On the surface, little had changed—except the logo. A pair of familiar symbols now intertwined in sleek corporate colors, stamped beneath the slogan: “Together, for the future of care.”
The rebrand, according to multiple press releases, signals innovation, progress, and unity—values which ostensibly drove the recent hospital merger in my hometown, Allentown, between Lehigh Valley Health Network and Jefferson Health, a larger health system based in Philadelphia. But beneath the PR polish, daily life at the hospital tells a different story: Patient quotas, strict dress codes, and a top-down management style are reshaping the workplace, turning a once mission-driven institution into a tightly controlled corporate machine.
I began working at Lehigh Valley Health Network—now Jefferson— in 2024, around the time that the merger was greenlit by leadership at both health systems and beginning to take shape. Though I had no clear sense of what things had been like before, the atmosphere was marked by uncertainty and unease. The environment felt frantic, with staff members voicing their anxieties about the transition and its implications.
Much of the communication from senior management was vague, which only heightened the stifling sense of instability. This was not a takeover, we were told, but a merger. Certain positions, made redundant by the merger, were not eliminated—they were sunsetted. The announcement was laden with corporate jargon, such as the claim that “complementary capabilities and footprints will accelerate access to affordable leading-edge health care services,” which effectively meant little. What did the future actually look like? Nobody really knew. In the end, higher-ups distributed T-shirts, emblazoned with the new logo, instead of answers, and we found ourselves wading into the murky waters of mergers and acquisitions with little understanding of what was happening.
In the healthcare industry, healthcare organizations such as hospitals, insurance companies, and pharmaceutical firms use various forms of “mergers and acquisitions”—or M&A, for short—to consolidate into larger health systems. According to the American Hospital Association, there have been an estimated 1,887 hospital mergers between 1998 and 2021. In 2024 alone, seventy-two mergers were announced nationwide.
Although hospital mergers have existed for decades, many scholars point to the passage of the Affordable Care Act (ACA) in 2009 as a major cause for the rise of “mega hospitals”—multi-million-dollar hospital giants, often formed through mergers and characterized by their immense size and capacity to deliver nearly every service a patient might need at a single site. By introducing reforms that encouraged “value-based care,” the ACA significantly reshaped the economics of healthcare by restructuring incentives to reward quality of care rather than quantity. One such reform was a shift from the fee-for-service payment model, which assigned fees based on the number of services provided, to a bundled payment model, which sets a flat fee regardless of the number of services provided.
In response to the financial pressures created by these new payment models—specifically penalties for failing to meet performance standards, the loss of fee-for-service revenue, and new upfront costs—hospitals increasingly coalesced into larger health systems. By bringing a wide range of services “under one roof,” these health systems aimed to streamline processes and trim unnecessary spending. They also save money by operating on a larger scale: By reaching more people, they can better absorb the occasional losses, such as the costs of treating uninsured patients. In other words, the money made from more paying patients helps soften the blow of financial setbacks, protecting overall profits.
The COVID-19 pandemic created new financial pressures that further fueled consolidation and the rise of mega hospitals. Although mergers initially slowed as hospitals confronted the immediate challenges of the pandemic, they eventually rebounded as health systems worked to alleviate growing financial distress.
While executives are quick to champion healthcare megasystems as efficient, cost-effective solutions that expand access to care, economic and healthcare policy experts have found that hospital consolidations in fact often reduce competition, leading to higher healthcare costs that insurers transfer to patients in the form of rising premiums. According to a study by the National Bureau of Economic Research, hospitals that do not have any competitors within a fifteen-mile radius charge prices that are 12 percent higher on average than those in markets with four or more competing hospitals. In a notable example, a 2000 merger between two hospitals in the northern Chicago suburbs led to price increases as high as 65 percent.
Likewise, the notion that mergers promote better quality of care is disputed by an ever-growing body of research. A report by Massachusetts Medical Society found that hospital acquisitions were linked to “moderately worse patient experiences.” Perhaps more startlingly, evidence suggests that serious health complications tend to creep up as competition among hospitals declines. As Martin Gaynor, an economist at Carnegie Mellon University and vocal proponent of federal price controls, told The New York Times in 2019: “When prices are set by the government, hospitals don’t compete on price; they compete on quality.” Without such regulation, he argued, the incentive to maintain or improve quality diminishes.
Closures and layoffs are another legitimate concern for those grappling with the aftermath of a hospital merger. While mergers are often touted as a reliable solution for financially distressed hospitals, a 2024 analysis by the Pennsylvania Health Access Network found that nearly 90 percent of Pennsylvania hospital closures in the past twenty years were preceded by a merger or acquisition. That same study found that since 2004, thirty-two hospitals across Pennsylvania have closed completely, while another twenty-five have discontinued essential services such as emergency and maternal care.
Patients and employees alike feel the negative impacts. A Healthcare Dive brief from January 2025 reported that Jefferson Health and Lehigh Valley Health Network planned to lay off 271 employees in multiple rounds over the following months. This move is part of a broader effort to increase what they call “operational efficiency” following the buyout.
In addition to the threat of layoffs, employees at newly merged hospitals often face disruptions, such as adapting to a new workplace culture and standards. In 2023, a coalition of labor unions filed a complaint with the Department of Justice alleging that University of Pittsburgh Medical Center, a large Pennsylvania health system commonly known as UPMC, had used its market dominance to suppress wages, increase workloads, and restrict workers’ ability to seek better employment elsewhere.
“If you want to be competitive, this is the way the business is,” an employee at Lehigh Valley Health Network tells me. “I mean, they’re not even hiding the fact that medicine is a business.”
The employee, who requested anonymity out of concern about potential backlash for speaking openly about the merger, says he has not personally observed any significant changes to operations or workplace culture so far, though he acknowledges that it may be too early to tell.
“I don’t know if [Jefferson] will go full, you know, takeover. I feel like it might be coming [because] we’ve been on the other end of it. There was a group called Coordinated Health and they eventually got acquired by Lehigh Valley. And [higher-ups] were like ‘Nothing was going to change.’ But it was a lie. And, over time, everything changed. So I don’t know. I don’t know, with time, if that’s going to happen.”
Without question, healthcare behemoths are entangled in a myriad of issues. However at the heart of it all lies a simple truth: These acquisitions are driven not by altruism, but by profit. Take my hometown as a case in point. For all the sanitized talk about integrating resources and expanding access to care, the merger was actually born out of a desire to expand Jefferson’s insurance arm, Jefferson Health Plans, into the Lehigh Valley.
The dynamic here, and in countless other merger examples, is one where patient care is a secondary consideration, an afterthought, pushed aside in favor of increasing profitability, which selectively benefits those at the top. And, when maximizing shareholder value or boosting quarterly earnings becomes the core mission, the well-being of patients and employees inevitably suffers.
In an article for the American Economic Liberties Project, an anti-monopoly advocacy group, journalist Sara Sirota unpacks this growing crisis and underscores the urgent need to confront corporate consolidation in healthcare. To address these mounting concerns, she argues, we must repeal the laws that enable hospital monopolies and replace them with meaningful antitrust reforms. This includes establishing a dedicated Federal Trade Commission task force to scrutinize healthcare mergers and acquisitions. Only through such action can we reorient the system toward its core purpose: providing accessible, affordable care to every patient.