[{"_1":2,"_123":-5,"_124":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,75,87,99,111],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":72,"_74":72},"mediaId",6141967,"mediaKeyId","5569391-a171f17044a44f34f44ad2664fa9e9b2","parentId",5569391,"title","Former insurer executive warns vertical integration and MLR loopholes let insurers shift profits into owned providers","audioSeconds",163,"startMs",3260000,"endMs",3423000,"viewUrl","/Search/View?dp=1&key=5569391-a171f17044a44f34f44ad2664fa9e9b2&start=3260&end=3423","thumbnailUrl","https://assets.pipeline.soar.com/5569391-a171f17044a44f34f44ad2664fa9e9b2/thumbnail_3260000.jpg","articleUrl","/articles/6141967/Former-insurer-executive-warns-vertical-integration-and-MLR-loopholes-let-insurers-shift-profits-into-owned-providers","mediaUrl","https://secure.pipeline.soar.com/6141967-aad714cf40e9539e5c6222030da1c0a9/orig.mp4?Expires=1770487461&Signature=ZmPDtiG~opm6SLbEfDMqBNTta6qMw8LrdGVIpbQZNNxbdPYNwTwUqSAMrh4OXnenw6DLC9No1Olce7trOjlg1~nTnDW~RPCu22U2JyZs1QXc~3M4Y6WCHdONkZYRQZfR45UU~pgAQsB~cHzu1c9FL40r8WU-EdgcELDSmSiTidGJpRF6En6u~RXPocCtmWesCqKrbXxfTjD6dRETPYaXXxP184CL5I1bRrFtGYOMwpghonUQ9c2oTtTLQQKFB-ZZ5Q81eu40YEWe0-qg0DDitiaZxpj1BmCHOzCipEdcbkbbm-6OR08b2k~1ae1jTh-lfgJdF1EuKqdyAPpFexLMwQ__&Key-Pair-Id=KUT5TJCACFTXG","author","U.S. Senate Committee on Health, Education, Labor, and Pensions","date","2025-07-31T00:00:00Z","article","At a Senate HELP Committee hearing, Wendell Potter, president of the Center for Health and Democracy and a former insurance executive, testified that insurers' vertical integration and accounting workarounds are contributing to consolidation, higher prices and reduced patient choice.

Why it matters: Witnesses argued that insurer‑owned provider entities and insurer‑owned PBMs allow companies to record intercompany transfers as medical spending under the Affordable Care Act's medical loss ratio (MLR) rules, enabling higher apparent medical spending while moving funds to corporate affiliates that contribute to profits.

Potter described UnitedHealth Group's strategy: \"United has almost 3,000 subsidiaries, most involved in healthcare delivery... UnitedHealth's intercompany transfers now account for 31% of its total revenues,\" testimony said. He added that the company now derives \"more than 75% of its health insurance revenue from public programs like Medicare Advantage, Medicaid, and VA contracts,\" and that insurers have used ownership of provider entities to satisfy MLR requirements while increasing consolidated profits.

Panelists said this vertical integration gives large insurers influence across the care pathway — from online provider discovery to employed physicians, PBMs and home care — and can weaken independent providers and reduce competition. Potter urged Congress to close MLR loopholes, require full transparency on ownership and acquisitions, restrict insurer ownership of physician practices and phase out insurer‑owned PBMs in public programs.

Witnesses suggested policy tools including tighter MLR enforcement, public reporting of affiliated transactions, stronger antitrust scrutiny, and consideration of global budgets (citing Maryland as a model). Senators asked the committee and regulators to examine whether public dollars (Medicare Advantage, Medicaid contracts) are disproportionately fueling insurer profits rather than patient care.

