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Health Law and Ethics
July 4, 2001

An Analysis of Physician Antitrust Exemption LegislationAdjusting the Balance of Power

Author Affiliations

Author Affiliations: Center for Organization and Delivery Studies, Agency for Healthcare Research and Quality, Rockville, Md (Dr Hellinger); and Management Decision and Research Center, Veterans Affairs Health Services Research and Development Service, and Program on Health Policy and Management, School of Public Health, Boston University, Boston, Mass (Dr Young).


Health Law and Ethics Section Editors: Lawrence O. Gostin, JD, the Georgetown/Johns Hopkins University Program in Law and Public Health, Washington, DC, and Baltimore, Md; Helene M. Cole, MD, Contributing Editor, JAMA.

JAMA. 2001;286(1):83-88. doi:10.1001/jama.286.1.83

Current antitrust law restricts physicians from joining together to collectively negotiate. However, such activities may be approved by state laws under the so-called state action immunity doctrine and by federal legislation under an explicit antitrust exemption.

In 1999, Texas became the first state to pass physician antitrust exemption legislation allowing physicians, under certain defined circumstances, to collectively negotiate fees with health plans. Last year, similar legislation was introduced in the US Congress, in 18 state legislatures, and in the District of Columbia. This legislation was passed only in the District of Columbia where its implementation was blocked by the city's financial control board. Nonetheless, legislation permitting physicians to collectively negotiate fees with managed care plans has been introduced in 10 state legislatures this year, and there is continued interest in introducing similar legislation in the US Congress. This analysis examines the basic features of this legislation and its potential impact on the balance of power between physicians and managed care plans.