Trump’s promise to end hospital consolidation rings hollow when examined against his administration’s actual antitrust enforcement record. What Trump claims he will do—and what his regulators are actually doing—are two different things. In February 2025, just weeks into his second term, Trump’s newly appointed FTC chair Andrew Ferguson signaled a sharp departure from his predecessor’s aggressive merger scrutiny by criticizing former chair Lina Khan’s antitrust approach as “clumsy” and “breathless.” More tellingly, Trump revoked Biden’s Executive Order 14036 on Promoting Competition in America, which had directed all federal agencies to prioritize market competition. This executive order had been a cornerstone of the Biden administration’s effort to slow healthcare consolidation.
The real story of antitrust enforcement under Trump is not about stopping hospital mergers—it’s about clearing them faster with minimal conditions. Trump’s regulators have already signaled they are “less inclined than his predecessor’s to intervene in health mergers” and willing to approve deals with acceptable divestiture remedies rather than blocking them outright. In May 2025, Northwell Health of New York merged with Connecticut’s Nuvance to create a 28-hospital system serving over 1,000 outpatient clinics. This major consolidation—precisely the kind of deal that might have faced serious scrutiny under Biden—proceeded under the Trump administration’s more permissive lens. Understanding what Trump’s antitrust enforcement actually looks like is critical for patients facing the direct consequences: higher hospital prices.
Table of Contents
- How Hospital Mergers Drive Up Healthcare Costs
- What Trump’s Antitrust Enforcement Actually Looks Like
- The Northwell-Nuvance Merger as a Case Study
- Trump’s Antitrust Enforcement vs. Biden’s: A Direct Comparison
- Physician Consolidation Accelerates Under Permissive Enforcement
- State-Level Enforcement Fills the Federal Gap
- What Comes Next Under Trump’s Antitrust Regime
- Conclusion
How Hospital Mergers Drive Up Healthcare Costs
Hospital consolidation is not an abstract economic issue—it directly impacts what patients pay for care. Research from the U.S. Government Accountability Office shows that horizontal hospital-to-hospital mergers in concentrated markets can raise prices anywhere from 6% to 65%, depending on the competitive landscape. When hospitals acquire physician practices, prices for physician services jump by an average of 14%. These are not theoretical projections. They reflect what happens in real markets when hospitals gain monopoly or near-monopoly power. A study from the University of Chicago Harris School examined 1,164 hospital mergers between 2000 and 2020.
The researchers found that overall mergers increased prices by an average of 1.6% over two years. But the most concerning finding: mergers that gave hospitals significant market power—consolidating competitors in the same geographic area—increased prices by 5.2%. In other words, the mergers most likely to reduce competition are also the ones most likely to harm patients’ wallets. The limitation of past antitrust enforcement is that many mergers proceeded even when they raised competition concerns, precisely because federal regulators lacked the political will to block them. Trump’s administration shows even less inclination to challenge these deals.
What Trump’s Antitrust Enforcement Actually Looks Like
Trump’s approach to antitrust enforcement differs fundamentally from Biden’s. Biden’s FTC under Lina Khan pursued a strategy of blocking mergers outright and challenging private equity involvement in healthcare consolidation. Trump’s FTC chair Andrew Ferguson has explicitly rejected this strategy, calling it ineffective. Instead, Ferguson’s approach is to let deals proceed if they can be remedied through divestitures—breaking off specific assets to preserve competition in local markets.
The problem with this remedy-focused approach is that it often fails to address the root consolidation problem. Divesting a single hospital or clinic in a region may preserve the appearance of competition while still leaving the combined entity with significant market power. Moreover, Trump’s regulatory philosophy assumes that markets work better with less federal intervention, even when empirical evidence shows that hospital consolidation raises prices. The warning here is explicit: patients should expect fewer merger challenges under Trump and more hospital consolidation in their regions, particularly in areas where one or two health systems already dominate local healthcare.
The Northwell-Nuvance Merger as a Case Study
The May 2025 merger of Northwell Health and Nuvance illustrates how Trump’s antitrust enforcement actually operates. Northwell Health, based in new York, is one of the largest health systems in the country. Nuvance Health operates in Connecticut. By merging, they created a combined system of 28 hospitals and over 1,000 outpatient clinics spanning two states. This is significant consolidation of healthcare infrastructure.