The hearing included calls for greater transparency and legislative fixes to ensure that regulatory safeguards achieve intended protections for consumers and taxpayers.","mediaType","Video","parentTitle","Making Health Care Affordable: Solutions to Lower Costs and Empower Patients","oneSentenceSummary","At a Senate HELP Committee hearing, Wendell Potter, president of the Center for Health and Democracy and a former insurance executive, testified that insurers' vertical integration and accounting workarounds are contributing to consolidation, higher prices and reduced patient choice.","taxTitle","Health, Education, Labor, and Pensions: Senate Committee, Standing Committees - House & Senate, Congressional Hearings Compilation, Legislative, Federal","taxId",1995,"location","","headline","shortSummary",{"_33":76,"_35":36,"_37":38,"_39":77,"_41":78,"_43":79,"_45":80,"_47":81,"_49":82,"_51":83,"_53":84,"_55":56,"_57":58,"_59":85,"_61":62,"_63":64,"_65":86,"_67":68,"_69":70,"_71":72,"_73":72,"_74":72},6141972,"Committee examines 340B discounts and whether savings reach patients or raise employer costs",3884,1165000,5049000,"/Search/View?dp=1&key=5569391-a171f17044a44f34f44ad2664fa9e9b2&start=1165&end=5049","https://assets.pipeline.soar.com/5569391-a171f17044a44f34f44ad2664fa9e9b2/thumbnail_1165000.jpg","/articles/6141972/Committee-examines-340B-discounts-and-whether-savings-reach-patients-or-raise-employer-costs","https://secure.pipeline.soar.com/6141972-52a1f152ab34dc11bed6ae7a2a7aaa04/orig.mp4?Expires=1770487461&Signature=ZEos-vzFe4XdAesXQIEfiex4~1ER3IYLoQ433ekKn-YxdPI3ilUzGWvmYBl31P7deXs~rU6oW4LYWRXLPkpuT1INEQkX2EcRFxjabSSkvfx8yGdGcpSoV8Ut3WxuFzIINKE72AZJEudDRcoo5YOCceFQeu8Oj0qyUoQTx74i1aDeZ0N9MDUsJeqyOx9ovaT4xko1FTjBclWyfdPOjLcKemzmIPA~5Hd4xLAoKGQubIBjhkCWZfYAr-Au5WtGhk~tO2QD0SKpEq2VKqq19j7-z7-YKbX7kQzvc2JBV9jiROMqXZGfpk8447J2L5oHnI4Sm6-NPDxk2Yx4M1PiQr1zLA__&Key-Pair-Id=KUT5TJCACFTXG","At the Senate HELP hearing, senators and witnesses raised concerns that the 340B drug discount program, created to help hospitals care for low‑income patients, may have unintended effects on commercial prices and employer costs unless the program is more transparent or better targeted.

Why it matters: Several witnesses told the committee that discounts captured by hospitals do not always flow to patients and that those discounts can create price incentives that affect employers and private insurers.

Chairman Cassidy and witnesses cited a recent National Pharmaceutical Council (NPC) study and internal staff work: the NPC estimate discussed at the hearing found that 340B \"may make employer sponsored insurance more expensive, costing workers an estimated $4,500,000,000 from 2017 to 2023.\" Witnesses said that hospitals can buy drugs at steep discounts but then bill insurers or patients at higher prices, creating an arbitrage that can push prices in the commercial market upward.

Panelists suggested several policy responses. AEI and other witnesses proposed tying 340B benefits more precisely to care delivered to low‑income or uninsured patients — for example, by requiring hospitals receiving discounts to report how the savings are used or by tying subsidies to the number of patients served. Dr. Brian Miller suggested an alternative: give hospitals explicit funds (a flat user fee or tax) to support uncompensated care rather than leaving discounts tied to list prices and downstream billing arbitrage.

Senators asked staff to study the program's transparency and potential legislative fixes. Panelists emphasized that 340B policy choices interact with larger market incentives and that Congress should consider targeted reforms — such as reporting requirements, audits, or a different funding mechanism — to ensure discounts benefit the intended patients rather than widening price differences in the commercial market.","Senators and witnesses questioned whether the 340B drug discount program achieves its goal of making care affordable for low‑income patients, citing a study attributing multi‑billion dollar costs to employer‑sponsored insurance and recommending greater transparency or alternative funding mechanisms.",{"_33":88,"_35":36,"_37":38,"_39":89,"_41":90,"_43":91,"_45":92,"_47":93,"_49":94,"_51":95,"_53":96,"_55":56,"_57":58,"_59":97,"_61":62,"_63":64,"_65":98,"_67":68,"_69":70,"_71":72,"_73":72,"_74":72},6141977,"Senators, experts press PBM reforms and ‘delinking’ proposals to lower drug costs",1709,2716000,4425000,"/Search/View?dp=1&key=5569391-a171f17044a44f34f44ad2664fa9e9b2&start=2716&end=4425","https://assets.pipeline.soar.com/5569391-a171f17044a44f34f44ad2664fa9e9b2/thumbnail_2716000.jpg","/articles/6141977/Senators-experts-press-PBM-reforms-and-delinking-proposals-to-lower-drug-costs","https://secure.pipeline.soar.com/6141977-30ec33077e6cc2d2a4529cbb82025e15/orig.mp4?Expires=1770487461&Signature=DPnqxd0jV7qISgCgqswqJ1NVtXFJHrzI7q9qNdIn6YXNbHOKTXpdFsM~g~KMOCOnra3JEbffXX5P42j~yAMuaFzY3EU6zIVr1iV6bmH48Qqe8r-P~SNChYHcVtWfj2qPcu59RjNtaCJFv8Hrg1r3UbLb3VwKI1DbwwCvd~tEdHBLOUsNzgs6IKhgY9D27oF9BX1WjPoKbkJa3lSnIRRtJw9TlCy3krlJ2wP6BNUcgHzZA95n4ClDVjH61OyZYAI2bSxAMKImrER4b-ttmfUoRLTvzR473AE7rRn~aiZftuQxGuXpXzrCVcI9DbFXqGjoP8f0w38xehzr4UHrV2ixaw__&Key-Pair-Id=KUT5TJCACFTXG","At a Senate HELP Committee hearing on health‑care affordability, lawmakers and witnesses focused on pharmacy benefit managers (PBMs), arguing that opaque rebate and fee arrangements raise drug prices and that structural reforms are needed so employers and patients benefit from negotiated discounts.

