These comments were submitted to the California Office of Health Care Affordability (OHCA) in advance of the Board’s meeting in Monterey County on August 28, 2024. The comments describe the data and research showing that Monterey County has among the highest hospital prices in the state and country. The letter discusses national research showing that health care market concentration, such as the high level of concentration seen in the Monterey hospital market, has been associated with high health care prices. The authors examine publicly available data on health care worker wages and uncompensated care costs in the region; any spending differences found do not appear significant enough to explain the large price differences. The letter also references research that finds little relationship between high commercial prices and hospitals’ share of Medicaid and Medicare patients. The authors discuss potential opportunities for OHCA to begin to address the health care affordability challenges in Monterey including considering a lower spending target for some or all hospitals in this region and increasing public understanding of the drivers of health care spending.

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