Sponsors (3)
Official title: 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 Jeff Merkley · Last progress September 17, 2025
The bill strengthens enforcement to curb anticompetitive common ownership and reduce conflicts of interest—potentially improving competition and patient care—but risks disrupting provider arrangements, reducing Medicare Advantage options, increasing legal and compliance costs, and exposing providers to serious liability.
State attorneys general, HHS OIG, DOJ Antitrust, and the FTC gain clearer authority to seek divestiture and injunctive relief against anticompetitive, common ownership arrangements, strengthening enforcement against vertical integration that harms markets.
Medicare beneficiaries and patients with chronic conditions face fewer conflicts of interest because Medicare Advantage plans cannot be commonly owned with providers, reducing incentives to steer care to affiliated providers.
Patients (especially those with chronic conditions) may retain broader provider choice and avoid price increases because the bill helps preserve competition and limits vertical integration between payers and providers.
Hospitals, health systems, and their patients may face disruption to care if owners with pre-existing common ownership are forced to divest within two years, potentially causing sales, changes in management, or service interruptions.
Medicare beneficiaries could see fewer Medicare Advantage plan options if MA organizations lose contracts because of ownership ties, reducing beneficiary choice starting in 2026.
Applicable providers risk severe False Claims Act liability (including treble damages and penalties) if claims are treated as false or fraudulent due to violations, exposing providers to large legal and financial penalties.
Based on analysis of 2 sections of legislative text.
Prohibits common ownership of covered providers/MSOs and health insurers and requires divestiture with civil enforcement and disgorgement for violations.
Prohibits any person or entity from simultaneously owning, operating, or controlling (directly or indirectly) both an "applicable provider" (or an MSO that contracts with such a provider) and a health insurance issuer. Owners with existing common ownership must divest one side within two years of enactment; acquisitions after enactment require divestiture within one year. Federal and state antitrust and enforcement agencies can seek injunctions, divestiture orders, and disgorgement of revenue; disgorged funds are to be used for the health-care needs of the harmed community. The measure creates a new standalone civil prohibition on vertical integration between insurers and certain providers, expands reporting requirements to the FTC/DOJ regardless of Hart-Scott-Rodino thresholds, tolls divestiture clocks during Clayton Act waiting periods, and directs government review of the competitive and financial effects of divestitures.