Most employers have no idea their healthcare contracts are working against them. The restrictions are buried so deep in the language that by the time the damage shows up, it looks like a cost problem. However, the real culprit is anticompetitive contracting, and it's been hiding in plain sight.
The Healthy Competition for Better Care Act, bipartisan legislation that would ban the anticompetitive contract clauses at the root of that problem, has been stalled for years. Now it's moving again.
The Healthy Competition for Better Care Act: What Changed in 2026
Why is the Healthy Competition for Better Care Act gaining momentum in 2026?
The employer community is driving real momentum behind this bill. A coalition including the American Benefits Council, the ERISA Industry Committee, and the National Alliance of Healthcare Purchaser Coalitions sent a letter to lawmakers this month in support, voices that represent the self-insured employer market at scale.
The bipartisan backing reflects the nature of the problem. Anticompetitive contracting is a market structure issue, and large health systems have used contractual leverage to suppress competition regardless of who controls Washington.
The policy environment is also shifting. Price transparency, direct contracting, and employer-driven benefit innovation are mainstream now. This legislation is catching up to where the market already wants to go.
The Three Contract Terms Driving Up Your Healthcare Costs
What are the anticompetitive contract clauses the Healthy Competition for Better Care Act would ban?
The bill would ban three specific types of contract clauses that large health systems routinely use to lock employers into arrangements that serve the system, not the employee.
Anti-steering and anti-tiering provisions prevent employers and health plans from directing employees toward higher-quality, lower-cost providers, even when the data clearly points that direction. You can know a better option exists. You just can't do anything about it.
All-or-nothing clauses require employers to contract with every provider affiliated with a given health system as a condition of accessing any of them. Want the flagship hospital in your network? You have to take the underperforming clinic across town too.
Most-favored nation clauses restrict other health plans from negotiating lower rates with providers, even plans that aren't party to the original contract. In practice, this means dominant health systems can lock in inflated pricing across an entire market.
These are standard features of commercial healthcare contracts, and they're a primary reason self-insured employers find themselves paying more than they should for care that may not be the best available.
Why Self-Insured Employers Should Support the Healthy Competition for Better Care Act
Nomi wrote a letter of support for this legislation in September 2024 because we see this problem from the inside every day.
Our mission is to move U.S. healthcare to the true cost of care: transparent pricing, direct relationships between employers and providers, and the flexibility for employers to build benefit designs that work for employees. All three of those things run directly into the contract clauses this bill would ban.
When an employer uses our analytics platform to identify a high-value provider, then discovers they're contractually prohibited from steering employees there, the data is doing its job. The contract is the barrier. That's the gap this legislation closes.
What the Healthy Competition for Better Care Act Means for Self-Insured Employers
How would the Healthy Competition for Better Care Act change what self-insured employers can do?
If this bill passes, self-insured employers would be able to:
- Steer employees toward high-quality, lower-cost providers and offer real incentives for doing so, without risk of retaliation or litigation from health systems
- Contract with the specific hospitals and providers that make sense for their workforce, without being forced to include affiliated providers they didn't choose
- Act on analytics and data tools to make value-based decisions that current contracts block
Direct contracting becomes a cleaner, more viable path. These structural barriers come down.
The Case for Healthcare Market Competition
Legislation doesn't move markets on its own. The employers and providers already doing this work, building direct relationships, demanding transparent pricing, using data to make better decisions, they're not waiting on Washington.
But policy matters. Anticompetitive contracting has been a structural ceiling on what the market can achieve. This bill removes part of that ceiling, and lets the market do what it's been trying to do for years.
We'll be watching closely. We think you should too.
Nomi Health is a healthcare infrastructure company whose mission is to ensure U.S. healthcare spending operates at the true cost of care. Learn more at nomihealth.com.
Frequently Asked Questions
What is the Healthy Competition for Better Care Act?
The Healthy Competition for Better Care Act is bipartisan legislation that would ban three types of anticompetitive contract clauses — anti-steering provisions, all-or-nothing clauses, and most-favored nation clauses — that large health systems use to prevent employers and health plans from directing employees toward higher-quality, lower-cost providers.
Who does the Healthy Competition for Better Care Act affect?
The bill primarily impacts self-insured employers, health plans, and health insurance issuers that contract with large health systems. If passed, it would give employers significantly more flexibility to design benefit plans around value and outcomes rather than system-driven network restrictions.
Why do anti-steering clauses matter for self-insured employers?
Anti-steering clauses prevent employers from using benefits data and analytics to direct employees toward better, lower-cost care, even when that data clearly identifies a superior option. Banning these clauses would make employer-sponsored analytics and direct contracting strategies far more actionable.
What is Nomi Health's position on the Healthy Competition for Better Care Act?
Nomi Health formally supported the legislation in a letter to Congress in September 2024. As a healthcare infrastructure company focused on moving U.S. healthcare to the true cost of care, Nomi views the bill as essential to removing structural barriers that prevent self-insured employers from accessing transparent, competitive healthcare arrangements.
