New white paper on healthcare consolidation in Oregon reveals trend likely to accelerate, jeopardizing access to care

Advocates call for urgent action to curb price hikes, safeguard access to services
February 4, 2021

Portland, OR — On Tuesday, researchers from SEIU Local 49 released Bigger, Not Better: The High Cost of Healthcare Consolidation, a white paper that analyzes the consequences of mergers, acquisitions and other partnerships in healthcare — a major trend predicted to rise in the coming year.

The evidence is clear that consolidation in healthcare leads to higher prices, does not necessarily improve quality, and can lead to reductions in services.  The financial pressures brought on by COVID-19 are expected to increase the rate of consolidation in healthcare across the nation.

“The widening gap between the haves and have nots of healthcare has only been magnified by this pandemic as more independent providers question if they have the funds to keep their doors open,” said Kirsten Isaacson, Research Director for SEIU Local 49. “Larger health systems are empire-building, there’s no question. But to whose benefit?”

Independent practices, small clinics, and community-based hospitals have been stretched thin by the pandemic and are increasingly vulnerable to larger health systems with billion-dollar endowments and large cash reserves looking to capitalize on the profit-potential.

The white paper explores the impact consolidation has on patients and communities and highlights current trends in Oregon. Key findings from the report include: 

  • The number of independent hospitals and physicians in Oregon is dwindling. The number of independent hospitals in Oregon has declined by 43 percent since 2000. The share of physicians affiliated with health systems in the Portland metro area grew from 39 percent in 2016 to 71 percent in 2018.
  • Oregon’s most competitive healthcare market is not only highly concentrated, but also one of the priciest in the nation. In 2017, Portland had the 14th highest healthcare prices out of 124 large metro areas across the nation. In addition, the amount Oregonians paid for their healthcare increased nearly 29 percent in four years, outpacing the rate of inflation.
  • Consolidation could exacerbate health disparities in Oregon. Experts argue that when hospitals raise prices, resources are redirected to facilities that cater to privately insured individuals (who are disproportionately white and high-income) as opposed to those that care for Medicaid patients (who are disproportionately Black, brown, and people of color).
  • Following affiliation, rural hospitals are more likely to lose access to services, such as onsite imaging, outpatient nonemergency care, and obstetric and primary care.
  • Reproductive, gender-affirming, and compassionate end-of-life care are at risk. Several large, religiously-affiliated healthcare entities are governed by ethical religious directives that prohibit or impose barriers that reduce access to these services. Past mergers have put reproductive, gender-affirming and compassionate end-of-life-care at risk, as could future ones. 

Authors of the white paper urge Oregon policymakers to establish greater scrutiny of healthcare deals to ensure patient health is not compromised.

The Equal Access to Care Act (House Bill 2362) pending before the Oregon Legislature would create a comprehensive review process for proposed healthcare mergers, acquisitions, and affiliations throughout Oregon’s healthcare market — from service providers to insurance carriers — and ensure all transactions enhance access to low-cost, high-quality services. 

Representative Andrea Salinas is chief sponsor of the legislation, which is also backed by Oregon’s leading advocates for reproductive rights, LGBTQ+ care and worker justice. 

“The findings in this report shed light on the reality that more work is needed to protect equitable access to healthcare in Oregon,” said An Do, Interim Executive Director for Planned Parenthood Advocates of Oregon. “It’s time to make the health and well-being of  local communities our bottom line, not increased profits for large health corporations and private equity.”

“It’s concerning that large healthcare systems can strike deals to purchase independent practices without any input from the communities that they serve. Small, independent practices, like Prism Health, provide culturally relevant care in authentic ways that prioritize people over profit. Consolidation of these practices will decrease patient choice and could result in more expensive or limited access to healthcare,” said Peter Parisot, Chief of Staff and Chief Legal Officer for Cascade AIDS Project and Prism Health. “This report sounds the alarm that we are going in the wrong direction. It’s time to make sure our communities are centered in any healthcare deal.”

On February 9th, the House Committee on Health Care will hold a hearing on the Equal Access to Care Act.

About the Equal Access to Care Coalition: 

Equal Access to Care is a collaboration between organizations that believe every Oregonian deserves access to the full range of medical services to stay healthy — no matter who we are, where we live, or how much money we make. We represent the state’s leading advocates for reproductive rights, LGBTQ+ care and worker justice; we work in and with communities to tear down barriers and improve access to healthcare for all in our state.  Members include ACLU of Oregon, Cascade AIDS Project and Prism Health, Basic Rights Oregon, Compassion & Choices, Forward Together Action, NARAL Pro-Choice Oregon, Oregon Nurses Association, Planned Parenthood Advocates of Oregon and SEIU Local 49.

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VICTORY: Colorado Gov. Jared Polis signed the improved End-of-Life Options Act.