During my time as a public servant in the state of Ohio, I learned a simple truth: markets work best when they are open, competitive, and accountable. When they are not, families pay the price. That’s why a recent lawsuit filed by Ohio Attorney General Dave Yost and the U.S. Department of Justice against OhioHealth caught my eye. Every Ohioan and every American should pay close attention to this case.
OhioHealth is one of the largest healthcare providers in central Ohio, operating 13 hospitals and standalone emergency rooms across Franklin and Delaware counties, along with more than 200 affiliated physician offices and clinics. Its facilities include Grant Medical Center and Riverside Methodist Hospital.
According to the lawsuit filed in federal court in Columbus, OhioHealth controls more than 35 percent of general acute-care hospital beds in those two counties. In some Ohio counties, OhioHealth is the only option. The complaint alleges that OhioHealth has been using its massive scale to restrict competition illegally.
Attorney General Yost and the U.S. Department of Justice assert that OhioHealth has imposed contractual restrictions on insurance companies that prevent them from offering lower-cost, “budget-conscious” health plans. In effect, insurers allegedly cannot design plans that steer patients toward more affordable or higher-value competitors, such as Mount Carmel Health System or The Ohio State University Wexner Medical Center, without risking exclusion from OhioHealth’s network.
The result, according to the lawsuit, is fewer choices and higher premiums for employers and families in central Ohio. If proven true, that is not competition. It is coercion.
Healthcare is not a luxury good. It is not discretionary spending. It is one of the largest line items in every family’s budget and in every employer’s cost structure. When hospital systems use market dominance to prevent insurers from offering lower-cost options, the impact cascades. Employers face higher premiums, workers see more money deducted from their paychecks, small businesses struggle to provide coverage, consumers have fewer plan choices, and competing hospitals are prevented from gaining the patient volume necessary to innovate and expand.
In my time overseeing Ohio’s finances as Treasurer, I saw firsthand how healthcare inflation applies pressure to public budgets, as Mayor of Cincinnati, I saw how rising healthcare costs strain city budgets and small businesses alike, and as Secretary of State, I saw how economic competitiveness affects whether companies choose to expand in Ohio or do business elsewhere. When markets are distorted, everyone pays the price.
The Department of Justice deserves credit for bringing federal antitrust enforcement to bear on the issue of hospital consolidation, which has been quietly reshaping American healthcare for years. Omeed Assefi, who has only been in the top antitrust job at DOJ for a matter of weeks since Gail Slater’s departure, deserves a round of applause for addressing this issue that affects all Ohioans.
Across the country, hospital mergers and system expansions have reduced competition in regional markets. While some consolidation can bring efficiencies, unchecked dominance can enable pricing power that harms consumers. The DOJ’s willingness to challenge alleged anti-competitive contracting practices sends a critical signal that market power does not exempt anyone from the law. Antitrust enforcement is not anti-business. It is pro-market, pro-consumer, and it ensures that success comes from value and innovation, not from locking competitors out of the playing field.
While this case focuses on central Ohio, the underlying concern is national in scope.
In many states, one or two dominant hospital systems control most hospital beds in metropolitan areas. Insurers frequently report difficulty negotiating flexible, tiered, or lower-cost network options when a single provider becomes “must-have” in any plan.
The DOJ should not stop at Ohio.
If the allegations in this case reveal a broader pattern of dominant hospital systems using contract terms to restrict insurers from offering cost-saving options, federal and state regulators must investigate and act.
Hospital systems obviously play a vital role in our communities. They employ thousands, invest in research, and provide essential care. The question is not whether a hospital system is charitable or respected. The question is whether it is using market power in a way that restricts competition and raises prices. If so, enforcement is not punitive, it is protective. Antitrust law is one of the most important consumer protection tools in our economic system.
As someone who has worked in public finance, elections administration, and city government, I believe deeply that healthy markets are foundational to healthy communities. Ohio families deserve affordable options, employers deserve fair negotiations, and competing hospitals deserve a level playing field. If similar practices exist elsewhere in America, the Department of Justice should not hesitate to look closely and act decisively.
Competition built Ohio. It can help restore affordability in healthcare, too.
Ken Blackwell has formerly served as Mayor of Cincinnati and Treasurer of State in Ohio.