Billions of dollars in Covid aid cushioned financial losses caused by the pandemic at some of the nation's largest hospital chains. But those bailouts also helped sustain the big chains' spending sprees as they expanded even more by scooping up weakened competitors and doctors' practices. More consolidation by several major hospital systems enhanced their market prowess in many regions of the United States, even as rural hospitals and underserved communities were overwhelmed with Covid patients and struggled to stay afloat. The buying spree is likely to prompt further debate and scrutiny of the Provider Relief Fund, a package of $178 billion in congressional aid that drew sharp criticism early on for allocating so much to the wealthiest hospital systems, and that had no limits on mergers and acquisitions. "It was not the intent to be a capital infusion to the largest and most financially stable providers to allow them to simply grow their slice of market share," said Representative Katie Porter. Major employers had warned Congress that bailouts to the health care industry could spur even more consolidation and lead to price-gouging in medical care. Some of the nation's most powerful hospital chains, experts cautioned, would take advantage of the crisis, resulting in even higher prices for medical care. The big well-resourced hospitals had, frankly, a banner year, and they are now in a position to swallow up these smaller, more vulnerable groups.