Why it matters: PBMs mediate most prescription drug purchases for insurers and employers; testimony at the hearing said employers and plan sponsors lack sufficient information to evaluate PBM contracts and that dominant PBMs contribute to consolidation that can raise costs.

Witnesses described how PBM practices can obscure true transaction prices and patient cost sharing. \"Plan sponsors and employers don't always have full insight into how rebates work, what the fee schedule looks like,\" said Dr. Brian Miller, a hospital physician and MedPAC commissioner. Another witness noted that list prices remain high while net paid prices can be far lower: \"It has become commonplace now for drugs to have 70% rebates,\" an AEI economist testified, urging alignment of patient cost sharing with net prices.

Several senators referenced a bipartisan bill called \"delinking\" (sponsored in the hearing discussion by Senator Marshall and Senator Kane) that would separate PBM compensation from a drug's list price so that PBMs are not paid a percentage that rises with the list price. Wendell Potter, president of the Center for Health and Democracy and a former insurer executive, endorsed delinking and said the practice incentivizes higher list prices and leads to middlemen extracting value from the supply chain.

Panelists and senators also discussed enforcement and competition tools: retrospective merger review of PBM consolidations by the Federal Trade Commission, clearer ERISA fiduciary responsibilities for PBMs and plan sponsors, and potential statutory limits on insurer ownership of PBMs. Dr. Miller urged the FTC to conduct retrospective merger review: \"The FTC approved a lot of PBM mergers thinking that they would decrease price and not result in monopsony power... the FTC should do a retrospective merger review.\"

Witnesses said improved transparency for plan sponsors — access to claims, detailed fee schedules and standardized reporting — would allow employers covering workers to compare PBMs and steer business to lower‑cost, higher‑value vendors.

Senators and witnesses agreed that PBM reform is not a sole solution to drug pricing, but that it is a practical, bipartisan policy area with specific legislative options that could reduce costs for employers, patients and taxpayers.","Witnesses and senators at the HELP hearing urged transparency and structural reforms for pharmacy benefit managers, including proposals to delink PBM compensation from list prices, retrospective merger review and stronger fiduciary rules for plan sponsors.",{"_33":100,"_35":36,"_37":38,"_39":101,"_41":102,"_43":103,"_45":104,"_47":105,"_49":106,"_51":107,"_53":108,"_55":56,"_57":58,"_59":109,"_61":62,"_63":64,"_65":110,"_67":68,"_69":70,"_71":72,"_73":72,"_74":72},6141982,"Senate hearing presses for stronger hospital price transparency and employer access to claims",3498,1846000,5344000,"/Search/View?dp=1&key=5569391-a171f17044a44f34f44ad2664fa9e9b2&start=1846&end=5344","https://assets.pipeline.soar.com/5569391-a171f17044a44f34f44ad2664fa9e9b2/thumbnail_1846000.jpg","/articles/6141982/Senate-hearing-presses-for-stronger-hospital-price-transparency-and-employer-access-to-claims","https://secure.pipeline.soar.com/6141982-9fddf2500d50bc4bbb35714c408e6e51/orig.mp4?Expires=1770487461&Signature=V-4MJ1POxe7FYzELnx0DZys3RRyUnkdRjI4N0bgnv11ml3rDVCsqE7XFi0cjcLcqgrIEZCg7QNKrz48DRxaW5IKTf-jau0o6iItxpMZbk9UUEuKSiOdos8JChhLdXW4tgft89GuAMfVUWybCPCKpCMZY9dv7L9jyzZQVwuLj8U-ksq3-DzgCM9vipQj8PGOBOjoucDA~P~dgVcazEFgb5cYT~kfrRCFxh2k-wNYU9-Twwddd4-qvP6fh5R~455J83cjjwH3X5M9G3icGrbTHO5~TIEgSILaBEfFqkfrjhfvddgQRfaeSMr1A9oORNu9-cYpPrffxMHzlcTL8VxGdkQ__&Key-Pair-Id=KUT5TJCACFTXG","At a Senate Health, Education, Labor and Pensions hearing on health‑care affordability, senators and witnesses called for stronger enforcement of hospital price transparency rules and for employers to be given usable access to claims data so they can control costs for the more than 160,000,000 Americans covered by employer‑sponsored insurance. \"Transparency is not a talking point. It is absolutely a prerequisite to affordability, competition, and accountability,\" testified Chris Deacon, principal and founder of Verson Consulting.

