Oct 22, 2026 · @https://x.com/myrtlebeachnews
As the publicly funded Medical University of South Carolina works to buy up private area hospitals, Washington budget-watchdog project is urging Congress to outlaw hospital and insurer contract terms that it says keep health care prices high, joining the White House, federal prosecutors and a bipartisan group of lawmakers who have targeted the same clauses this year. The focus on banning Anticompetitive Health Care Contracts is crucial for addressing these issues.
The Health Savers Initiative, a joint project of the nonpartisan Committee for a Responsible Federal Budget, Arnold Ventures and West Health, in a policy brief released Thursday, argues that banning so-called anticompetitive contracts, including Anticompetitive Health Care Contracts, would “modestly” lower costs for patients and taxpayers on its own, and more when paired with other reforms such as price transparency and stronger antitrust enforcement.
The stakes are large. The group cites projections that national health spending will total about $6 trillion this year, roughly 19% of the economy, and climb to $9 trillion by 2034. For workers with employer coverage, a White House analysis released in June estimated a ban could trim premiums by about 6.5% in the markets where these clauses are in force.
The clauses are written into the private deals that set what insurers pay hospitals and doctors. Patients never see them, but critics say they show up in premiums and out-of-pocket bills.
The Health Savers Initiative defines them as terms that let a dominant hospital system or provider network block insurers from shopping for better prices, or that let an insurer block providers from offering lower prices to its rivals.
| Clause | What it does | Who usually demands it |
|---|---|---|
| All-or-nothing | An insurer that wants any of a system’s hospitals or doctors in network must take all of them | Hospital systems |
| Anti-steering | Bars insurers from using lower copays or other incentives to steer patients to cheaper providers | Hospital systems |
| Anti-tiering | A form of anti-steering that keeps the system in the plan’s best cost-sharing tier regardless of price | Hospital systems |
| Gag clauses | Limit what insurers can tell patients about price or quality | Hospital systems |
| Most-favored-nation | Bars a provider from giving a competing insurer a lower price | Insurers |
Definitions follow the White House Council of Economic Advisers and the Health Savers brief; the Source on Healthcare Price and Competition at UC Law San Francisco and UC Berkeley tracks the same list.
Federal actuaries project U.S. health spending will hit $6.0 trillion in 2026 and $9.0 trillion by 2034, or 20.6% of the economy, according to CMS projections published in Health Affairs in June. Spending grew 7.3% in 2025, the third straight year above 7%.
The Health Savers brief says Washington will spend $25 trillion on health care over the next decade and give up another $7 trillion in tax breaks tied to employer coverage.
It points to provider consolidation, as hospitals merge into larger systems, as one driver. Outside research largely backs that up:
Not every study agrees. A University of Florida analysis of 1990s Florida mergers found some consolidations lowered prices through efficiencies, though acquired hospitals generally saw prices rise.
The Health Savers brief lands in a year when both parties and the Trump administration have moved against the same clauses.
The White House. In a June 18 report, the Council of Economic Advisers estimated a nationwide ban on all-or-nothing, anti-steering and anti-tiering terms would cut hospital and affiliated-doctor prices 18% in directly affected markets, with a range of 11% to 26%. That works out to about $4,100 per inpatient stay.
| CEA estimate, directly affected markets | Central | Range |
|---|---|---|
| Hospital and physician prices | -18% | -11% to -26% |
| Employer premiums | -6.5% | -4% to -9% |
| Savings per family, per year | $1,800 | $1,100 to $2,500 |
| Savings per individual, per year | $600 | $380 to $860 |
The council estimated 24% of Americans with employer coverage live in markets where the clauses bite. Spread nationally, that is about $45 billion a year in premium savings. It also said multi-market systems can use the clauses to carry urban pricing power into rural hospitals.
Federal prosecutors. The Justice Department and Ohio’s attorney general sued OhioHealth in February over anti-steering, gag and all-or-nothing terms, and settled in June with a deal that voids those provisions and bars the system from seeking them again. A separate DOJ complaint against NewYork-Presbyterian, filed in March, is pending. In the Carolinas, the government’s 2016 case against Charlotte’s Atrium Health ended in a 2019 settlement in which the system agreed not to enforce anti-steering clauses for a decade.
Congress. Sen. Jon Husted, R-Ohio, introduced the Healthy Competition for Better Care Act in March. A House companion is sponsored by Reps. Jodey Arrington, R-Texas, Rick Allen, R-Ga., Don Davis, D-N.C., and Chuck Edwards, R-N.C. Major employer groups, including the American Benefits Council and the ERISA Industry Committee, have endorsed it. The Senate bill sits in the Health, Education, Labor and Pensions Committee.
