Oregon’s landmark law to block healthcare mergers has yet to block a single deal in five years. While the program has imposed conditions on some transactions and led to the withdrawal of two high-profile mergers, critics and healthcare providers say the law’s impact has fallen far short of its ambitious goals—especially in protecting vulnerable communities from disruptions in care.
The story of Dana Gibbon, an 18-week pregnant woman in Corvallis, Oregon, illustrates the law’s limitations. When her OB-GYN practice abruptly closed two years after being acquired by UnitedHealth Group’s Optum subsidiary, Gibbon found herself scrambling to find a new doctor. Two other obstetrics practices had already shut down, leaving her with few options. She eventually gave birth at a small hospital with only four maternity beds—all of which were full when she went into labor. Her induction was delayed three times before her healthy son was born by cesarean section, a procedure she had hoped to avoid.
“It’s impossible not to wonder if things may have gone differently if there had been more labor and delivery beds in the area,” Gibbon said. Her experience reflects a broader pattern: despite Oregon’s pioneering law, patients in rural and underserved communities continue to face disruptions in care after mergers and acquisitions.
Oregon’s Pioneering—but Flawed—Approach to Healthcare Consolidation
In 2021, Oregon made history by becoming the first state in the U.S. To grant its health department the power to block mergers and acquisitions of hospitals, medical practices, and hospices. Lawmakers designed the law to counteract the wave of healthcare consolidation that research shows is driving up costs and reducing competition nationwide. The Oregon Health Authority (OHA) was given broad authority to reject transactions, impose conditions, or levy fines if companies failed to comply with regulatory requirements.
The law was hailed as a national model, with proponents arguing it would prevent multibillion-dollar deals from reducing access to care or increasing costs for patients. Yet five years later, Oregon has not formally blocked a single transaction. While the program has led to the withdrawal of two high-profile deals—a proposed merger between Oregon Health & Science University and Legacy Health, and an acquisition involving CareOregon, which serves over 500,000 Medicaid patients—the broader impact remains limited.
According to state records reviewed by investigative journalism, at least three of the nine healthcare deals that underwent follow-up reviews resulted in outcomes the law was meant to prevent, including closures of rural hospices and reductions in patient satisfaction. Critics argue the program’s effectiveness is undermined by short review timelines, limited enforcement tools, and an overreliance on corporate assurances.
How the Law Was Supposed to Work—and Where It Fell Short
The Oregon Health Authority’s merger oversight program was designed to ensure that transactions would not harm patient access, increase costs, or reduce the quality of care. Regulators were empowered to:
- Block transactions if they posed significant risks to healthcare access or affordability.
- Impose conditions such as maintaining existing services, preserving reproductive and gender-affirming healthcare, or requiring detailed annual reporting.
- Levy fines if companies violated the terms of approved deals.
However, the law’s implementation has faced significant challenges. Oregon regulators have typically chosen the fastest review option allowed under the statute—a 30-day process—which critics say is insufficient for adequately assessing the long-term impacts of mergers. Larry Kirsch, a health economist at Oregon State University, has called the reviews “superficial” and “nonrobust,” arguing that regulators often take companies at their word without conducting rigorous analyses.
“Some of them were so outrageous, you’d have to say that their eyes were totally closed,” Kirsch said in an interview. His assessment aligns with concerns raised by healthcare providers and patient advocates, who argue that the law’s teeth are too weak to prevent harm.
Case Study: The Corvallis Clinic and the Limits of Oversight
The story of the Corvallis Clinic, a doctor-owned practice that operated independently for nearly 80 years, highlights the law’s shortcomings. In 2023, the clinic—then facing financial distress—was acquired by Optum Oregon, a subsidiary of UnitedHealth Group, the largest health insurer in the U.S. The deal was approved by Oregon regulators after the clinic’s executives testified against the merger oversight law in 2021, arguing that independent practices were best suited to deliver care.
Yet within months of the acquisition, the clinic’s OB-GYN services were shut down, leaving hundreds of patients—including Gibbon—without providers. Dr. Nicole Kruppa, a former OB-GYN at the clinic and a shareholder, quit after her workload became unsustainable. She described a breakdown in operations, including unfilled vacancies and postponed exams, that forced her to leave the practice.
“I felt I could no longer provide my patients the care that they deserved,” Kruppa said. “Burnout became so intense that I worried I would either make a medical mistake or get in a late-night car accident while driving to deliver a baby.”