Why it matters: Employers that pay premiums on workers' behalf cannot reliably steward those dollars if vendors and carriers withhold negotiated prices or deny access to claims. That opacity, witnesses said, undermines employers' ability to direct patients to lower‑cost providers and keeps patients from seeing facility fees until after care.

Witnesses and senators described the 2021 hospital price transparency rule as a first step but said compliance and usefulness remain insufficient. Dr. Brian Miller, a hospitalist and associate professor of medicine at Johns Hopkins, said the most recent Office of Inspector General audit found low compliance: \"37 out of 100 hospitals complied with the 2 major components of the rule. Frankly, that's in my view a crime against patients.\" He urged Congress to codify transparency, routinely audit large health systems (with special attention to tax‑exempt institutions), and impose penalties and public naming of noncompliant hospitals.

Testimony and committee discussion focused on two practical transparency fixes. First, witnesses urged that hospitals and insurers post standardized, machine‑readable files (MRFs) that reliably show negotiated and out‑of‑pocket prices and that employers be given technical access to analyze those files. Deacon described machine‑readable files as the starting point for employers and their vendors to identify price variation and decide whether to include lower‑cost providers in their networks.

Second, senators and witnesses singled out hospital outpatient department (HOPD) or \"facility\" fees — extra charges tacked on when a clinic is acquired by a hospital or was designated an HOPD. Miller said patients commonly pay roughly 70% more at HOPD sites and offered a typical facility fee range: \"a couple $100.\" He urged clearer disclosure in electronic health records and provider billing so clinicians and patients can discuss cost at the point of care.

Several senators — including Marshall and Hickenlooper — highlighted the bipartisan Patients Deserve Price Tags Act, a bill to codify and expand price posting requirements so pricing is machine readable and standardized. Supporters said the measure would help self‑insured employers and other purchasers exert market pressure. Senator Marshall asked whether better price information could produce large premium savings; Deacon replied employers that used price data have achieved sizable savings and that some employers have realized premium reductions in the 30–40% range after reconfiguring networks and steering volume.

Committee members asked regulators to pair transparency rules with enforcement, audits (CMS and OIG), and consumer‑facing improvements (ONC/EHR integration) so prices appear in clinician workflows. The witnesses also urged the Federal Trade Commission to review marketing and HOPD practices that make prices opaque.