The states. Connecticut, Massachusetts, Nevada and Texas have restricted several of these clauses, according to a Health Affairs analysis. The same analysis found limited evidence that Texas’ 2023 ban has lowered prices, citing continued bundling and an already consolidated market.
Hospital groups have long opposed federal limits on these terms, arguing that contract terms are a matter for private negotiation.
When Congress weighed a similar ban in 2020, the American Hospital Association urged leaders to drop it. The group argued insurers could win discounts tied to value-based care deals and then steer patients away anyway. It also warned plans might cut rural hospitals out of networks, and that patients could lose access to services systems don’t duplicate at every site.
In court, systems have argued that steering limits are not harmful on their face. Atrium Health, then Carolinas HealthCare System, told a federal judge the government had to prove real-world damage to competition, citing an appeals ruling in a case against American Express.
Some market-oriented critics say the bigger culprit is state certificate-of-need rules that limit new hospitals. North Carolina’s John Locke Foundation argued insurers could walk away from dominant systems if more competitors were allowed to open.
The Health Savers brief itself calls a ban only “one small step,” with larger savings dependent on reforms such as hospital price caps and site-neutral payments.
South Carolina already pays some of the nation’s highest hospital prices. In RAND Corp.’s most recent hospital price study, private insurers and employers in the state paid more than 300% of what Medicare pays for the same care, versus about 254% nationally. RAND tied much of the variation between hospitals to market power, not quality.
The local market is increasingly organized into systems. In Horry and Georgetown counties:
| Hospital or system | Ownership |
|---|---|
| Grand Strand Medical Center, Myrtle Beach | HCA Healthcare, a national for-profit chain |
| McLeod Health Seacoast and McLeod Health Loris | McLeod Health, based in Florence |
| Tidelands Waccamaw Community and Tidelands Georgetown Memorial | Tidelands Health; MUSC Health moved to take an 85% stake in 2025 |
| Conway Medical Center | Independent nonprofit |
The White House analysis warned that systems spanning several markets can use all-or-nothing and anti-steering terms to carry big-city bargaining power into smaller communities. Three of the four local operators belong to multi-market systems.
Whether any local contracts contain these clauses is not public. The terms are confidential, and South Carolina is not among the four states Health Affairs identified as restricting several types of them.
Competition rules are also about to change. Under the state’s 2023 certificate-of-need repeal, the last requirement for state approval of new hospitals in counties that already have one ends Jan. 1, 2027.
Open questions for local follow-up: Do contracts between Grand Strand hospitals and major insurers include all-or-nothing, anti-steering or gag terms? How do HCA, McLeod, MUSC/Tidelands and Conway Medical Center view a federal ban? Where do Horry County’s congressional delegation stand on the Husted bill?
No federal ban has passed. The Husted bill and its House companion are in committee, and the DOJ case against NewYork-Presbyterian is pending. The Health Savers brief does not set a timeline; it urges lawmakers to pair a ban with price transparency, hospital price caps, tougher antitrust enforcement, limits on provider non-competes and site-neutral payments.
Anticompetitive Health Care Contracts – Health Savers Initiative (Committee for a Responsible Federal Budget, Arnold Ventures, West Health), “Banning Anticompetitive Contracts to Lower Health Care Costs,” Oct. 22, 2026 · project page
Anticompetitive Health Care Contracts – White House Council of Economic Advisers, Effects of Banning Anti-Competitive Hospital Contracts, June 18, 2026
Anticompetitive Health Care Contracts – CMS Office of the Actuary projections, via Becker’s Hospital Review and CRFB
Anticompetitive Health Care Contracts – American Bar Association, DOJ Settles Challenge to OhioHealth
Anticompetitive Health Care Contracts – Health Affairs Forefront, Challenges to Anti-Competitive Hospital Contracting, March 2026
Anticompetitive Health Care Contracts – Sen. Jon Husted, Healthy Competition for Better Care Act announcement; MedCity News on employer support
Anticompetitive Health Care Contracts – American Hospital Association, 2020 letter to congressional leaders
Anticompetitive Health Care Contracts – Bradley Arant Boult Cummings, Is Anti-Steering Anticompetitive?; Source on Healthcare, Carolinas HealthCare case
Anticompetitive Health Care Contracts – Merger research: Journal of the American College of Surgeons review, NEJM study, cross-market mergers study, University of Florida study
Anticompetitive Health Care Contracts – RAND hospital price study, via Association of Health Care Journalists
Anticompetitive Health Care Contracts – Post and Courier on MUSC and Tidelands; Live 5 News on certificate-of-need repeal
Anticompetitive Health Care Contracts – John Locke Foundation, certificate-of-need commentary
