Congress bans exclusive health contracts—but carves out huge loopholes

What it does

This bill bans health insurance plans and providers from using exclusive or restrictive contracts that prevent plans from steering patients to lower-cost or higher-quality providers, or from negotiating lower rates with competing providers. It carves out exceptions for HMOs with exclusive physician groups and 'value-based' networks (like ACOs and centers of excellence), allowing those arrangements to remain exclusive. The bill applies to group health plans, individual insurance, and self-insured plans under three federal statutes (PHSA, ERISA, IRC).

Why we flagged it

The bill's core function is to restrict exclusive contracting in health insurance and provider networks to increase price competition and patient steering. It is framed as an antitrust/competition measure, though the exceptions are broad enough to potentially undermine its stated purpose.

What the text implies

• The exceptions for 'value-based network arrangements' are defined by reference to agency guidance/rulemaking, not statute. This delegates the scope of the ban to regulators and creates uncertainty about which exclusive arrangements remain legal—potentially allowing insurers and providers to repackage existing exclusive contracts as 'value-based' to evade the prohibition.
• The bill does not define 'directing or steering' or specify what incentives are permissible. Insurers may argue that tiering, prior authorization, or narrow networks constitute legitimate 'network design' rather than prohibited steering, creating litigation risk and regulatory ambiguity.
• The 18-month implementation delay allows existing exclusive contracts to remain in force for 1.5 years post-enactment, giving large health systems and insurers time to restructure arrangements or lock in long-term exclusive deals before the ban takes effect.
• The bill applies only to 'agreements' that directly restrict steering or rate negotiation. Vertical integration (where a health system owns an insurance plan) may not be covered, allowing de facto exclusivity through common ownership rather than contract.
• The exceptions for HMOs and multi-specialty physician groups may entrench existing market consolidation, as large integrated health systems can claim they operate 'primarily through exclusive contracts with multi-specialty physician groups' and remain exempt from the ban.

Who it affects

The bill may increase price competition and patient choice by blocking exclusive contracts that lock plans into high-cost providers, potentially lowering premiums and out-of-pocket costs for consumers. However, the broad exceptions for 'value-based' networks and HMOs—which are defined vaguely and delegated to agency rulemaking—may swallow the rule, allowing the same restrictive arrangements to persist under a different label. The net effect on actual consumer costs and access depends entirely on

Who stands to gain

• smaller health systems and independent providers (may gain access to insurance networks)
• health insurance plans (may gain negotiating leverage and ability to steer to lower-cost providers)
• pharmacy benefit managers and third-party administrators (if they can offer competing networks)
• patients/consumers (if competition reduces premiums and out-of-pocket costs)

Named in the bill

HUM (Humana), UHS (Universal Health Services), MRK (Merck), ELV (Elevance Health), MRNA (Moderna), HHS (Department of Health and Human Services), DOL (Department of Labor), Treasury, PHSA (Public Health Service Act), ERISA (Employee Retirement Income Security Act), IRC (Internal Revenue Code), HMOs — and 3 more

Where it stands

5 cosponsors: 4 Republicans, 1 Democrats.

• Nov 21, 2025 — Introduced · Congress.gov: “Introduced in House”
• Nov 21, 2025 — Referred to House Committee on Ways and Means and House Committee on Education and Workforce · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

20 lobbying clients named this bill on 24 disclosure filings across 2 quarters, Dec 2025 to Jun 2026. Those filings disclosed $4,928,347 in lobbying spend. A filing names 10 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 97% of bills with at least one filing.

Jodey Arrington, the sponsor, reported $573,000 in PAC receipts in the 2026 cycle.

• Kaiser Foundation Health Plan Inc — $1,950,000 on 3 filings
• Blue Cross and Blue Shield Association — $990,000 on 1 filing
• Blood Cancer United (fka the Leukemia & Lymphoma Society) — $590,000 on 1 filing
• Blue Cross Blue Shield of Michigan — $276,347 on 1 filing
• American Benefits Council — $214,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.