Sponsors (6)
Official title: To prohibit health insurance issuers and certain health care providers under Medicare from being under common ownership, and for other purposes.
Introduced September 17, 2025 by Val Hoyle · Last progress September 17, 2025
The bill aims to protect patients and local communities by separating payers and providers and directing recovered funds to harmed areas, but does so at the risk of forcing disruptive divestitures, raising administrative costs, and possibly undermining integrated care arrangements that some communities rely on.
Medicare Advantage enrollees and patients in communities served by divested providers will face clearer separation between payers and providers, reducing insurer steering and likely improving care choices and network access.
Recovered/disgorged revenues must be directed to serve the harmed community's health needs, providing targeted funding for local healthcare services and programs.
Multiple-enforcement authority (DOJ Antitrust, FTC, HHS OIG, state AGs) increases oversight and the likelihood that unlawful insurer-provider conduct will be detected and remedied.
Hospitals and health systems — especially in rural or thin markets — could lose economies of scale or integrated care arrangements due to forced divestitures, risking reduced access to care and weakened financial viability.
Owners required to divest may incur large financial losses and operational disruption from forced sales on a 1–2 year timetable, harming small business owners and potentially local employers.
Compliance and enforcement requirements will raise administrative burdens and costs for Medicare Advantage organizations, which could translate into higher plan costs or reduced benefits for enrollees.
Based on analysis of 2 sections of legislative text.
Makes it illegal for one entity to own or control both a health care provider (or MSO) and a health insurer and requires divestiture within set timeframes, with civil enforcement and disgorgement remedies.
Makes it illegal for a single person or entity to simultaneously own or control both a health care provider (or a management services organization that runs a provider) and a health insurance issuer. Owners who currently hold both must divest one interest within a set time (two years for pre-enactment holdings; one year for post-enactment acquisitions). Federal and state enforcement agencies can seek orders to stop violations, force divestiture, and require disgorgement of revenues; disgorged funds must be used to serve the harmed community. The bill also directs federal agencies to review divestitures, tolls antitrust waiting periods, and requires FTC implementing rules to carry out the law.