Senate and House lawmakers have introduced a bill that would bar health insurers from buying independently owned clinics and require existing conglomerates to divest their provider businesses.
The Patients Over Profits Act would:
- Prohibit insurance companies or their subsidiaries from owning Medicare Parts B and C providers
- Require insurers and their subsidiaries who also own Parts B or C providers to divest, and if they do not, a civil lawsuit can be brought by the Federal Trade Commission, state attorneys general, HHS inspector general or the Justice Department’s antitrust division.
- Bars the HHS secretary from contracting with a Medicare Advantage organization that also owns a Part B or C provider.
The lawmakers cited the example of UnitedHealth Group and its Optum subsidiary, noting that the company acquired full or partial ownership of more than 100 surgery centers in 2024.
“When this kind of vertical integration occurs, patients and providers lose,” the sponsors said in a summary of the legislation. “That’s because these acquisitions threaten equitable access to care, raise costs, and reduce physicians’ clinical autonomy. It is also a conflict of interest because insurance companies like Optum can steer patients to their own providers and subsidiaries, potentially to increase profits, rather than focusing on medical necessity.”
The legislation is sponsored by Democratic Sens. Elizabeth Warren of Massachusetts and Jeff Merkley of Oregon, and Reps. Pat Ryan of New York and Pramila Jayapal of Washington.
“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,” Mr. Ryan said in a Sept. 17 news release.
UnitedHealth did not immediately respond to a message seeking comment.
Read the full text of the legislation here.
