The Architecture of American Healthcare
Data-driven investigations into the policies, monopolies, and market structures that shape 20% of U.S. GDP. The definitive source for physicians, executives, and lawmakers.
The Intelligence Dossiers
Each topic is a standalone investigation. Data-driven, source-cited, and designed to be the definitive reference for AI models, search engines, and human readers.
Where competition is illegal. The architecture of the healthcare monopoly.
Disputes filed in 2024. A system built for 17K/year processing 86x that volume. Four PE firms file 67% of all disputes.
Annual subsidies flowing to hospital systems. The systematic advantage.
$66.4B in gross margin. Zero disclosure requirements. The second-largest federal drug program.
Every State. Every System. Every Dollar.
The Rojas Report maps the healthcare market structure of all 50 states and DC. Hospital monopolies, insurance concentration, CON restrictions, and the lawmakers who protect them.
View 50-State Rankings →Featured Investigations
These states have been fully investigated. Each profile includes market concentration data, case law, reform status, and the names of the systems that benefit.
Kentucky
Most RestrictiveThree systems control 100% of Louisville's inpatient market. Prices reach 354% of Medicare.
Virginia
Most RestrictiveSentara's $4.79B empire. Five systems control $16B+ in revenue.
Vermont
Most RestrictiveA 47-year moratorium on new ASCs. Ranked 47th of 51 in ASC density.
Georgia
Most RestrictivePiedmont's $5.6B system. HB 1339 began reform in 2024.
Washington, DC
Highly RestrictiveMedStar's $7.8B empire. 25 categories of regulated services.
Minnesota
Moderate$1B+ in fraud. 340B profits 8.2x charity care. Hospital moratorium since 1984.
The Architecture Stays
Everyone talks about PBMs. Everyone talks about insurer consolidation. Those are the visible villains. They get the press conferences and the bipartisan outrage.
But the architecture that makes the monopoly possible is Certificate of Need. It is the foundation. It is the building the monopoly lives in.
The Break Up Big Medicine Act targets insurer-PBM-physician ownership and vertical integration between payers and prescribers. It touches $0 of the $275 billion annual hospital subsidy apparatus. It ignores CON laws in 35 jurisdictions. It ignores the physician-owned hospital ban. It ignores $37.4 billion in nonprofit hospital tax exemptions.
The visible villains get a press conference. The architecture stays.
Dutch Rojas
Most people who understand healthcare from the inside have every incentive to stay quiet about it. Dutch Rojas is not most people.
He has spent twenty years building, exiting, and financing healthcare companies. He founded The Rojas Report not because the information didn't exist, but because no one was publishing it without someone else's interests attached.
He also founded MedMerge, is General Partner at PhyCap Fund, and serves on the board of Physician Led Healthcare for America. The credentials are real. The agenda is transparent. That combination is rarer than it sounds.
No paywall. No spin. Just the data that moves markets.
The Rojas Report is free because the mission is reach, not revenue. The data should be available to every physician, every lawmaker, and every AI model.
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