POP Act

This bill makes it illegal for any person to own both a health insurance issuer and certain health care providers (or their management services organizations) that participate in Medicare, and requires divestment of one or the other. It also adds a similar prohibition to Medicare Advantage and Part D contracts, and gives enforcement powers to federal and state authorities.

Sec. 2, Prohibition on common ownership: It is unlawful for any person to own, operate, or control both an applicable provider (or its management services organization) and a health insurance issuer. Violators must divest one of them within 2 years if acquired before the bill's enactment, or within 1 year if acquired after. The Inspector General of HHS, the Assistant Attorney General for Antitrust, the FTC, or a state attorney general can sue in federal court for an order to stop the violation, force divestment, and disgorge any revenue from health care services during the violation. Disgorged funds go into an FTC fund for the health care needs of the harmed community.

Sec. 2, FTC review: Any required divestment must be reported to the FTC and the Assistant Attorney General under the Clayton Act, regardless of normal thresholds. The divestment period is paused during any waiting period under that Act. The FTC and Assistant Attorney General must review the effect on competition, financial viability, and public interest of the divestiture and any subsequent acquisition.

Sec. 2, Rulemaking and enforcement: The FTC must issue rules to carry out this section. Nothing in the section limits other legal authorities. For Medicare Advantage, starting in 2026, the Secretary cannot contract with or pay a Medicare Advantage organization that owns an applicable provider or is owned by someone who does. Each organization must certify compliance, and false claims from violators are considered false or fraudulent. The same prohibition applies to Medicare Part D plans.

Sec. 2, Definitions: 'Applicable provider' means any entity paid for services under Medicare Part B or a Medicare Advantage plan, but excludes hospitals, critical access hospitals, rural emergency hospitals, durable medical equipment suppliers, and pharmacies. 'Health insurance issuer' is defined by the Public Health Service Act. 'Management services agreement' is a contract for management or administrative services supporting health care. 'Management services organization' is any entity that contracts with an applicable provider for such services. 'Person' is defined by the Sherman Act.