The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
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A leadership development program for early and mid-career state government officials who are committed to improving the health of all people in their communities.
A leadership program for senior state government officials who are committed to improving population health.
The Fund focuses on creating an affordable health care system built on strong primary care and partnerships that improve health outcomes for all.
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Advancing policies that create a more prevention- and primary care-oriented health system.
Improving population health through policies that contain health care cost growth.
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Short takes on health policy issues from Milbank staff and guest authors.
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The Milbank Memorial Fund is a private foundation that works to improve population health and health equity.
January 25, 2024
Policy Report
Erin C. Fuse Brown
Katherine L. Gudiksen
Publication
Nov 11, 2025
Oct 16, 2025
Sep 15, 2025
State policymakers are urgently seeking tools to address rampant health care market consolidation, which drives health care costs higher and can threaten health care access and quality for patients. Traditional antitrust tools are often inadequate to address novel forms of health care consolidation, including vertical consolidation of health systems and physician practices, cross-market acquisitions across state lines, and the rapid entry of private equity, retail giants, and health insurers into health care provider markets. In response, some states have strengthened and expanded the authority of their attorney general, along with the health department or an independent state entity, to provide greater oversight over health care transactions. This report describes how states have expanded oversight over health care transactions in two primary ways:
(1) Expanding the Review Authority of the Attorney General or Other State Agency: by requiring prior notice of a broader scope of transactions and/or establishing the ability to block or impose conditions upon the transaction without a court order; and
(2) Giving Authority to Review Transactions to Additional Oversight Entities: by vesting another state entity (in addition to the state attorney general) with the authority to review and report on a proposed transaction’s broader health care market impact.
To assist state policymakers seeking to increase health care market oversight, we reviewed state statutes and regulations regarding health care transactions and interviewed state officials and staff members in eight states with expanded authority to review health care transactions. This report synthesizes this legal analysis and lessons from state conversations to present recommendations and policy considerations for state policymakers to strengthen oversight authority of health care transactions.
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