The Corvallis Clinic’s struggles were exacerbated by a ransomware attack on Change Healthcare, a UnitedHealth subsidiary, which disrupted billing and claims processing nationwide. The clinic sought an emergency exemption from Oregon’s merger review, arguing it was on the brink of bankruptcy. Regulators granted the exemption in just five days, waiving the conditions they had previously proposed.
UnitedHealth Group has maintained that Optum is working to stabilize the clinic, recruit new clinicians, and expand services. However, patients and former staff describe ongoing disruptions, including delayed procedures, longer wait times, and a steady exodus of doctors. Rebecca Geier, a 67-year-old patient, has lost four doctors at the clinic in the past year alone.
“It wasn’t just an inconvenience—it was disruptive to my continued care with these doctors,” Geier said. “The dreaded letters from Optum informing me that my doctor had left or was soon leaving the clinic just kept coming, one after another.”
National Trends: Consolidation Continues Despite Oversight
Oregon’s experience reflects broader trends in healthcare consolidation. According to the Commonwealth Fund, about 50% of U.S. Doctors were employed by hospital systems in 2024, up from less than 30% in 2012. Studies show that as competition narrows, prices rise, quality of care declines, and access becomes harder to obtain—particularly in rural areas.
Following Oregon’s lead, five other states—including Maine and New Mexico—have adopted similar laws in the past year. Maine’s new bill, signed in April 2025, requires state approval for the sale of healthcare facilities when private equity firms are involved. However, experts warn that without stronger enforcement mechanisms, these laws may struggle to achieve their goals.
Dr. Jane Zhu, a primary care physician and associate professor at Oregon Health & Science University, acknowledges that programs like Oregon’s add transparency to merger decisions. But she cautions that they “don’t necessarily change the equation” when it comes to the broader trend of consolidation.
“Regulators can approve a merger and prices go up and consolidation worsens, or they can block a merger and maybe there’s an immediate effect on the clinic’s solvency,” Zhu said. “The challenge is ensuring that the oversight is robust enough to prevent harm in the first place.”
What’s Next for Oregon’s Merger Oversight Program?
Despite its limitations, Oregon remains a national leader in healthcare merger oversight. Clare Pierce-Wrobel, the health policy and analytics director at the Oregon Health Authority, acknowledges that the program’s early reviews were held to a lower standard. She says regulators are now better equipped to assess transactions and impose meaningful conditions.
“If those notices were received when the program was fully up and running, there may have been a different result,” Pierce-Wrobel said. She added that the OHA welcomes public input to improve the program’s implementation, particularly in advancing health equity, lowering costs, and increasing access to care.
The next major test for Oregon’s merger oversight program will come as it evaluates additional transactions in the coming months. The state has already required deeper six-month reviews for seven deals, three of which are still underway. Advocates are pushing for stronger enforcement, including the ability to conduct post-merger audits to ensure compliance with regulatory conditions.
For now, patients like Dana Gibbon and Rebecca Geier remain at the mercy of a system that has yet to live up to its promise. Their stories serve as a reminder that even the most ambitious healthcare policies require rigorous enforcement to protect those who need care the most.
Key Takeaways
- Oregon’s merger oversight law has not blocked a single deal in five years, despite its ambitious goals to prevent healthcare consolidation from harming patients.
- Short review timelines and limited enforcement tools have undermined the program’s effectiveness, with critics arguing regulators often take corporate assurances at face value.
- Patients in rural communities, like those in Corvallis, continue to face disruptions in care after mergers, including closures of OB-GYN practices and delays in critical procedures.
- Five other states have adopted similar laws, but experts warn that without stronger oversight, these measures may fail to curb consolidation.
- The Corvallis Clinic’s acquisition by Optum illustrates the law’s limitations, as patients and doctors describe ongoing challenges despite regulatory approval.
- Public input and stronger enforcement are seen as critical to improving Oregon’s merger oversight program in the years ahead.
What’s Next?
The Oregon Health Authority is currently reviewing several healthcare transactions, including:
- A proposed merger involving a rural hospital system in Eastern Oregon (review details).
- A private equity acquisition of a home health provider in Southern Oregon (review details).
- Follow-up audits on three previously approved deals to assess compliance with regulatory conditions.
The next public hearing on healthcare mergers is scheduled for June 15, 2025, where regulators will discuss potential updates to the oversight program. For updates, visit the Oregon Health Authority’s merger oversight page.
Have you been affected by a healthcare merger in Oregon? Share your story in the comments below or contact the Oregon Health Authority at [email protected].
Keep reading