New legislation proposed by Congressional democrats aims to limit the ability of large insurance companies to acquire independently owned clinics and health practices. The Patients Over Profits (POP) Act specifically singles out UnitedHealth Group and its Optum subsidiary.
The act is led by senators Jeff Merkley and Elizabeth Warren, along with representatives Val Hoyle, Pat Ryan and Pramila Jayapal. Sen. Edward Markey and Rep. Alexandria Ocasio-Cortez co-sponsored the bill.
The POP Act says the consolidation of clinics and health practices by large insurance companies has led to decreased patient access, increased costs and lower quality of care, all in the name of higher profits for corporations. Provider groups, surgery centers, pharmacies and software have all been looped into this trend of vertical integration, creating monopolistic entities that control virtually all aspects of health care delivery, according to the legislation.
Supporting documents point to Optum’s purchase of Corvallis Clinic and Oregon Medical Group, which led to staff departures and reduced access to care for thousands of patients. Optum has made $31 billion in acquisitions in two years, white parent UnitedHealth acquired more than 100 surgery centers in 2024. The insurer contracts with 10% of all US physicians and owns 750 clinical subsidiaries, the bill’s supporters said.
Among the concerns about vertical integration raised by the bill’s supporters are the loss of local independent physician control, inflated prices and profit-driven practices, reduced clinical autonomy for doctors, conflicts of interest, lower wages for health care workers and possible denial of necessary treatments.
The POP Act outlines three core provisions, including preventing insurance companies and their subsidiaries from owning Medicare Part B or C providers, requiring insurance companies owning such providers to divest these assets, and banning the Health and Human Services Secretary from contracting with Medicare Advantage organizations that own Part B and C providers in an effort to disincentivize vertical integration by making it less profitable. Failure to comply with divestiture requirements would trigger civil action by the Federal Trade Commission, state attorneys general, the HHS Inspector General and the DOJ antitrust division.
Commenting in support of the legislation, Rep. Ryan called for the breakup of UnitedHealth.
“We need to bring back the local, independent doctors offices and pharmacies whose sole priority is caring for you and your family – not United’s quarterly earnings report,” said Ryan. “We need to bring down the price of your care, and make sure you’re not billed a dime more than you owe. We need to build a system where patients can quickly access quality care right here in the community, without facing endless roadblocks, and health care workers get the fair wages they deserve for their heroic work. Breaking up UnitedHealth’s insurance and physician businesses is the first step toward building something better, where every American is able to get the care they deserve at a price they can afford.”
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