Why Breaking Up Integrated Healthcare Systems Would Hurt Patients and Raise Costs
On September 17, 2025, Congressman Pat Ryan introduced the so-called “Patients Over Profits Act.” The bill takes direct aim at vertical integration in health care by making it illegal for insurers like UnitedHealth to own medical practices, requiring divestiture of subsidiaries like Optum. Supporters claim this would restore competition, improve quality, and reduce costs.
But the reality is very different. Forcing the breakup of integrated health care systems would actually harm patients, increase costs, and reduce access to coordinated care.
This blog explores why legislation like the “Patients Over Profits Act” represents the wrong prescription for America’s healthcare challenges — and why vertical integration is part of the solution, not the problem.
What the Bill Proposes
The legislation would:
Ban insurers from owning medical practices. Companies like UnitedHealth would be required to sell subsidiaries like Optum, which today employs one in ten physicians nationwide.
Force divestitures. Existing integrated businesses that combine insurance and provider services would be broken up.
Restrict Medicare Advantage contracts. HHS could not contract with insurers that also own Medicare Part B or C providers, a penalty that would discourage investment in integrated care.
In short: the bill dismantles the efficiencies created when insurers, providers, and pharmacy benefit managers operate under one roof.
Vertical Integration Explained
At its core, vertical integration in healthcare means combining different parts of the care ecosystem:
Insurers (payer side)
Provider groups and clinics (care delivery)
Pharmacies and PBMs (prescription drug management)
Data and technology platforms (claims, records, scheduling)
When aligned, these components reduce duplication, streamline approvals, and create a single point of accountability for patients.
This is why large companies like UnitedHealth, CVS Health (with Aetna and Caremark), and Cigna (with Evernorth) have pursued integration. The goal isn’t just market share; it’s building systems that are better able to deliver affordable, coordinated care at scale.
Why Breaking Up Integrated Healthcare Systems Would Backfire
1. Higher Costs for Patients
Fragmented systems mean more middlemen and more overhead. Without integration, insurers must contract with thousands of outside practices and pharmacies — each with their own billing systems, administrative staff, and IT platforms.
That overhead gets passed directly to patients through higher premiums and out-of-pocket costs. Vertical integration eliminates many of these redundancies, which is why integrated systems can offer lower prices on bundled services.
2. Worse Care Coordination
Patients with chronic conditions often see multiple specialists. In a fragmented system, each office may use different electronic health record (EHR) systems, leading to gaps in data and delays in treatment.
Integrated systems ensure that a patient’s insurance, doctor, and pharmacy are aligned. This reduces medical errors, speeds up prior authorizations, and makes it easier for providers to deliver coordinated care.
Breaking this apart would return patients to the frustrating, disjointed experience of navigating a maze of disconnected providers.
3. Less Investment in Innovation
Large integrated systems have the scale and capital to invest billions into health IT, telemedicine, and advanced care models. Independent practices rarely have the financial bandwidth to do so.
For example, integrated companies can:
Build AI-driven claims systems to reduce denials.
Deploy remote monitoring for chronic disease management.
Create bundled payment models that reward outcomes, not volume.
Divestiture mandates would discourage these investments and leave smaller practices struggling to modernize.
4. Reduced Access in Underserved Areas
Critics often frame acquisitions as “corporate takeovers,” but the reality is that in many rural or underserved areas, large integrated providers are the only ones with the resources to maintain offices, recruit physicians, and expand services.
Breaking up these systems could lead to fewer doctors in hard-to-serve communities, widening disparities in access to care.
5. Conflicted Logic on Competition
Supporters of the bill argue that integration reduces competition. But in practice, integration creates intra-company competition between different service lines to demonstrate value.
Moreover, insurance premiums are already heavily regulated at the state level, and Medicare Advantage plans are benchmarked against federal standards. Patients don’t benefit from more fragmentation — they benefit from cost savings that come from scale.
The Flawed Assumptions Behind the Bill
The “Patients Over Profits Act” is built on anecdotal complaints about customer service and billing errors. No one disputes that these issues exist. But they exist in every healthcare setting — whether independent or corporate-owned.
Punishing vertical integration for these shortcomings is like banning airlines from owning booking platforms because of a delayed flight. The solution should be better oversight and accountability, not dismantling the very infrastructure that can deliver efficiency.
Who Really Pays the Price
If this bill were to pass, the real losers would be:
Patients: Facing higher costs, longer wait times, and a return to the era of fragmented care.
Doctors and nurses: Losing access to the resources and infrastructure that large systems provide.
Communities: Watching local offices close or downsize as they lose the backing of integrated systems.
Meanwhile, the administrative costs that integrated systems cut out would creep back in — swelling insurance paperwork, billing disputes, and out-of-pocket surprises.
A Better Path Forward
Instead of dismantling integrated systems, policymakers should focus on:
Improving transparency. Require clearer billing practices and stronger patient protections.
Enhancing accountability. Hold integrated providers to measurable quality benchmarks.
Encouraging innovation. Incentivize investments in digital health, telemedicine, and coordinated care models.
Expanding choice. Allow patients to select integrated plans that deliver convenience and affordability.
This approach builds on the strengths of vertical integration without throwing out the benefits.
Bottom Line
Healthcare in America needs reform — but not the kind proposed by the “Patients Over Profits Act.” Breaking up integrated systems would raise costs, reduce access, and undermine care coordination at a time when patients need more affordability and reliability, not less.
Instead of legislating fragmentation, policymakers should recognize the value that vertical integration brings to patients and communities. With the right guardrails, large integrated systems can deliver lower costs, better care, and more equitable access.
And that’s progress.