Oregon congressional Democrats aim to prohibit insurers from owning medical clinics

Democratic lawmakers are pushing a federal bill that would bar large health insurers from buying or owning medical clinics — a change that could reshape Oregon communities where UnitedHealth Group’s Optum has expanded in recent years.

The measure, called the Patients Over Profits Act, aims to crack down on conflicts of interest when the same company both pays for care and owns the places that provide it. Sponsors of the bill include Sens. Jeff Merkley of Oregon and Elizabeth Warren of Massachusetts, along with Rep. Val Hoyle of Oregon and other House members.

The bill would prohibit insurance companies and their subsidiaries from owning or controlling medical providers that bill Medicare, including Medicare Advantage plans. Where those ties already exist, companies would have to divest within set timelines.

The proposal would also prohibit federal contracts with Medicare Advantage insurers that own medical providers. Federal and state agencies, including antitrust enforcers, could take action if companies don’t comply.

The bill’s backers argue that when insurers also own clinics, patients may face fewer choices and doctors can feel pressured on referrals, as well as drive up costs over time. They say separating insurers from provider ownership would reduce incentives to steer patients to company-owned clinics and protect doctors’ independence.

“You shouldn’t be in the business of both providing insurance and then providing the health care itself,” Merkley said. “There’s a natural contradiction there that doesn’t serve any of us well.”

Merkley pointed to Optum, the physician and services arm of UnitedHealth Group, which has acquired practices in the state in recent years, including Oregon Medical Group in Eugene and, more recently, the Corvallis Clinic.

The Oregonian/OregonLive has chronicled the fallout from those changes, including physician departures and concerns about appointment access. Optum, at the time, said it was working to stabilize staffing and maintain care.

Those ownership questions drew even more attention after last year’s cyberattack on Change Healthcare, another UnitedHealth subsidiary that processes medical claims nationwide. The outage disrupted payments to clinics across the country and highlighted how problems inside a large, interconnected company can ripple through the system.

Congressional committees will decide whether to hold hearings or revise the bill. Even if it clears one chamber, the measure faces a difficult path in a closely divided Congress and heavy lobbying from insurers, provider groups and patient advocates.

The move comes amid a growing trend of health care consolidation. Oregon launched its Health Care Market Oversight program in 2021 to regulate health care consolidation, and state lawmakers recently passed some of the nation’s strictest regulations on corporate ownership of doctor’s offices and medical clinics.

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