How the easing of federal regulations is influencing healthcare M&A

The rescission of the 2021 Executive Order on Promoting Competition, coupled with a more permissive tone from the Federal Trade Commission (FTC), marks a pivotal shift in the hospital and health system M&A landscape. While not a full deregulation, this change signals greater flexibility for health systems pursuing strategic growth, consolidation, or restructuring. For executives, this moment presents both a time-sensitive opportunity and a call for disciplined, community-conscious action.    

A strategic opportunity: Federal tailwinds, local imperatives 

Guidehouse’s health system M&A playbook emphasizes that M&A is not just transactional—it’s transformational. In today’s climate, transaction decisions around acquiring, divesting, or partnering must align with long-term strategy, community benefit, and operational sustainability. 

 With federal scrutiny easing, regulatory authority will increasingly shift to state regulators—attorneys generals, governors, certificate of need (CON) laws, local/municipal stakeholders, and health system boards. Health systems must now evaluate M&A through parallel lenses: regulatory feasibility, community impact, operational transformation, and long-term sustainability. Local factors like payer mix, provider relationships, workforce dynamics, cost structure, digital maturity, and rural access carry greater weight than ever. 

Market conditions create advantages 

While many health systems may benefit from increased latitude under this revised posture, the greatest advantage accrues to organizations that know their transactional identity—buyer, seller, or partner—and can align it to local market needs, organizational strengths, and community responsibilities. Systems that previously paused transactions due to federal headwinds should revisit those plays under today’s conditions. Buyer and seller archetypes will help executives navigate this evolving M&A environment with greater precision. 

Buy-side leverage 

Organizations with scale, capital, and strategic clarity can seize this opportunity, particularly if they operate with a disciplined integration playbook and a transformative operating model vision. 

• Large regional health systems can pursue tuck-in acquisitions and cross-market partnerships without prolonged federal review—enabling faster clinical integration and service line rationalization. 
• Academic medical centers can expand referral networks and attract talent by acquiring or affiliating with community hospitals that complement mission—extending specialty care and research reach into rural areas. 
• Investor-backed multi-state health systems with access to capital and proven integration muscle can move quickly on stressed assets or non-core divestitures—accelerating portfolio optimization and scale-based efficiencies. 

Sell-side negotiating power 

Certain health systems and standalone hospitals, especially those facing performance or sustainability challenges, may find this climate more favorable to reposition, realign, or offload assets on better terms. Selling is not a retreat but a strategic act of stewardship when it preserves access, unlocks needed capital, and improves community resilience. 

• Rural hospitals, especially in CON states, offer geographic exclusivity and political importance. With new federal funding (e.g., the One Big Beautiful Bill Act), they can attract buyers and partners who bring digital tools and staffing support. For large health systems, partnerships with rural hospitals can offset Medicaid rate reductions by stabilizing volumes, optimizing network configuration, and aligning care pathways. 
• Stressed urban safety-net hospitals hold strategic value through expanded access, payer negotiations, 340B drug pricing, and disproportionate share hospital benefits. M&A can secure essential services and unlock more strategic exit or turnaround options. 
• Specialty or faith-based hospitals can structure partnerships or exits in a way that preserves mission and cultural identity, especially with buyers or collaborators open to flexible governance models. 

Balancing speed with strategy 

Looser regulations may accelerate deal-making, but speed alone is not the goal—it’s a lever for strategic alignment. Without discipline, rapid moves risk unrealized synergies, integration drag, and financial strain. The optimal posture is to move quickly where the strategic fit is clear. A fast, focused, and deliberate tempo can seamlessly shape markets, set terms, mitigate risk, and secure stakeholder buy-in. 

Five ways to align strategy with speed  

1. Advance your strategic role: Focus on acquisitions, affiliations, and JVs that reinforce your identity—regional integrator, specialty hub, rural anchor, or ambulatory platform—and avoid distractions. 
2. Use the regulatory window wisely: Define terms, community benefits, and affordability commitments early to build trust with state and local regulators.
3. Sequence M&A for strategic advantage: Secure control points—physician alignment, rural access nodes, specialty programs, digital front door—to narrow rival options.
4. Demonstrate trust through action: Tie early steps to visible gains in access, quality, and affordability to sustain stakeholder support.
5. Pace capital and capacity: Size and time deals to match integration ability. Preserve credit-rating headroom and contingency reserves to realize value and avoid costly financing delays and erosion of deal value. 

Next steps for executives 

The health system M&A playbook provides a disciplined lens to evaluate this changing terrain. The focus now must shift from regulatory hurdles to strategic alignment and operating model impact. 

• Reassess paused M&A strategies under the new regulatory posture 
• Apply the Acquire/Divest/Partner framework to align deals with long-term transformation 
• Revive due diligence pipelines, especially for stressed assets—without skipping stage gates
• Engage local stakeholders early and build community-benefit narratives into deal structures
• Update board education and scenario planning for newly viable deal models 

Moving with urgency 

The regulatory climate may be more permissive, but the real opportunity lies in strategic execution. Executives who align M&A moves with their system’s mission, market role, and technology priorities will drive resilient, value-based growth—and shape the future of healthcare delivery—amid uncertainty.