CONGRESSMAN PAT RYAN INTRODUCES “PATIENTS OVER PROFITS ACT” TO LOWER COSTS AND IMPROVE CARE QUALITY FOR HUDSON VALLEY FAMILIES BY BREAKING UP UNITEDHEALTH AND OPTUM

Congressman Pat Ryan Introduces "Patients Over Profits Act" To Lower Costs and Improve Care Quality for Hudson Valley Families by Breaking Up UnitedHealth and Optum

Congressman Ryan's bill makes it illegal for insurance companies like UnitedHealth to own medical practices, requiring the company to sell its Optum subsidiary, which has acquired more than 2,500 Hudson Valley providers since 2022 and controls 10% of physicians nationwide

UnitedHealth's mass acquisition of medical practices has sparked a litany of community concerns; an inquiry from Ryan's office revealed instances of declining quality of care, an increase in fees and incorrect billing, provider burnout, and issues with customer service and accessibility negatively impacting people's ability to get health care

Following the results of the inquiry Ryan submitted the full dataset to the DOJ, HHS, and FEC encouraging them to continue their numerous investigations into UnitedHealth and led a Community Speak Out on the devastating local impacts of health care cuts and consolidation

WASHINGTON, DC - Today, Congressman Pat Ryan introduced the "Patients Over Profits Act" to undo the harms inflicted by UnitedHealth's mass acquisition of Hudson Valley medical practices and to lower care prices across the region. Optum - a subsidiary of UnitedHealth - has bought up practices employing more than 2,500 doctors in the Hudson Valley since 2022, and controls 10% of physicians nationwide. After receiving numerous complaints of issues at United-owned practices, Ryan launched a community inquiry in February revealing a litany of concerns including declining quality of care, an increase in fees and incorrect billing, and issues with customer service and accessibility negatively impacting people's ability to get health care.

United's insurance business also pays its own Optum practices more in order to squeeze local competitors, causing prices to shoot up and forcing local practices out of business.

Ryan's legislation bars insurers - including UnitedHealth Group - from buying medical practices through subsidiaries like Optum, and requires existing healthcare conglomerates to separate their insurance and healthcare provider businesses. He is introducing the bicameral legislation alongside Senator Jeff Merkley and Representative Val Hoyle of Oregon, which - like New York - has also seen mass United acquisition in recent years, as well as Senator Warren (MA) and Representative Pramila Jayapal (WA).

"UnitedHealth has gobbled up our local healthcare practices, creating a monopoly that directly hurts everyone in our community. In their greedy pursuit of profits, they now own the insurance company, they own your doctor, they own the pharmacy and they own the software that processes all of your information - and they use it all to keep prices high and drive quality down. Enough - it's time to break up UnitedHealth and put you back in control of your own healthcare," said Congressman Pat Ryan."We need to bring back the local, independent doctors offices and pharmacies whose sole priority is caring for you and your family - not United's quarterly earnings report. We need to bring down the price of your care, and make sure you're not billed a dime more than you owe. We need to build a system where patients can quickly access quality care right here in the community, without facing endless roadblocks, and healthcare workers get the fair wages they deserve for their heroic work. Breaking up UnitedHealth's insurance and physician businesses is the first step toward building something better, where every American is able to get the care they deserve at a price they can afford."

"Your doctor's office should be in the business of making sure you get the best possible care, not functioning as a profit center for billionaire health care corporations," said Senator Merkley. "In Oregon and nationwide, greedy executives are using sick people to turn healthy profits-with one Oregon clinic reportedly losing dozens of physicians and subsequently kicking out thousands of patients after it was purchased by Optum. The Patients Over Profits Actreins in these out-of-control consolidations, which are great for corporate greed and a bad deal for patients."

"UnitedHealth and other major corporate health care giants clearly cannot be trusted to put the needs of patients over profits, as they show time and time again," said Rep. Jayapal. "As they consolidate the market around them, they are also creating a structure that denies people the ability to visit a physician of their choice. This is absolutely unacceptable, and it allows them to jack up already absurdly high health costs, deny necessary treatments if they're too expensive, and keep wages low for doctors, nurses, and the staff that keep hospitals running. I'm proud to co-lead the Patients Over Profits Act to break up this corporate ownership and ensure that all people can access care when and where they need it."

"Across the country, insurance companies are buying up doctors' offices, driving up costs, and putting insurance company profits over patients. Our bill cracks down on greedy insurance companies' attempts to control doctors and squeeze patients for every cent," said Senator Warren.

"When you get sick, you should be able to receive the treatment and care that you need. For too long, Wall Street has made that harder by buying up local clinics and care facilities and then focusing on turning a profit instead of delivering care," said Rep. Hoyle."The Patients Over Profits Act stops multi-billion-dollar companies from buying up every part of the system and tying our health care access to their profit margins and shareholder returns. The message we are sending in response is clear: Americans should be able to expect quality, affordable, and appropriate care when they need it and that should be the focus of our health care system."

The introduction also follows the passage of Trump's domestic spending agenda, which cuts health care from 17 million Americans and threatens to raise care prices for everybody.

Across the country, Optum has spent $31 billion on acquisitions over a two-year period, and has purchased everything from physician practices to ambulatory surgical centers. These acquisitions threaten equitable access to care, raise costs, and reduce physicians' clinical autonomy. It is also a conflict of interest - insurance companies like United can steer patients to their own providers and subsidiaries, potentially to increase profits, rather than focusing on medical necessity.

