POP Act
Sponsored By: Representative Hoyle (OR)
Introduced
Summary
Stops common ownership between health insurers and certain Medicare providers to limit conflicts of interest and anticompetitive behavior. This bill would bar a person from simultaneously owning an applicable provider or a management services organization that serves that provider and a health insurance issuer, and it creates divestment, enforcement, and rulemaking tools to separate those interests.
Show full summary
- Medicare Advantage enrollees: Would prevent Medicare Advantage (MA) organizations from contracting with or receiving payments if the insurer directly or indirectly owns or controls an applicable provider or MSO that serves that provider. The MA prohibition applies for plan years beginning on or after January 1, 2026.
- Providers and management services organizations: Entities found in violation would have to divest either the provider or the insurer. Deadlines are 2 years after enactment for existing acquisitions and 1 year after acquisition for future deals.
- Insurers, enforcement, and communities: The HHS Inspector General, the Department of Justice Antitrust Division, the Federal Trade Commission, or state attorneys general could seek injunctions, divestiture, and disgorgement. Disgorged revenues would be deposited into an FTC-created fund to meet harmed community health care needs.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 2 benefits, 0 costs, 1 mixed.
Ban on insurers owning Medicare providers
If enacted, this would bar the same person from owning or controlling both a health insurer and certain Medicare providers, or their management groups. It would cover direct or indirect control and include management services organizations with management contracts. “Applicable providers” would mean those paid under Medicare Part B or Medicare Advantage, but not hospitals, critical access hospitals, rural emergency hospitals, DMEPOS suppliers, or pharmacies. The FTC would have to issue rules to carry this out, and those rules could not weaken the ban.
Violators must sell and repay revenues
If enacted, anyone breaking the ownership ban would have to sell either the provider (or its management group) or the insurer. If the overlap existed before the law, they would have up to 2 years to sell; if acquired after, up to 1 year after the purchase. The clock would pause during any Clayton Act waiting period, and all sales would be reported to the FTC and DOJ for review. HHS’s Inspector General, DOJ Antitrust, the FTC, or a state attorney general could sue to stop violations. Courts could order a stop, require a sale, and force repayment of revenues earned during the violation into an FTC fund to meet harmed community health needs. People’s rights to bring other legal claims would not change.
Medicare Advantage plans face ownership bar
Starting with plan years on or after January 1, 2026, the government would not be allowed to contract with or pay a Medicare Advantage plan if the plan or its owner also owns or controls a covered provider or its management group. MA organizations would have to certify they follow this rule and give any needed information to the Secretary. Any payment claim from a plan in violation would be treated as a false or fraudulent claim under federal law.
Sponsors & CoSponsors
Sponsor
Hoyle (OR)
OR • D
Cosponsors
Ryan
NY • D
Sponsored 9/17/2025
Jayapal
WA • D
Sponsored 9/17/2025
Ocasio-Cortez
NY • D
Sponsored 9/17/2025
Khanna
CA • D
Sponsored 10/8/2025
Balint
VT • D
Sponsored 10/8/2025
Roll Call Votes
No roll call votes available for this bill.
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