The hearing closed with senators and witnesses urging immediate, enforceable steps on price transparency while recognizing that transparency alone will not solve all affordability challenges — for instance, in markets with only one hospital where choice is limited. The committee invited follow‑up questions and requested written materials for additional review.","At a Senate HELP Committee hearing, witnesses and senators urged stronger enforcement of hospital price transparency rules, machine‑readable price files and employer access to claims data, saying current opacity prevents employers from using purchasing power and leaves patients unaware of facility fees.",{"_33":112,"_35":36,"_37":38,"_39":113,"_41":114,"_43":115,"_45":116,"_47":117,"_49":118,"_51":119,"_53":120,"_55":56,"_57":58,"_59":121,"_61":62,"_63":64,"_65":122,"_67":68,"_69":70,"_71":72,"_73":72,"_74":72},6141962,"Sanders and panelists clash with colleagues over Medicaid cuts, coverage and Medicare for All",421,1329000,1750000,"/Search/View?dp=1&key=5569391-a171f17044a44f34f44ad2664fa9e9b2&start=1329&end=1750","https://assets.pipeline.soar.com/5569391-a171f17044a44f34f44ad2664fa9e9b2/thumbnail_1329000.jpg","/articles/6141962/Sanders-and-panelists-clash-with-colleagues-over-Medicaid-cuts-coverage-and-Medicare-for-All","https://secure.pipeline.soar.com/6141962-55c1f16c352b53479f016f190d2ebe16/orig.mp4?Expires=1770487461&Signature=ZWFogjoDdSMe6CrspLQQDV8DNOqP412uqzyumxriQSOlfThypGpFVCcj1Ubu9P6oB4p3zyYPpxKt0XsHD~TlICC3hLTbTDCIUoZBe5uOMXnY25TBZYv~Yz3TH-WuqhjY6eieRLcthvqKg0dAGVhbYj-rsIgDBPU30dXzxW3luHT4WuQw8I6GkEAIMrp~D5KQhafZbwiDcDzzryW1HpzUfuCnyGtPCkfwXPqvhycOv07aSyx~jcc89jyrLUP0hS8zxYb1g~ZdI~jMGjXxwwoHEzsKeNql4WQu1J-A2NRUdPLYElkrgzZsg5aBYJe3XvdKvEA2P5wbeY62y~9fORXf4g__&Key-Pair-Id=KUT5TJCACFTXG","Senator Sanders used his opening remarks at the Senate HELP Committee hearing to argue that the U.S. health‑care system is \"dysfunctional\" and to press for a national single‑payer approach, while other senators and witnesses emphasized targeted, bipartisan reforms like price transparency and PBM oversight.

Why it matters: Lawmakers debated whether the immediate priority should be to undo near‑term federal budget provisions that witnesses said will reduce coverage, or to pursue structural reforms such as Medicare for All to expand coverage and reduce costs over time.

Sanders called the system \"totally broken\" and said other wealthy countries provide universal coverage at far lower per‑person costs; he noted that a recent budget reconciliation bill and expiration of enhanced premium tax credits \"will cause over 15,000,000 people to lose the health insurance they have,\" a figure he attributed to the Congressional Budget Office. Sanders said he introduced Medicare for All and cited an estimate that the proposal could save the country hundreds of billions annually: \"The director of the CBO... estimated that the Medicare for all bill that I introduced would save the American people $650,000,000,000 a year,\" he said.

Other witnesses presented different diagnoses and remedies. Dr. Adam Gaffney, an intensive care physician and health services researcher, described harms from lack of coverage — including patients foregoing treatment and higher mortality risk — and said price transparency and PBM reforms are insufficient alone to protect people lacking coverage. He emphasized that tens of millions are uninsured or underinsured and that coverage expansions that reduce out‑of‑pocket costs — no co‑pays or deductibles — are central to making care affordable.

Other panelists urged more incremental or targeted policies: Bennett Bolita and Dr. Brian Miller highlighted practical steps employers and regulators can take to improve price transparency, reduce administrative waste and enable purchasers to steer patients to lower‑cost care. The committee's questioning reflected a range of views, with some senators urging immediate steps to shore up Medicaid and community health centers and others emphasizing the long‑term debate over the proper scope of public and private roles in the health‑care system.

The hearing underscored a central political divide: whether to pursue comprehensive public options like Medicare for All or to seek a suite of narrower, bipartisan reforms focused on transparency, competition and targeted program fixes. Senators requested follow‑up materials and placed several contested claims — including the estimates of coverage loss tied to recent budget actions — on the record for further review.","Senator Sanders and several witnesses warned that recent federal budget changes will cause millions to lose coverage and argued for broad reforms, including Medicare for All; other witnesses and senators emphasized transparency and targeted reforms instead of sweeping system replacement.","actionData","errors"]

Article not found

Former insurer executive warns vertical integration and MLR loopholes let insurers shift profits into owned providers

Committee examines 340B discounts and whether savings reach patients or raise employer costs

Senators, experts press PBM reforms and ‘delinking’ proposals to lower drug costs

Senate hearing presses for stronger hospital price transparency and employer access to claims

Sanders and panelists clash with colleagues over Medicaid cuts, coverage and Medicare for All