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Congress·In Committee·6 months ago

House Bill Would Ban Insurers From Owning Medicare Provider Groups Under POP Act

Also known as: POP Act

Legislative Progress

✓ Filed
Review
House
Senate
President

Impacts

Mixed Impacts(5)
Medicare
Neutral
Retiree
Neutral
Chronic Illness
Neutral
Disability Benefits
Neutral
Small Business Owner
Neutral

Key Points

  • Would ban one company (or investor) from owning both a health insurance company and certain Medicare-paid health care providers at the same time.
  • Companies already set up this way would have to sell off either the insurance side or the provider/management side within 2 years; new deals would have 1 year.
  • Enforcement could come from the Federal Trade Commission, Justice Department antitrust office, the Health Department watchdog, or state attorneys general, through civil lawsuits.
  • If a company violates the rule, a court could order it to stop, sell assets, and give back money earned during the violation; returned money would be used to help the harmed community.
  • For Medicare Advantage and Medicare drug plans, the government could stop contracting with plans tied to this kind of shared ownership starting with plan years beginning on or after Jan. 1, 2026. Taxes or premiums are not directly changed in the bill.
HealthcareMedicare MedicaidConsumer Protection

Milestones

2 milestones2 actions
Sep 17, 2025House

Referred to the Committee on the Judiciary, and in addition to the Committees on Energy and Commerce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Sep 17, 2025

Introduced in House

What Happens Next

Projected impacts based on AI analysis

After the bill is enacted

FTC writes rules explaining how the ownership ban and reporting work

The details that determine who must sell what, and what paperwork is required, would become clearer. Companies and medical groups would start compliance planning based on these rules.

Before affected plan years after enactment (timing set by HHS)

Medicare Advantage organizations submit compliance certifications to HHS

Plans would have to prove they don’t have the banned ownership ties. If they can’t certify, they risk losing Medicare payments and contracts.

As violations are investigated after enactment

Enforcement lawsuits and possible court orders (stop conduct, sell assets, pay back revenue)

If regulators or state attorneys general sue and win, companies could be forced to split up and repay revenue earned during violations. Some of that money could later be directed back to local health needs.

Related News

5 articles
KLCC·6 months ago

Oregon Senator's bill aims to ban insurance-owned health practices

Senator Jeff Merkley and Rep. Val Hoyle introduced the Patients Over Profits Act to force insurers to divest ownership of medical practices. The bill aims to return clinics to physician or non-profit ownership, citing conflicts of interest when for-profit insurers own the providers they pay.

C=
Fierce Healthcare·6 months ago

Democrats introduce bill to bar payers from owning certain clinics

The Patients Over Profits Act would bar large insurers and their subsidiaries from owning Medicare Part B or C providers. The bill specifically targets vertical integration seen in companies like UnitedHealth's Optum, requiring existing conglomerates to divest or face civil enforcement.

C=
Becker's Payer Issues·6 months ago

Lawmakers debut bill to bar insurers from buying medical clinics

A new bill would prohibit insurance companies from owning Medicare Parts B and C providers and bar the HHS secretary from contracting with Medicare Advantage organizations that maintain such ownership. The legislation was introduced by Sens. Elizabeth Warren and Jeff Merkley.

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Source Information

Document Type

Congressional Bill

Official Title

POP Act

Bill NumberHR 5433
Congress119th Congress
ChamberHouse of Representatives
Latest ActionReferred to the Committee on the Judiciary, and in addition to the Committees on Energy and Commerce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Sponsor

Cosponsors

(5)
D: 5

Analysis generated by AI. While we strive for accuracy, this should not be considered legal or professional advice. Always verify information with official government sources.