Congress moves to break up insurer-provider mergers, forcing divestitures by 2026
H.R. 5433 — POP Act · Filed by Valerie Hoyle (D-OR) · 5 cosponsors · Introduced Sep 17, 2025 · Referred to committee
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What it does
This bill prohibits any company from simultaneously owning both a health insurance company and certain healthcare providers (doctors, clinics, etc.) that bill Medicare. Companies currently in violation have 2 years to divest one or the other; future acquisitions have 1 year. The bill empowers the FTC, DOJ, state attorneys general, and HHS to enforce the rule through lawsuits, requiring divestment and disgorgement of profits earned during the violation. Medicare Advantage and Part D plans are barred from contracting with organizations that violate the rule starting in 2026.
Why we flagged it
The bill's core mechanism is a structural prohibition on vertical integration between insurers and providers—a classic antitrust remedy designed to eliminate conflicts of interest in healthcare markets. It is not a price control, subsidy, or regulatory carve-out, but rather a forced separation of competing economic interests.
What the text implies
- Divestment may reduce operational synergies and increase administrative costs for affected entities, potentially raising premiums or reducing provider network efficiency in the short term.
- The rule applies only to Medicare-billing providers, leaving commercial insurance-provider integration untouched, creating a two-tier market where non-Medicare patients may still face steering incentives.
The full analysis lists 4 implications of this text.
Who stands to gain
Medicare beneficiaries (lower costs, reduced steering); Independent healthcare providers (reduced competition from integrated insurers); State attorneys general (enforcement authority and potential settlement revenue)