Competition and Transparency - Addressing Unfair Business Practices and Anticompetitive Behavior

Unfair contracting practices and anticompetitive behavior in the health care market are driving up costs for employers and employees alike in the employer-sponsored insurance system. ERIC is actively advocating for reforms that promote fairness, transparency, and competition, supporting legislative efforts to eliminate restrictive contracting clauses and prevent market abuses by dominant health systems. Through support letters, coalition efforts, detailed research, and other activities, ERIC is leading a campaign to expose the true drivers of high hospital prices—namely, provider consolidation and market power—and is pushing for targeted policy solutions that restore balance and accountability in health care contracting.

• Fairness in Contracting – Fairness in contracting refers to the principle that health care agreements should be transparent, equitable, and free from coercive or anticompetitive terms. This means:
• Preventing large hospital systems or insurers from using their market power to impose restrictive or one-sided terms in contracts with employers, providers, or third-party administrators.
• Eliminating “anti-steering” or “all-or-nothing” clauses, which can block employers or insurers from directing patients to lower-cost, higher-value care options.
• Ensuring that prices, billing practices, and provider networks are clearly disclosed and negotiable, rather than hidden behind complex or secretive agreements.
• Restoring competitive dynamics so that employers can shop for health care services the same way they do in other markets—based on price, quality, and value.

In short, fairness in contracting promotes a level playing field where all parties—especially employers and consumers—can make informed decisions and avoid being locked into high-cost, low-transparency arrangements. Below are bills that ERIC supports and other resources.

• Healthy Competition for Better Care Act (119th Congress)
  • Press release
    • Melissa Bartlett, Senior Vice President of Health Policy at ERIC was quoted in supporting the bill because it promotes transparency, eliminates anti-competitive barriers, and empowers patients to choose high-quality, lower-cost care.
• Healthy Competition for Better Care Act Employer Group Support Letter
  • ERIC and other aligned employer groups endorse legislation to prevent restrictive contracting terms and promote price transparency.
• ERIC Support Letter for H.R. 3120 Markup in House Education and the Workforce Committee
  • Reinforces employer support for removing anti-competitive contracting practices.
• Stakeholder Letter on the FAIR Act
  • Coalition urging passage of the FAIR Act to curb unfair health care contracting clauses.
• Education & Workforce Affordability Hearing
  • ERIC statement on linking health care consolidation and contracting abuses to rising cost.

• Beyond Cost Shifting: Market Power as the Key Driver of Hospital Prices
  • ERIC’s issue brief evaluates the primary drivers of hospital prices in employer-sponsored health plans. According to research performed by Charm Economics, it is not cost shifting what may be lacking in federal payments onto the employer sponsored insurance market. Rather, market forces—including provider consolidation, employer bargaining power, and regional pricing dynamics—play a more influential role in shaping the rates employers ultimately pay for health care services. The issue brief also includes policy recommendations to address rising health care costs.
  • Access the webinar recording, a virtual event in highlighting our advocacy campaign to advance policies related to price transparency and aligning payment rates to more accurately match services.