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Between 2002 and 2020, there were 1,164 hospital mergers in the United States, with the FTC taking enforcement action against only 13 transactions—an enforcement rate of approximately 1%. Research by Yale economists found that between 2010 and 2015, the 322 hospital mergers raised overall hospital prices by an average of 1.6%, with predictably anticompetitive mergers causing price increases over 5%. The 53 hospital mergers that occurred annually from 2010 to 2015 raised health spending on the privately insured by $204 million per year. Using standard screening tools available to the agency, the FTC could have flagged 20% of mergers (238 transactions) as likely to reduce competition and increase prices, but failed to act. Cross-market mergers increased healthcare prices by 13% over six years, with prices rising 21.8% when the acquired hospital had larger market share. By this period, 90% of U.S. metropolitan areas had hospital markets classified as 'highly concentrated' with Herfindahl-Hirschman Index scores over 2,500. The FTC's average annual budget for antitrust enforcement between 2010-2015 was only $136 million, contributing to systematic underenforcement. Rural regions and areas with lower incomes experienced even larger price increases from consolidation. This decade of unchecked hospital consolidation established market concentration that enabled systematic price gouging, with researchers estimating the underenforcement cost privately insured Americans billions in excess healthcare spending.