By: TAHP | Thursday, June 25, 2026

Part of TAHP's Complete Coverage affordability series.

What's new: A new White House report finds that banning three anticompetitive contract terms hospitals use to block competition would lower hospital prices by 18% and cut workplace insurance premiums by 6.5%.

Why it matters: Texas banned most of these terms in 2023. But it left all-or-nothing contracts in place, and that one gap keeps hospital prices and premiums higher than they need to be for Texas families.

By the numbers: The White House Council of Economic Advisers put real dollars on what a ban would save.

• Lower premiums: Workplace premiums would fall 6.5% in the markets where these anticompetitive contract terms are currently used, putting about $1,755 back in a family's pocket each year and $606 for an individual.
• Cheaper hospital stays: Hospital prices would drop 18% in affected cities, saving about $4,100 on a single hospital stay.
• Billions in savings: A nationwide ban would save employers and families about $45 billion a year on premiums.
• Nearly 1 in 4 workers: About 24% of Americans with job-based coverage live where dominant hospitals use these contracts.

What these anticompetitive contract terms actually do: These tactics block competition and artificially inflate prices.

• All-or-nothing: A hospital system tells an insurer it has to include every one of the system's hospitals and doctors, or none of them. That blocks plans from building a network around the lower-cost, high-quality hospitals and doctors families want. These contract terms are still legal in Texas.
• Anti-tiering: These terms stop a plan from placing lower value providers into higher cost sharing tiers to encourage patients to be smart shoppers. These terms are prohibited in Texas so families can clearly see more affordable option exist.
• Anti-steering: These terms stop a plan from rewarding families with lower copays or deductibles when they choose a more affordable hospital. These terms are banned in Texas so patients can be rewarded for being smart shoppers.

Where Texas stands: Texas originally led on banning anti-competitive contracts. In 2023, lawmakers passed HB 711, which banned anti-steering, anti-tiering, gag, and most-favored-nation clauses in provider contracts. But prior to passage HB 711 was amended to remove a ban on all-or-nothing contracting, one of the most expensive and anticompetitive contract terms.

Solutions to lower hospital prices in Texas:

• Close the all-or-nothing loophole: Ban all-or-nothing contracts so plans can build networks around the hospitals and doctors that offer families the best value, instead of being forced to take a system's most expensive providers to get its essential ones.
• Repeal any mandates that prevent shopping incentives: Repeal all Texas mandates that limit how health plans can reward families with lower copays and deductibles for choosing more affordable, high-quality care.
• Allow innovative, affordable networks: Reform Texas network mandates that force oversized, one-size-fits-all networks and require plans to include every expensive provider. Let plans offer flexible designs, such as narrow, high-performance networks, that promote competition and lower prices proven to create savings.

The bottom line: Cracking down on anticompetitive hospital contracts lowers premiums and makes care more affordable. Texas got most of the way there in 2023. Finishing the job means closing the "all-or-nothing" loophole and letting plans reward families who shop for value.

Go deeper: Read TAHP's Employer Market & Mandates one pager and the Affordability Solutions one pager for the full 90th Legislature agenda.

Keep up with TAHP's affordability series:

Series Opener: Why is health insurance getting more expensive?
May 28: Small Employers Are Paying for Texas's Mandate Problem
May 7: Health Insurance 101, Latest Texas Data
April 29: Shopping Around Matters: Where Texans Get Their Care Can Mean Very Different Prices
April 14: Addressing affordability starts with hospital prices.
April 7: Health care fraud is wasting billions.
April 2: The No Surprises Act is protecting patients, but private equity is creating a new affordability crisis.
March 30: Hospitals are using AI to charge more.