America’s healthcare system is built on a concentration of corporate power that puts patient care in the hands of giant, for-profit businesses. Many Americans find their health coverage claims denied arbitrarily, drug prices are growing out of control, and large healthcare companies routinely post massive profits. These problems have their origins in many different parts of our healthcare system: hospital systems that provide poor service or charge outrageous prices, middlemen like pharmacy benefit managers manipulating drug prices for profit, or predatory private equity firms looking to cut back spending on patient care. The U.S. pays more for healthcare per capita than almost all other countries and does not receive a similar quality of care or experience positive health outcomes.
While the federal government can and must play an important role in regulating and fixing America’s healthcare system, state governments have many tools and powers at their disposal to block healthcare consolidation, control drug prices, prevent absentee corporate control, ensure high levels of patient care, and protect healthcare workers. Hospitals are subject to state regulation, many aspects of pharmaceutical markets are not preempted by federal law, state antitrust law can specifically target healthcare as an important sector, and states can implement a range of policies to support healthcare workers or limit the influence of predatory investors.
This toolkit breaks the problem into several categories and outlines practical steps that state lawmakers can take to reform different aspects of American healthcare to improve health outcomes, the affordability of care, price transparency, and fairness in healthcare markets. Where applicable, we note model legislation that has been adopted or proposed.