Under Biden’s more aggressive antitrust stance, this merger would have faced serious scrutiny, particularly regarding whether it would reduce competition in overlapping markets. Under Trump’s approach, the deal proceeded. The merger was cleared, likely with some limited divestitures or conditions, but the fundamental consolidation was permitted. This sets a precedent: large, multi-state health system mergers are back on the table. For patients in the regions served by these systems, the consequence may be higher hospital prices, less choice, and reduced negotiating power with health insurers.
Trump’s Antitrust Enforcement vs. Biden’s: A Direct Comparison
The contrast between the two administrations is stark. Under Biden, the FTC actively challenged healthcare consolidation and focused on private equity’s role in rolling up physician practices and urgent care clinics. Lina Khan’s strategy was confrontational: block mergers that harm competition, challenge existing consolidation, and use the FTC’s enforcement power as a counterweight to market forces pushing toward consolidation. Trump’s strategy is permissive: allow mergers to proceed if they can be remedied; assume that markets regulate themselves; skeptically view antitrust enforcement as government overreach.
The tradeoff is real. A permissive approach may reduce regulatory burden on hospitals and allow them to pursue cost-saving mergers more freely. But empirical evidence suggests that cost savings from consolidation rarely materialize, and price increases for patients do. Hospitals typically consolidate to gain market power and raise prices, not to become more efficient. Trump’s enforcement philosophy accepts this as the cost of a less interventionist government.
Physician Consolidation Accelerates Under Permissive Enforcement
While hospital-to-hospital mergers receive the most attention, physician consolidation is an equally concerning trend. In 2024, 47% of physicians were consolidated with hospital systems—up from less than 30% in 2012. Corporate entities, including insurers and private equity firms, employed 23% of physicians in 2024, up from 15% in 2019. This rapid consolidation of the physician workforce reduces their independence and bargaining power.
When hospitals employ physicians, they often convert independent practitioners into salaried employees, which can reduce competition in local healthcare markets. Trump’s less interventionist stance on antitrust enforcement means fewer obstacles to this consolidation trend. The limitation of current antitrust law is that it focuses on price effects to consumers, not on the professional independence of physicians or the sustainability of independent practice. As more physicians become employees of large corporations, the ability of the healthcare system to function as a competitive market diminishes further.
State-Level Enforcement Fills the Federal Gap
Recognizing that federal antitrust enforcement has become less vigorous under Trump, several states have stepped in. California, Oregon, and Minnesota have enacted laws giving state authorities power to impose conditions on hospital mergers and block deals that harm state-level competition. This state-level enforcement represents a significant shift: regulation is moving from the federal government back to states. The example of state action is instructive.
States have the advantage of understanding local healthcare markets better than federal regulators and can impose more tailored conditions on mergers. However, state enforcement is fragmented and inconsistent. A large health system can proceed with consolidation in one state while facing scrutiny in another, leading to inefficient and patchwork regulation. For patients, this means protection depends on which state they live in, not on consistent federal antitrust policy.
What Comes Next Under Trump’s Antitrust Regime
Healthcare deal volume remained steady throughout 2025, with quarterly deal counts in the mid-260s to low-300s range. Fourth quarter 2025 saw deal value reach $22 billion. These numbers suggest that consolidation will continue at a robust pace under Trump’s permissive enforcement stance.
Looking forward, the question is not whether hospital consolidation will accelerate—it almost certainly will—but whether states can mount sufficient enforcement action to offset the federal government’s permissiveness. The outlook for the remainder of Trump’s term is clear: expect more hospital mergers, more physician consolidation, and continued upward pressure on healthcare prices. Federal antitrust enforcement will remain focused on blocking only the most egregious deals, not on reversing existing consolidation or slowing the trend. The administration’s philosophy is to let markets work, even when empirical evidence suggests those markets are broken.
Conclusion
Trump’s claim that he will end hospital consolidation is contradicted by his administration’s actual antitrust enforcement record. By revoking Biden’s Executive Order on Competition and appointing an FTC chair skeptical of merger challenges, Trump has signaled that less federal intervention in healthcare consolidation is the new policy. The real-world consequences—higher hospital prices, reduced competition, and less physician independence—will be borne by patients, not by hospital executives or Trump’s regulatory appointees.
For consumers, the practical takeaway is this: antitrust enforcement is weaker now than it was two years ago, hospital consolidation is accelerating, and prices are likely to follow. The only meaningful counterweight is state-level enforcement, which remains fragmented and inconsistent. Trump’s antitrust enforcement looks like permission—permission to consolidate, to raise prices, and to concentrate healthcare power in the hands of large corporations. Understanding this gap between Trump’s rhetoric and his regulatory reality is essential for anyone navigating the increasingly consolidated American healthcare system.