A new bill introduced in both chambers of Congress aims to prevent health insurance companies and their subsidiaries from owning clinics that provide Medicare services. The legislation, titled the “Patients Over Profits Act,” was drafted in response to growing concerns that health care corporations are acquiring independent clinics, a practice that lawmakers say prioritizes corporate earnings above patient care.
The proposed bill would also compel health carriers and their subsidiaries to relinquish ownership of any existing Medicare Part B or Part C providers. Failure to comply could lead to civil action from multiple federal and state entities, including the Federal Trade Commission, state attorneys general, and the Department of Health and Human Services’ inspector general.
In a move designed to discourage future acquisitions, the bill would also bar HHS from entering into contracts with Medicare Advantage organizations that own Medicare Part B or C providers, thereby requiring them to forfeit potential profits from those plans.
Sponsors of the bill include Democratic Reps. Val Hoyle of Oregon, Pat Ryan of New York, and Pramila Jayapal of Washington, along with Democratic Sens. Jeff Merkley of Oregon and Elizabeth Warren of Massachusetts.
“When you get sick, you should be able to receive the treatment and care that you need,” Hoyle said in a statement. “For too long, Wall Street has made that harder by buying up local clinics and care facilities and then focusing on turning a profit instead of delivering care.”
Lawmakers cited provider consolidation as a widespread issue, pointing to UnitedHealth Group’s Optum subsidiary, which spent $31 billion in a two-year span on acquisitions ranging from physical practices to surgical centers, according to BestWire. The bill’s summary noted that UnitedHealth, through its various entities, employs or contracts with around 10% of the nation’s physician workforce and owns more than 750 clinic subsidiaries nationwide.
This trend, legislators argue, hinders pricing transparency and blurs the distinction between a provider and an insurer.
“Your doctor’s office should be in the business of making sure you get the best possible care, not functioning as a profit center for billionaire health care corporations,” Merkley stated. He highlighted an instance in Oregon where a clinic reportedly lost dozens of physicians and dismissed thousands of patients after being acquired by Optum.
America’s Health Insurance Plans, representing the industry, countered that Medicare Advantage supports over 35 million Americans and said “health plans continue to advance reforms that will strengthen the program for the members they serve.”
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