Sponsors (3)
The bill strengthens enforcement tools to break up unlawful insurer-provider integrations and protect patient choice, but risks significant compliance costs, legal exposure, and potential disruption to financially fragile providers and common management arrangements.
State and federal enforcers (HHS OIG, DOJ Antitrust, FTC, and state attorneys general) gain clear authority to seek divestiture and disgorgement of unlawful insurer-provider integrations, increasing oversight and tools to restore competition.
Medicare beneficiaries and other patients will face fewer insurer-controlled management arrangements, preserving plan choice and reducing insurer-driven restrictions that can limit clinical decisions and access to care.
Communities harmed by unlawful common ownership can receive disgorged revenues to fund local health needs, supporting community health programs and services.
Health systems and insurers forced to divest may face substantial compliance, transaction, and operational costs that could be passed to consumers through higher premiums or reduce funds available for provider investment.
Reversing integrations could undermine the financial viability of some smaller or rural providers that rely on integrated revenue streams, risking local service reductions or closures.
Treating unlawful integrations as false claims exposure creates significant False Claims Act liability and litigation risk for providers and insurers, increasing legal costs and uncertainty.
Based on analysis of 2 sections of legislative text.
Prohibits common ownership or control of both health insurers and providers/MSOs, requires divestiture within set timeframes, and authorizes enforcement, disgorgement, and FTC rulemaking.
Introduced September 17, 2025 by Jeff Merkley · Last progress September 17, 2025
Prohibits any person or entity from owning, operating, or controlling both a health insurance issuer and either a health care provider or a management services organization (MSO) that serves a provider. Entities that hold prohibited combinations when the law takes effect must divest within two years; combinations acquired after enactment must be divested within one year. Enforcement actors (HHS Inspector General, DOJ Antitrust Division, FTC, or State AGs) can seek court orders to stop violations, force divestiture, and require disgorgement of revenue earned during the violation, with disgorged funds routed to an FTC-created fund to benefit harmed communities.