The vertical integration of independent physician practices into large, corporate entities, hospitals and health systems has been a dominant trend in healthcare over the last 20 years,
By January 2026, 82% of all practicing U.S. physicians were employed by hospitals or corporate entities, up from 52% at the start of 2018, according to an Avalere study sponsored by Physicians Advocacy Institute.
Lawmakers at both the state and federal levels have been pushing back on this behavior in recent years, with three active bills being deliberated by Congress that would strengthen antitrust enforcement in healthcare, according to a May 12 article published by the Center on Health Insurance Reforms at Georgetown University.
1. The Break Up Big Medicine Act was introduced by senators Elizabeth Warren, a Democrat from Massachusetts, and Josh Hawley, a Republican from Missouri, abd would prohibit common ownership between several entities with financial conflict of interest. This would include providers and insurers or pharmacy benefit managers, as well as between providers and drug or device wholesalers. The bill would ban vertical integration among these entities and require structural separation for entities that are already vertically integrated.
2. The Patients Over Profits Act was introduced by Representatives Pranuka Jayapal, a Democrat from Washington, Pat Ryan, a Democrat from New York, Val Hoyle, a Democrat from Oregon, and Sen. Jeff Merkely, a Democrat from Oregon, along with Ms. Warren. This bill would ban common ownership between payers or their subsidiaries and certain physicians or outpatient providers, except hospitals. Payers and their subsidiaries who already own these providers would be required to structurally separate. The bill would also prevent CMS from contracting with payers under Medicare Advantage if they also own these outpatient providers or entities.
3. The Competition and Antitrust Law Enforcement Reform Act was introduced by Sen. Amy Klobuchar, a Democrat from Minnesota, and would strengthen merger enforcement by creating an evaluation process for proposed deals based on their risk of harming competition. For mergers that do cross the risk threshold, the bill would shift the burden in merger review to companies by requiring them to demonstrate that proposed transactions are unlikely to materially reduce competition or create a monopoly or monopsony power. Monopsony can manifest as payers imposing low reimbursement rates on providers or hospitals depressing staff wages. The bill would also boost funding for antitrust agencies and expand their enforcement tools.
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