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News
A new Brown University study finds that public threats to exit hospital-insurer networks — a tactic called "brinkmanship" — occur in about 8% of contract negotiations, with 2% ultimately resulting in a network split. These disputes are most likely when both sides hold a mid-sized share of the local market. Patients often get caught in the crossfire, facing coverage gaps and care disruptions.
A Brown University study published in Health Affairs reveals that public threats to exit commercial insurance networks during hospital-insurer contract negotiations are a surprisingly common — and growing — phenomenon. Analyzing nearly 15,000 hospital-insurer relationships from August 2021 to July 2025, researchers found that brinkmanship occurred in roughly 8% of cases, with 28% of those threats ultimately leading to a network exit (about 2% of the total sample).
The study identifies a "Goldilocks zone" where disputes are most likely: when hospitals control 25%–45% of local inpatient capacity and insurers hold 30%–45% of commercial membership. For-profit hospitals, those with positive operating margins, and those negotiating with national payers were also more prone to going public with threats. Researchers note that most events clustered in the study's later years, possibly fueled by expiring pandemic supports and rising operating costs.
By the Numbers:
Why it matters: Patients frequently get caught in the middle of these high-stakes negotiations, facing coverage lapses and care uncertainty. While the No Surprises Act offers some protection, gaps can extend beyond the 90-day continuity period — making this a pressing access and affordability issue for millions of Americans.
