In a recent “Meet the Press” appearance, Sen. James Lankford, R-Okla., joined a growing number of Republicans who are speaking out against Obamacare. One of his lines of attack: that the Affordable Care Act fueled health care consolidation.

“What Democrats did 15 years ago was they radically changed all health care in America. They moved all physicians under hospitals. They changed all the reimbursement programs. They shifted everything in,” Lankford said Nov. 9.

This is one of a collection of Republican talking points related to the ACA that’s been regularly reprised, and there’s a reason for it.

Democrats have been promised a Senate vote this month on whether to extend the ACA’s enhanced subsidies, set to expire at year’s end. The debate, however, has given Republicans an opportunity to resurface old criticisms and reignite efforts to overhaul or even undo the ACA. One GOP argument is that the sweeping health law fueled industry consolidation, which has led to higher prices and pushed more doctors to sell their practices to hospitals or insurers.

But industry experts disagree about how much this market trend can be tied to the law known as Obamacare.

Like everything in health policy, it’s complicated.

“Most of us live in a different reality,” said Chip Kahn, president and CEO of the Federation of American Hospitals, which supports extending the enhanced tax credits. “Our health system has many challenges, and I can’t say the cost to individuals, to taxpayers, is not an issue. But to say having better coverage for more people made all these problems worse is really a stretch.”

First, some context. The ACA was passed by Congress in 2010, and most of its major provisions became effective in 2014.

Many health care mergers took place both before and after Obamacare became law, so it’s hard to quantify its effect.

From 1998 to 2017 — a nearly two-decade period that included the first three years of full ACA implementation — 1,573 hospital mergers took place. An additional 428 hospital and health system mergers were announced from 2018 to 2023, according to a 2024 brief by KFF, a health information nonprofit that includes KFF Health News.