Note: Single-source report; awaiting corroboration.
Anti-steering, anti-tiering, and all-or-nothing contracting clauses are used by dominant hospital systems to reduce price competition. Anti-steering limits insurers from directing patients to lower-cost providers; anti-tiering prevents insurers from placing dominant systems in less favorable benefit tiers; and all-or-nothing contracting requires insurers to include all affiliated hospitals and physicians or none at all. The Department of Justice has filed complaints alleging that anti-steering restrictions are anticompetitive, with cases pending against OhioHealth and New York-Presbyterian.
According to a White House memo, banning these mechanisms nationwide could reduce hospital and affiliated physician prices by about 18%, or roughly $4,100 less per inpatient admission in directly affected markets. These reductions would result from restored insurer bargaining power, a shift of patients toward lower-cost providers, and further price concessions as competition increases among hospital systems.
The memo also estimates that employer-sponsored insurance (ESI) premiums in affected markets could fall by an average of 6.5%, translating to annual savings of about $1,800 per family and $600 per individual (in 2025 dollars). Because the economic burden of ESI premiums falls on workers, these savings are expected to appear as lower out-of-pocket costs or higher take-home wages. Additionally, lower hospital prices may boost payroll and employment outside healthcare and increase federal income tax revenues, particularly benefiting lower- and middle-income workers.
The analysis finds that 24% of Americans with ESI live in markets where these clauses have significant impact. Nationwide, the estimated reduction in ESI premiums is about 1.6%, or around $45 billion per year. Savings vary with market structure: in markets dominated by hospital systems with competitive insurers, premiums may fall 4 to 6%, while in markets where both hospitals and insurers have market power, reductions may be 2 to 3%. More competitive markets with limited use of these clauses may see reductions of 1 to 2%.