When Marcelle Crago tore her meniscus in 2025 and needed surgery to remove meniscus cartilage, Mission Health quoted her more than $9,000 for the procedure. She postponed the operation and arranged it instead at an outpatient center, which charged substantially less for her care.
Crago's experience in Asheville, North Carolina, illustrates a pattern researchers say has become the norm at hospitals with little local competition. As reported by Miami Herald, Mission Hospital charged around $40,000 for a knee replacement under the same health plan that paid Catawba Valley Medical Center in Hickory about $16,000 for the identical procedure. The Herald reports the gap extends across other common services, too: Mission charged $17,700 for a hernia repair compared with $9,600 at Catawba Valley, and $7,500 for a breast biopsy compared with $1,700 at the same competitor. Mission Health offered Crago a 20% discount if she paid upfront, according to the Herald's reporting, but she chose the outpatient route instead.
Why One Hospital Can Charge So Much More
Mission Hospital was formed in 1998 when St. Joseph's Hospital and Memorial Mission Medical Center merged. The Herald notes that hospital scale can affect bargaining leverage, and Yale economist Zack Cooper described to the Herald how hospitals with bargaining leverage tend to have higher prices. Mission Hospital charged 334% of Medicare prices that same year, according to the Herald's review of pricing data.
A Mission Hospital spokesperson told the Herald that comparing hospitals' prices was unfair or misleading. HCA Healthcare purchased Mission Health System in 2019 for $1.5 billion.
Lawsuits and Federal Warnings Pile Up
Legal and regulatory pressure on the hospital has intensified well beyond pricing disputes. A North Carolina Business Court judge in July denied HCA Healthcare's motion for summary judgment, clearing the way for a state lawsuit originally filed in December 2023 to proceed to trial, according to Blue Ridge Public Radio. The suit alleges HCA breached its purchase agreement by degrading emergency and oncology care at Mission Hospital. Affiliated Monitors identified potential noncompliance by the hospital for the 2025 calendar year, citing cessation of Industrial Rehabilitation services and diminished access to certain other services alongside federal patient safety warnings, as reported by North Carolina Health News.
The Herald's reporting adds further detail to that oversight record: CMS inspectors issued multiple immediate-jeopardy findings to Mission Hospital in recent years, including another earlier in 2026, and an 88-year-old patient died after going a night without receiving a blood transfusion. Separately, Asheville chef Katie Button filed a pending class-action lawsuit against Mission Health with five other residents in 2021, and a group called Reclaim Healthcare WNC launched in 2024 to hold Mission accountable for harmful practices, the Herald reports.
Those cases followed an earlier antitrust fight. In August 2025, HCA Healthcare settled an antitrust lawsuit filed by four Western North Carolina local governments — the cities of Asheville and Brevard along with Buncombe and Madison counties — according to Carolina Public Press. The lawsuit alleged anticompetitive conduct by HCA.
A National Pattern Beyond Asheville
Mission Hospital is far from an isolated case. The Herald cites similar gaps around the country: Holmes Regional Medical Center in Melbourne, Florida charged insurer Cigna twice what another hospital charged for a knee replacement, while Banner North Colorado Medical Center in Greeley charged a UnitedHealthcare patient $20,000 more for the same surgery than a Denver health system did. Hospital prices have risen faster than prices in any other economic sector over the last quarter century, the Herald reports, and U.S. knee replacement procedures alone occur more than a million times a year.
Consolidation continues at a rapid clip. Hospitals and health systems announced 46 mergers and acquisitions in 2025, with mega-mergers valued at more than $1 billion, according to the Herald. Sanford Health and Marshfield Clinic Health System, for instance, created a 56-hospital system across the Midwest with combined revenue of about $10 billion, while Northwell and Nuvance merged 28 hospitals across Connecticut and New York. Since 2002, more than 1,000 U.S. hospital mergers have occurred, yet the Federal Trade Commission challenged only a small fraction of cases to stop a merger, the Herald notes, while FTC Chair Andrew Ferguson has called for a task force on healthcare mergers leading to higher prices and decreased quality.
Healthcare Dive and HealthLeaders Media have also covered hospital consolidation beyond Asheville.
The American Hospital Association has argued that hospital mergers can improve quality and reduce healthcare costs, the Herald reports. But independent research points the other way: a January 2025 Department of Health and Human Services synthesis cited by the Bipartisan Policy Center found that horizontal hospital mergers in already concentrated markets increase hospital prices by 6% to 65%. Independent research similarly links hospital market power to higher prices.
States and Regulators Push Back, With Mixed Results
A handful of states have tried to get ahead of the trend. Minnesota passed a law in 2023 banning anticompetitive healthcare mergers and bolstering state oversight, while Oregon passed a law in 2021 enabling its state health department to block hospital acquisitions and mergers, according to the Herald. California passed a law in 2022 requiring healthcare businesses to give the state 90 days' notice of large mergers, and California regulators have continued investigating merger effects.
Federal transparency rules add another layer: the Centers for Medicare & Medicaid Services required hospitals to disclose prices starting in 2021, and CMS can now levy civil monetary penalties of up to $2 million annually per hospital on systems that fail to publish comprehensive price files, a policy that has drawn recent scrutiny in markets like Nashville. Yet the Herald reports that Donald Trump revoked Joe Biden's 2021 directive urging federal agencies to challenge mergers that could harm consumers, and federal merger enforcement has focused on market concentration, while only a small fraction of deals face challenges in practice.
Financial anxiety is part of the broader affordability debate. Efforts to bypass traditional health plans are another response discussed in that debate. Similar consolidation pressures have shown up elsewhere, including in Utah, where an analysis by Yale's Health Care Affordability Lab found 61.7% of hospitals operate in concentrated ownership markets or function as effective monopolies within a 30-minute travel time.
Medical debt underscores the broader affordability pressures surrounding hospital care. North Carolina's Medicaid policy is also part of that broader discussion.