The introduction of the "Patients Over Profits Act" is decisive action in Congressman Ryan's months-long fight to hold UnitedHealth Group accountable for their role in degrading the quality and accessibility of health care in the Hudson Valley. Ryan launched a community inquiry into UnitedHealth following numerous complaints about care at acquired practices, revealing an avalanche of dysfunction impacting care quality, customer service, billing practices, costs, accessibility and more. Following the bombshell results, Ryan submitted the entire dataset to the DOJ, HHS, and FECand urged them to continue pursuing their numerous investigations into the healthcare giant, and led a Speak Out raising the alarm on the community impact of health care consolidation.

Among the survey respondents were families plagued by incorrect billing, mothers who had to wait over a year for a cancer diagnosis, parents unable to access care for their disabled children, and physicians grappling with intense burnout:

"I have been dealing with billing issues for over a year which started with my pregnancy. I am still waiting for a $660 refund from January of last year, where Optum kept billing my insurance incorrectly," said Catherine Zagoreos of Poughkeepsie."I have called numerous times and each time they tell me they will fix the issue, and check back in 30-45 days. When I call back the next technician tells me the last one made a mistake, and to call back in another 30-45 days. Over a year later I still keep calling, and still waiting for them to refund me for THEIR billing mistakes. It's exhausting."

"I have had no shortage of negative experiences since Optum took over my medical practice. I tried for more than a year to get an appointment with a specialist and kept getting pushed off, my appointments were repeatedly cancelled," said Kimberley from Tivoli."Once I finally did get in, it turned out to be cancer. They made me wait a year to be seen, and it was cancer. I was incredibly lucky that it wasn't too late. I've had to go without essential medication for days, despite calling in my refills, because Optum has messed up my prescriptions. Most recently, I went in for a torn rotator cuff. The doctor, who I could only see by walking in, said he needed to see me again in a week. That was nearly a month ago and I haven't been able to get back in. I've been lucky so far, but someone is going to die if they don't get these problems under control."

"The accessibility of people who work at Crystal Run has gotten so much worse since Optum took over," said Marc Buchannan of Rock Tavern. "If I need to ask a nurse a simple question, or get the results of a test-something fairly common as I have a disabled son who has a lot of medical needs- it can take weeks to get a response. Even if they finally do call you back, trying to actually speak with a provider is impossible. We've taken to scheduling appointments, even when my son is healthy, just to talk to a real person."

"I worked at Crystal Run for a long time, and can confidently say that the purchase by Optum has accelerated the decline in the patient experience. The management doesn't listen to the providers, and makes it near impossible for them to leave and provide care elsewhere in the Hudson Valley. They don't care that we're overworked, and manage us through fear and edict," said a former Crystal Run provider. "The care given in the office is still great care. The doctors are still doing a great job, but they are overwhelmed, under staffed and have very low morale. The patients are suffering for this, and it won't stop unless someone holds the corporate machine accountable."

"What Optum has done is put a corporate wall between my children and their physician and therefore their overall health," said Naomi from Marlboro. "After the Optum takeover, their doctor became less attentive and less relaxed in our visits, and seemed to need to push us out the door to see the next patient. Their phone tree method of triaging patients is an absolute disaster. I have waited for hours and hours for a call-back while my kids are sick. I am working towards leaving them, though I've discovered that there are very few alternatives in the area and am nervous about finding the right fit for my kids since we're starting over from scratch."

Specifically, Ryan's "Patients Over Profits Act":

• Prevents insurance companies or their subsidiaries from owning a Medicare Part B or C provider.
• Requires insurance companies or their subsidiaries who also own Medicare Part B or C providers to divest and if they do not, a civil action can be brought by the FTC, a State Attorney General (AG), the Inspector General of HHS, or the Assistant AG in charge of Antitrust at DOJ.
• Prevents the Secretary of HHS from contracting with a Medicare Advantage (MA) Organization that also owns a Medicare Part B or C provider - this would strongly disincentivize these insurance companies from owning clinics because they would not want to forego profits from MA plans.

In 2022, Optum purchased CareMount Medical, a medical group with over 2,100 providers and 1.6 million patients in the tri-state area. In 2023, Optum further consolidated the market for physician services in the Hudson Valley with its acquisition of Crystal Run Healthcare, with about 400 providers. Patients across the Hudson Valley have reported that the shift to Optum has worsened the quality of their care and reduced access to medical providers in our area. This includes difficulty scheduling doctor's appointments, inaccurate billing, unexplained fees, long wait times, and poor customer service. In addition, Optum employees have reported layoffs and chaotic, overburdened work schedules, leading to staff burnout.

Across the country, Optum has purchased doctor's offices at an aggressive pace. It has become the largest employer of doctors, with one in ten physicians nationwide now under its control. Optum's parent company, UnitedHealth Group, also owns the largest insurance company, one of the three largest Pharmacy Benefit Managers, and the largest medical claims manager. United has used this vast power to rip off patients and enrich its shareholders, with profits of $14 billion in 2024.

In the Hudson Valley, concerning reports have emerged that United may be paying its own Optum practices more in order to squeeze local competitors, as well as manipulating patients' medical records in order to receive higher payments under the Medicare program. United is facing multiple investigations by the Department of Justice, including an antitrust review of Optum's acquisition of doctor's offices that was opened in February 2024. According to reports, investigators are looking into anticompetitive harms for patients and providers.

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