Time to Stop Watching Hospital Consolidation—and Start Confronting It

This week, I published an open letter to Congress urging them to take meaningful action on one of the most urgent but overlooked drivers of America’s healthcare cost crisis: hospital consolidation.

For years, policymakers have studied the issue. They’ve held hearings, published reports, and debated the impact. Meanwhile, large nonprofit health systems have steadily consolidated market power—acquiring profitable outpatient centers, closing unprofitable hospitals, and building vast investment portfolios under the protections of tax-exempt status.

Nowhere is this more visible than in the recent behavior of Ascension.

Over just 16 months, Ascension sold or consolidated 35 hospitals across the country. At the same time, they entered what they openly describe as “acquisition mode,” preparing to spend $3.9 billion to acquire AmSurg, one of the largest ambulatory surgery center networks in the country. These moves aren’t isolated—they’re strategic. And they’re happening in a policy environment that rewards scale, margin, and recurring revenue over community health, access, or affordability.

While Ascension reported a $466 million operating loss in the first nine months of FY 2025, it also brought in $910 million in non-operating investment income—more than twice what it spent on charity care during the same period. Its $1 billion+ venture capital arm is investing in startups and outpatient tech platforms, while the communities it once served lose essential services like emergency departments and obstetrics.

This isn’t just an Ascension issue. It’s a system issue. And that’s why the letter calls on Congress to finally move past discussion and into action.

In 2023, Medicare and Medicaid spent over $425 billion on hospital care—more than the entire U.S. defense budget. That money is increasingly flowing into systems that operate like private equity firms, yet still receive the benefits of nonprofit status.

The letter doesn’t offer a single solution. It presents several possible paths. But its core message is clear: if Congress thinks stopping consolidation is hard, try unwinding it once entire markets have been captured and communities have lost their access to care.

Letter to Congress re. Ascension.pdf

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