger guardrails are needed. Congress should consider banning anti-steering, anti-tiering, and all-or-nothing clauses when used by dominant health systems. Lawmakers should strengthen transparency requirements so employers and patients can better understand pricing and contract terms. They should also ensure that the Federal Trade Commission and the Justice Department have the resources and authority to challenge anticompetitive behavior before it becomes entrenched.
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This is not about punishing hospitals. Hospitals provide essential services and anchor many communities. But size should not translate into unchecked power. Competitive markets help keep prices in check, expand choices, and reward value.
The lawsuits unfolding across the country tell a clear story. When competition is blocked, costs climb. When dominant systems write the rules, patients and employers lose bargaining power. Federal policymakers should act now to protect competition in healthcare markets before higher costs and fewer choices become the norm nationwide.
Stefano Forte is the President of the New York Young Republican Club and Executive Director of The 1776 Project Pac. Follow @StefanoLforte
