Since the early 1990s, health care provider consolidation in states like Oregon has led to higher prices, reduced access, and worsened health inequities. In response, Oregon established the Health Care Market Oversight Program in 2022 to review major health care transactions, aiming to ensure they reduce costs and improve care access, especially for underserved populations. While the program has approved most transactions so far, concerns about transparency, resource adequacy, and high profit thresholds for review persist. CHIR’s Nadia Stovicek discusses the need for ongoing evaluation and improvement, and how other states can learn from Oregon.