Impact of Anti-Steering and Contracting Practices on Hospital Pricing and Insurance Premiums

Anti-steering, anti-tiering, and all-or-nothing bundled contracting are strategies employed by major hospital systems to mitigate price competition. Anti-steering limits insurers from guiding patients to more cost-effective service providers. Anti-tiering, a variant of anti-steering, prevents insurers from placing these systems in an unfavorable benefit tier. All-or-nothing contracting obligates insurers to either include all facilities and physicians within a network or exclude them entirely. In early 2026, the Department of Justice filed complaints against OhioHealth and New York-Presbyterian, alleging these restrictions suppress competition. These legal proceedings are ongoing.

A recent report quantifies potential reductions in hospital pricing and health insurance premiums if these practices are banned nationally. Such a ban could decrease hospital and physician service prices by approximately 18 percent, with potential variations between 11 and 26 percent. This translates to an estimated saving of around $4,100 per inpatient admission in directly impacted markets. These reductions would come from enhanced negotiating power for insurers, shifts of patient volumes to lower-cost providers, and potential price concessions due to increased competitiveness.

Applying these savings to the hospital and physician portions of employer-sponsored insurance (ESI) spending, which constitute about 57 percent of the total, and assuming a 70 percent transmission of these savings to premiums, ESI premiums in affected regions could decrease by about 6.5 percent, ranging from 4 to 9 percent. For families, this may mean annual savings of approximately $1,800, with individuals saving around $600 when adjusted for 2025 dollar values.

These premium savings largely benefit employees, manifesting as reduced out-of-pocket expenses or increased wages. Lower hospital pricing could stimulate job growth and payroll increases outside healthcare, potentially boosting federal tax revenue, particularly for lower- and middle-income employees. It is estimated that such contractual clauses affect 24 percent of Americans with ESI, potentially resulting in a national ESI premium savings of 1.6 percent, or $45 billion annually.

The impact of eliminating these clauses varies by market conditions. Regions with dominant hospital systems and competitive insurers may see premium reductions between 4 and 6 percent. In areas with considerable market power held by both hospitals and insurers, reductions are expected to be 2 to 3 percent. More competitive environments with fewer instances of these clauses may experience reductions between 1 and 2 percent.

In rural communities, large health systems might use these contracting practices to extend pricing power from urban centers to rural hospitals, increasing costs. Prohibiting such clauses could lower premiums for rural businesses and workers, strengthen the negotiating ability of independent rural hospitals, and exert minimal financial pressure on system-owned rural hospitals.