Lexology November 10, 2025
For years, the conversation around health insurer consolidation and vertical integration has simmered through antitrust inquiries, oversight hearings, and policy papers. The Patients Over Profit Act (the “POP Act”)[i], introduced in both chambers of Congress this fall, marks a decisive shift. Rather than regulating insurer-provider integration, the POP Act proposes to ban it outright.
If passed, the POP Act would fundamentally reshape how Medicare dollars move through the U.S. healthcare system, not by adjusting incentives or introducing new reporting rules, but by redrawing the structural map itself. The POP Act draws a bright, enforceable line that prohibits common ownership or control between health insurers and physician or certain outpatient provider entities that bill Medicare Part B or participate in Medicare...
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