By Megan R. Wilson

Listen to this briefing

In today’s issue:

• The rise in hospital mergers is catching the attention of lawmakers and regulators
• Children’s Health Defense, the group founded by RFK Jr., hires its first lobbying firm
• The conditions GLP-1s can improve, broken down by science

Happy Friday, and welcome to Health Brief. Do you have any health policy tips or industry intel for me? Reach out. I’m at megan.wilson@washpost.com. If you prefer to message me securely, I’m also on Signal at megan.434.

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The hospital industry is becoming more consolidated. And policymakers are taking notice. (Arin Yoon/Reuters)

	The Lead Brief

The hospital industry is under a bipartisan microscope as lawmakers and regulators probe how the industry has become more consolidated — and how that raises costs or creates barriers to access for patients.

A new analysis from KFF shows that just one or two health systems controlled more than 75 percent of the market in 83 percent of metropolitan areas around the United States.

The analysis also found that the number of hospitals that are part of a health system has increased from 56 percent in 2010 to 69 percent in 2024. Of the hospitals affiliated with health systems, 52 percent are part of a system with 15 or more hospitals. Nearly 20 percent were in health systems comprising 50 or more hospitals.

“As policymakers consider a variety of strategies to make health care more affordable, they have been increasingly attentive to the effects of consolidation in health care markets and the potential implications for cost and quality of care,” the KFF report notes. “Hospital consolidation has been a subject of particular focus in part because spending on hospital care is the largest source of spending on health.”

The hospital industry has argued that consolidation can make patient care more efficient, and mergers are sometimes the only way to keep struggling facilities afloat.

“Competition is reduced when hospitals are forced to close their doors,” said Molly Smith, the group vice president for policy at the American Hospital Association. Smith took issue with the methodology of the report, which looked only at metropolitan statistical areas rather than larger regions.

“A more productive analysis would be on the many financial pressures that put hospitals at risk and can force them to merge to continue providing care to their communities,” Smith said.

→ Still, many studies have shown that hospital consolidation increases prices, which has prompted criticism from Congress. It was one of the primary points that Republicans, in particular, kept hammering during a House hearing focused on providers and affordability earlier this month.

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“We’re hearing that integration improves coordination and expands access, but for so many patients and so many of my constituents, they’re seeing the opposite,” said Rep. Kat Cammack (R-Florida). “It’s not what that feels like, it feels like they’re getting worse outcomes as consolidation increases in market after market. .”

“It’s important that we separate theory from reality and we focus on what patients are actually experiencing,” Cammack said.

The House hearing suggests bipartisan appetite for action, but consensus among lawmakers on the how, especially during a contentious election year, remains thin.

The increasing consolidation has also caught the attention of regulators. Over the last month, the Justice Department has sued health systems in New York and Ohio.

The similar lawsuits allege that the health systems have used their market power to leverage “anticompetitive” contract restrictions with insurers that the suits say kept plans from offering cheaper options for patients. (The health systems have denied the allegations or said they are cooperating with DOJ to ensure they’re in compliance.)

→ Yet hospitals say they’re about to be hit hard by Medicaid cuts and other provisions stemming from Republicans’ signature policy law enacted last year, known as the One Big Beautiful Bill. They’re telling lawmakers not to impose any additional burdens, such as some policies that could do further damage to their balance sheets.

“There’s a recognition among most policymakers — including many who supported the One Big Beautiful Bill Act last year — that the Medicaid cuts are going to be untenable as those are implemented, and [they] need to work with hospitals to preserve access in communities across the country,” Charlene MacDonald, the president and CEO of the Federation of American Hospitals, told me in a call earlier this month before the House hearing.

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MacDonald said lawmakers are aware that “targeting hospitals or providers in this effort is one that brings with it its own complications.”

→ What’s not said is that adding more financial stress could accelerate the very merger activity Washington wants to rein in.

	Lobbying Ledger

Children’s Health Defense, a group founded by Robert F. Kennedy Jr., is enlisting a lobbying firm to push back on the federal government’s efforts to speed the expansion of cell service towers nationwide.

The group, most known for its views opposing vaccines, has long warned about numerous health issues that could stem from being exposed to radio frequency radiation by living near cellphone towers — even though there has been no proven link.

→ The hire is significant because it’s Children’s Health Defense’s first-ever outside lobbying firm.

Lobbyists at AxAdvocacy Government Relations, a firm that’s signed nearly a dozen new clients so far this year, will be addressing Children’s Health Defense’s concerns about federal efforts to, as the group puts it, “limit community control over cell tower siting decisions.”

“Legislative advocacy is necessary to ensure policymakers understand the public health impacts of an unchecked wireless rollout and the importance of local control and clear limits on federal preemption in this space,” said Miriam Eckenfels, the director of the Children’s Health Defense’s Electromagnetic Radiation and Wireless Program, in an emailed statement. 

The group didn’t respond to follow-up questions about the lobbying plans.

Lobbyists on the account include Jeff Billman, who’s served as chief of staff to multiple GOP lawmakers, including Rep. Ronny Jackson (Texas). Billman did not respond to requests for comment about the work.

→ Children’s Health Defense, which has gained prominence alongside Kennedy’s Make America Healthy Again movement, frames its cell tower campaign as part of a broader mission to protect children and communities from what it views as toxic environmental exposures.

The hire comes as the Federal Communications Commission is proposing to remove “regulatory burdens imposed at the state and local level” around where cellphone towers are located. In Congress, lawmakers — all Republicans — have introduced bills that would expand federal powers over cell tower approvals and streamline or waive environmental reviews.

Children’s Health Defense has been encouraging its grassroots network to reach out to policymakers and push back on the efforts.

→ In 2021, Children’s Health Defense won a federal court order that requires the FCC to revisit its safety assessments of wireless radiation, saying the agency’s long-standing guidelines — last updated in 1996 — don’t adequately address long-term exposure or the impacts on children and the environment.

“CHD questions the push for unchecked expansion of wireless cellular infrastructure as it negatively impacts the health and property of those near it,” Eckenfels said.

What to watch: In January, the Department of Health and Human Services said it would launch a study about cellphone radiation, part of a sweeping plan penned by the Make America Healthy Again Commission chaired by Kennedy.

Around the same time, the Food and Drug Administration removed websites that detailed the lack of evidence surrounding whether cellphones pose a danger to a person’s health — including websites focused on children and teenagers. (The summaries of those websites, however, remain.)

	Industry Rx

The GLP-1 drug market is booming, and drugmakers are rushing to find more benefits of the medications beyond simply treating obesity and diabetes — and providers are examining new ways to help patients.

→ That’s where my WaPo colleagues Ariana Eunjung Cha and Aaron Steckelberg come in. They’ve written a new story breaking down how the medications are making scientists rethink what the drugs can do — and they lay out what conditions have been shown to improve with GLP-1 use, based on the evidence.

(The Washington Post)

Read the full story here: “13 surprising ways GLP-1s may benefit the body, according to science.”

	What We’re Reading

“As Kennedy Takes on Food Policy, Companies Push Back,” Christina Jewett writes at the New York Times.

“Shaheen, Murkowski propose FDA user fee program for vapes,” reports CQ’s Lia DeGroot.

“AstraZeneca lung drug gets ‘surprise’ win in COPD trials,” Jonathan Gardner reports at BioPharma Dive.

“She uncovered a terrifying lab hidden in California, with alleged ties to China,” Hannah Fry reports in the Los Angeles Times.