A group of congressional Democrats have submitted a bill to prevent large payers from buying up clinics.
The Patients Over Profits Act would bar large insurers and their subsidiaries from owning certain clinics participating in Medicare, in what a press release described as a move to “pad their own pockets and leave patients out in the cold.” The announcement specifically called out UnitedHealth’s Optum, which has bought up a string of clinics across the members' home states of Oregon, New York and Washington.
The bill was introduced by Sens. Jeff Merkley (Ore.) and Elizabeth Warren (Mass.), as well as Reps. Val Hoyle (Ore.), Pat Ryan (N.Y.) and Pramila Jayapal (Wash.). It is also co-sponsored by Sen. Edward Markey (Mass.) and Rep. Alexandria Ocasio-Cortez (N.Y.).
The lawmakers allege that such acquisitions threaten equitable access to care, drive up costs and limit doctors' clinical independence. They also suggest the acquisitions represent a conflict of interest, since insurers can steer patients to their own provider networks with the potential goal of juicing profits.
The bill would prevent insurers from owning Medicare Part B or C providers; require payers who already own them to divest or face civil actions; and prevent the HHS secretary from contracting with a Medicare Advantage plan that also owns a Medicare Part B or C provider.
“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 said in the press release. “The Patients Over Profits Act reins in these out-of-control consolidations, which are great for corporate greed and a bad deal for patients.”
Warren has previously pressed UnitedHealth Group on other matters, including reports that it is engaging in cost-cutting policies that put nursing home patients at risk. She is also among the lawmakers who have probed direct-to-consumer telehealth platforms that they believe may allow drugmakers to inappropriately influence doctors’ prescribing habits. She has also called on insurers and pharmacy benefit managers to divest any pharmacies they own, and introduced a bill to curb private equity’s negative impacts on patient care.
"Across the country, insurance companies are buying up doctors’ offices, driving up costs, and putting insurance company profits over patients. Our bill cracks down on greedy insurance companies' attempts to control doctors and squeeze patients for every cent,” Warren said.
UnitedHealth employs or contracts with over 90,000 doctors, or about 10% of the U.S. physician workforce. It also owns over 750 clinical subsidiaries nationwide. This consolidation has shifted the company’s profits and obscured transparency, according to a report from the Center for Health & Democracy cited in the announcement.
“Enough—it’s time to break up UnitedHealth and put you back in control of your own healthcare,” Ryan said. “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.”