Hospital prices  make up the largest share of U.S. health spending and have climbed far faster than inflation, driving up premiums, out-of-pocket costs, and state budgets. In many markets, a small number of hospital systems dominate, using their market power to negotiate higher rates with insurers and charge patients more for the same services that cost far less elsewhere. Consolidation has also allowed hospitals to acquire physician practices and bill routine outpatient visits at higher hospital rates and charge facility fees, further inflating costs. As a result, Americans pay more per person for health care than residents of any other wealthy nation, while patients face unpredictable, unaffordable bills. These rising prices cause many people to delay or forgo needed care, worsening health outcomes and deepening inequities. The result is not just a health care problem — it’s a price crisis.

States with conservative political environments are facing some of the most pressing challenges in this price crisis, impacting both health care affordability and access. These challenges have only deepened in the wake of federal funding cuts enacted under H.R.1. as many rural and economically vulnerable communities contend with rising health care costs that outpace both wages and state budgets. As federal progress stalls, these pressures will increasingly fall on states to address. Yet, red states are also uniquely well-positioned to lead in developing and advancing health care solutions aimed at reducing the underlying cost of care. Their history of pragmatic, fiscally conservative policymaking—focused on local control, market-driven reforms, and transparency—provides a strong foundation for innovative approaches to improving affordability and sustainability. 

To this end, this cohort aims to build on that momentum by bringing together health policy advocates from red states to share strategies, align on best practices, and strengthen state-based capacity to design and advance policies aimed at reducing the underlying cost of care to ensure long-term sustainability and affordability. By learning from one another and leveraging shared experiences, participating states can chart a path toward meaningful, bipartisan solutions that make health care more affordable and accessible for their residents.

The deadline for submissions is Friday, January 2, 2026.