In 2021, Oregon became the first state in the country to grant its health department broad authority to block acquisitions and mergers of hospitals, hospices, and medical practices. The law was designed to counteract consolidation that research shows reduces competition and drives up healthcare costs. Five years later, Oregon has not formally rejected a single transaction or issued any fines under this authority.
The legislation represented an ambitious attempt to give state regulators teeth in reviewing multi-billion dollar healthcare deals. Lawmakers said the new oversight power would prevent transactions from reducing care access or increasing costs for patients. State regulators received authority to reject deals outright or impose conditions and financial penalties on companies that disregarded requirements. The approach was hailed as a national model by health policy experts.
What the Left Is Saying
Democratic legislators and progressive health advocates say the law's implementation has fallen far short of its promise. Dr. John Santa, a retired physician and former member of the Oregon Health Policy Board, which oversees the agency implementing the law, offered a blunt assessment: "My interactions with the program were so disappointing and fell so short of what I expected. I never imagined it would perform as poorly as it has."
State Sen. Khanh Pham, who supported the original legislation, said regulators need more resources and political will to fulfill the law's intent. "The authority exists on paper, but if you're not using it, then what's the point?" she said in a statement. Progressive advocacy groups argue that major corporations have exploited weak enforcement, pointing to outcomes that contradict the law's purpose.
Patients like Dana Gibbon of Corvallis say they have felt the real-world consequences. When her OB-GYN practice closed two years after being acquired by a UnitedHealth Group subsidiary, she struggled to find alternative care for her pregnancy. "It's impossible not to wonder if things may have gone differently if there had been more labor and delivery beds in the area," Gibbon said.
What the Right Is Saying
Conservative critics argue the law represents government overreach that discourages investment and innovation in healthcare markets. Business groups and some Republican lawmakers say market forces, not bureaucratic review boards, should determine how healthcare providers operate and consolidate.
Private equity firms and major health corporations have continued to invest in Oregon despite the oversight framework. Industry representatives note that two high-profile transactions were withdrawn following regulatory scrutiny—a Portland-area hospital merger and an acquisition affecting a nonprofit serving 500,000 Medicaid recipients—arguing this demonstrates the law's deterrent effect without requiring formal rejection.
Some fiscal conservatives worry that aggressive enforcement could drive healthcare companies to invest in other states, reducing capital available for Oregon facilities. They contend that companies like Clayton, Dubilier & Rice have maintained quality care while improving operational efficiency, as shown by higher ratings than any other national hospice provider in standardized consumer surveys according to the firm's spokesperson.
What the Numbers Show
Of nine healthcare deals subject to follow-up reviews under the law, at least three resulted in outcomes the legislation was intended to prevent, ProPublica's examination of state records found:
UnitedHealth Group acquired home health provider LHC Group for $5.4 billion in 2023. The company closed a rural hospice agency in Central Oregon two months later, redirecting staff and patients nearly 30 miles away. The Oregon Health Authority later said the move raised concerns about potential reduction in access.
Amazon purchased One Medical for $3.9 billion in 2023. It subsequently closed the group's downtown Portland practice while cutting $100 million in operating expenses nationwide. State reviews noted a drop in Oregon patient satisfaction scores as measured by an outside organization.
In 2022, Oregon approved acquisition of a hospice provider by private equity firm Clayton, Dubilier & Rice. The firm told regulators it would not change locations or staffing. After the deal closed, the company closed a Salem hospice facility. In a follow-up report, the state noted the closure and alluded to "some changes" in Oregon staffing, though officials would not disclose whether this referred to additions or cuts, citing confidentiality designations by involved companies.
The law authorized the Oregon Health Authority to reject transactions, add conditions, or levy fines. None of these enforcement mechanisms have been deployed in five years.
The Bottom Line
Oregon's experiment in healthcare merger oversight remains a work in progress. While the law achieved its goal of stopping at least two high-profile deals through negotiation rather than formal rejection, critics argue this approach lacks transparency and accountability. The disconnect between regulatory authority and actual enforcement raises questions about whether the framework can achieve its stated goals of preserving care access and controlling costs.
Clare Pierce-Woobel, health policy and analytics director for the Oregon Health Authority, acknowledged that some mergers were held to low standards during review. Healthcare consolidation continues nationwide, with research consistently linking reduced competition to higher prices and sometimes diminished care quality. What happens next in Oregon could influence how other states approach healthcare market oversight—or whether similar efforts gain traction at all.