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health care, health care costs, health insurance, Patient Protection and Affordable Care Act, PPACA, ACA, Affordable Care Act, accountable care organizations, ACOs, monopoly, health care reform


The wave of new Accountable Care Organizations (ACOs), spurred by financial incentives in the Affordable Care Act, could become the latest chapter in the steady accumulation of market power by hospitals, health care systems, and physician groups. The main purpose behind forming many ACOs may not be to achieve cost savings but instead to strengthen negotiating power over purchasers in the private sector. This would be an unfortunate sequel to the waves of mergers in the 1990s when health care entities sought to counter market pressure from managed care organizations. The possibility that ACOs might further concentrate health care markets brings new urgency to understanding why provider monopolies are pernicious and to considering how government can ensure that ACOs pursue efficiency rather than market power.

Library of Congress Subject Headings

Health insurance, Health care reform, Monopolies, Patient Protection and Affordable Care Act, Accountable care organizations (Medical care), Medical care, Cost of medical care, United States