White House CEA Report Projects $45 Billion Annual Savings from Banning Hospital Anti-Steering and All-or-Nothing Contracts

The CEA analysis isolates three contract provisions that currently prevent insurers from directing patients to lower-cost providers or negotiating individual facilities within systems. Removing these clauses is projected to increase insurer bargaining leverage by 8 percent, shift volume to efficient providers by 4 percent, and intensify competition by another 3 percent, yielding the $45 billion aggregate reduction.

Existing state-level bans in Connecticut, Massachusetts, and Texas, plus two pending DOJ antitrust suits against OhioHealth, provide the empirical baseline for the national estimate. The report explicitly links higher premiums to reduced take-home pay for workers and elevated costs for small employers, framing the mechanism as a direct transfer from opaque contracting to consumer prices.

Rural hospitals are exempted from the proposed ban framework to avoid access disruptions. Congressional consideration centers on the Healthy Competition for Better Care Act, which would codify the restrictions without price controls.

Implementation would require new federal monitoring of contract filings and continued antitrust enforcement to prevent re-emergence of equivalent clauses through other language.