The article discusses the state's protection of academic medical centers from antitrust oversight in the US. Antitrust law is intended to prevent harm from consolidation of markets, including in health care, where consolidation has led to higher prices without improving quality or access to care. Larger health systems gain a stronger negotiating position vis-à-vis insurance companies in wider regions. An example is the Chicago merger, which could allow an acquisition but prohibit mergers between direct competitors in cardiology. Federal agencies recently revoked three health-care antitrust rulings and plan to review mergers more strictly on a case-by-case basis. This approach supports vigorous antitrust enforcement in the healthcare industry.