Sponsors (6)
Introduced September 17, 2025 by Val Hoyle · Last progress September 17, 2025
The bill strengthens enforcement and reduces insurer-provider affiliations to improve patient choice and direct funds to harmed communities, but it risks disrupting integrated care, imposing financial losses and compliance costs, and creating legal uncertainty for providers and owners.
Medicare Advantage enrollees and patients in affected communities will see clearer separation between payers and providers, reducing incentives for plans to steer care to affiliated providers and improving care choices and network access.
State governments, federal agencies, and taxpayers will have stronger enforcement tools because multiple agencies (DOJ Antitrust, FTC, HHS OIG, state AGs) oversee compliance, increasing the likelihood violations are detected and addressed.
Patients and local communities harmed by improper affiliations will receive targeted funds because disgorged revenues must be used to serve those communities' health needs, providing local healthcare support.
Hospitals, health systems, and residents of rural or underserved areas could lose access or see degraded integrated care because forced divestitures may reduce economies of scale or break beneficial integrated arrangements.
Owners required to divest will face large financial losses and operational disruption due to forced sales within 1–2 year deadlines.
Medicare Advantage organizations and beneficiaries could face higher administrative costs because compliance and enforcement requirements raise plan administrative burdens and potentially plan costs or premiums.
Based on analysis of 2 sections of legislative text.
Bans common ownership of a health insurer and a health-care provider/management services organization and requires divestiture with civil enforcement and disgorgement to help harmed communities.
Prohibits any person or entity from simultaneously owning, operating, or controlling both a health insurer and a health-care provider (or a management services organization that manages a provider). Owners who currently hold both must divest one interest within two years; any future acquisition that creates such a combination must be divested within one year. Federal and state enforcement agencies can seek orders to stop the conduct, force divestiture, and require repayment of revenue earned while the violation occurred, and recovered funds must be used to serve the harmed community.