Unfortunately, it appears that the Luigi Mangione amen chorus is going to be with us for quite a while. Recently, retired lawyer Paul Eisner submitted to the California Attorney General the “Luigi Mangione Access to Health Care Act.”
Named after the alleged assassin of UnitedHealthcare CEO Brian Thompson, it would make it illegal for insurance companies in California to deny, delay, or modify medical procedures or medications. Eisner aims to get on the ballot for the November 2026 election. (RELATED: Luigi Mangione’s Cognitive Dissonance)
He has said the initiative is inspired by his own battle with claims denials while he was battling cancer 15 years ago. Unfortunately, he misdiagnoses the problem. The real culprits are the cartelization of American hospital systems and the government regulations that incentivize it. (RELATED: Trump’s Surprising Healthcare Ally)
Due to mergers and acquisitions, hospitals face less and less competition. That has given them more power to demand huge rate increases in negotiations with insurance companies. For example, last year, CommonSpirit Health, the country’s third-largest hospital system, demanded rate increases three times higher than inflation from insurer Anthem Blue Cross Blue Shield in Colorado. About 35,000 Anthem policyholders would have lost access to the 12 hospitals CommonSpirit has in Colorado if Anthem had not cut a deal. (RELATED: Trump’s Drug-Price EO Should Have Happened Decades Ago)
Similarly, in 2024, Hospital giant HCA Healthcare used the same tactics with insurer UnitedHealthcare. HCA demanded a 30 percent increase in rates over two years in South Carolina, a one-year 16 percent increase in Texas, and a double-digit hike in Colorado. HCA operates hospitals in 19 states with over 38,000 beds, more than twice its nearest competitor.
In Missouri, 500,000 Anthem policyholders were threatened with a loss of access to Mercy hospitals, which demanded rate increases five times higher than inflation from the insurer.
Late last year, Baptist Health demanded a 60 percent increase in rates over five years from insurer Florida Blue to keep its policyholders in the Baptist system. The dispute was settled. Florida customers will have to see what impact it has had on premiums and cost-sharing.
All of the hospitals listed above have absorbed other hospitals in recent years. CommonSpirit merged with Dignity Health in 2019, HCA Healthcare bought Memorial University Medical Center in 2017 and Catholic Medical Center in February 2025, Mercy acquired Southeast Health in Missouri in 2023, and Baptist merged with Bethesda Health in 2017 and Boca Raton Regional Hospital in 2019.
They are part of a trend that has accelerated since the passage of Obamacare in 2010. That law unleashed a flood of new regulations on hospitals, especially non-profit ones, including bundled payments, financial assistance policies, and Community Health Needs Assessments. About 56 percent of hospitals were part of a larger system in 2010. That had risen to 67 percent by 2022. From 1998-2010, there were an average of 71 hospital mergers and acquisitions annually. From 2011-2023, the average was 87. According to the Health Care Cost Institute, over 76 percent of hospital markets in the U.S. were highly concentrated in 2021, up from 71 percent four years earlier.
Complying with regulations is costly, and mergers are an effective way of dealing with those costs. When hospitals merge, they can spread the costs of regulation over more resources. (RELATED: Rage Against the (Healthcare) Machine)
In markets, more competition is better, and hospital markets are no exception. As competition declines among hospitals, hospitals have more leverage over insurance companies. When insurers can no longer fend off hospitals’ demands for large rate increases, that leaves insurers with few options to keep premiums down other than policies like prior authorization and denial of claims that don’t meet standards demonstrating the critical nature of particular procedures, treatments, tests and more.
Congress and the president need to take a hard look at hospital regulation and find ways to reduce it. That will slow the rate of hospital mergers.
By targeting insurers instead of hospital regulation, a measure like the Luigi Mangione Access Health Care Act misses the mark. It won’t reduce healthcare costs. It will only shift them. If insurers can’t keep costs down with tools like claims denials, policyholders will see larger premium hikes, cost-sharing, and copays. As well-meaning as Mr. Eisner may be, his efforts should instead focus on making hospital markets more competitive.
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