It turns out that UnitedHealth Groups's attempts to use the failure of its own
payment system to take over now cash strapped medical practices did not go
over well in the Beaver State.
When further juxtaposed with other UHC actions, which consisted of f%$#ing
with the healthcare of 2 Oregon state reps, led to this bill passing:
Two days ago, [June 9, I just found the story] Oregon Governor Tina Kotek signed the nation’s strictest law
against corporate control of health care practices in the state. It’s a major
defeat for private equity and large health insurers, and something that
advocates and physicians have been advocating for years, as more and more of
the state’s capacity got bought up by financiers. It’s also a ground-breaking
event that could catalyze the creation of a new health care system, one
managed by medical professionals and patients instead of Wall Street. And it’s
all thanks to UnitedHealth Group.
………
The logic of the bill is clear. As Oregon nurses noted in lobbying
for the bill, corporate control of medicine is fundamentally
antagonistic to quality care, as it removes decision-making from medical
professionals and patients and puts it in the hands of financiers. For
instance, private equity owned clinics charge 20% more for the same
procedures. Such ownership arrangements increase
costs, make patient outcomes worse, and foster physician burnout, and
of course, there are no improvements to quality or access.
………
And we can actually thank UnitedHealth Group, which provided Oregon
with a particularly noxious experience in health care, and the political
culture to do something about it. Because UHG’s tactics are so brazen
and extensive the company actually screwed over two separate Oregon
state representatives, both of whom have cancer, and both of whom in
turn testified on behalf of the bill. To understand how UHG messed up so
badly politically, it helps to look at the actual process of how the
bill got passed.
In March of 2024, Optum, the largest for-profit
medical provider in America and a unit of UnitedHealth Group, applied
for emergency approval to take over a large primary and specialty
physician practice in Oregon, the 600 person Corvallis Clinic in Western
Oregon. If the Oregon Health Authority didn’t approve the acquisition
immediately, the clinic claimed, it wouldn’t be able to cover rent,
payroll or other expenses. Only UHG’s cash infusion could keep the doors
open. And this claim was likely true, Corvallis was in desperate
financial condition.
What caused Corvallis’ cash crunch? Well, its application to Oregon regulators was redacted, but the American Prospect reported
what insiders all knew - a different UHG subsidiary, the Change Health
payment network, had been hacked and was nonfunctional, which meant that
hospitals, pharmacies, and clinics nationwide couldn’t get paid for
their services. And that included Corvallis Clinic, which couldn’t get
access to money it was supposed to be paid by, among others,
UnitedHealth Group. In other words, UHG caused a cash flow crisis at
Corvallis, and then swooped in to buy it on the cheap.
Two
months ago, Oregon state representative Sarah Finger McDonald gave
testimony to the state legislature on what happened next. It’s an ugly story.
The
most obvious impact was on the working conditions in the Corvallis
clinic; doctors had to see too many patients, and began burning out.
Nine primary care doctors left. Now the clinic isn’t accepting new
patients. All of the neurologists departed as well, leaving entire
counties without any of those specialists. Three of five
gastroenterologists departed, and the two remaining ones no longer do
on-call work. Medicaid insured patients can’t really use the clinic
anymore, and Optum closed the lab for six months. These experiences
affected not just Corvallis patients, but the entire region. They put
pressure on other physician practices to accept an extra caseload,
especially of poorer patients. Similarly, the other labs in the area are
overloaded, and patients have to wait hours for a simple blood draw.
McDonald herself has cancer, and she explained how she has “spent a lot
of time” sitting around at the remaining regional lab.
………
This new law is fairly simple; Oregon is simply closing up the
loopholes that allow corporations to sidestep its CPOM rules. The law
doesn’t block investment by corporations in medical practices, but it
prohibits control of clinical practices by anyone
but licensed medical providers. Now, a clinician, not a banker, must
have decision-making authority over staffing levels, wait times,
clinical decisions and operations, and as well diagnostic coding
decisions, billing and collection policies, price setting, and payer
contract negotiations.
The law also bans non-competes and gag clauses that lock in
doctors and nurses, which was a major incentive for corporations to
acquire practices and then worsen working conditions. It’s not ironclad;
there are carve-outs for behavioral health, telehealth, and hospitals,
and hospitals can still acquire clinical practices. iI’s also not
immediate; It kicks into effect in three years, leaving substantial time
to adjust, and it has a private right of action for enforcement, so
aggrieved employees or competitors can litigate against lawbreakers. If
you want the specifics, here’s the legislative analysis from the state Senate, and here’s a FAQ from Oregon Senator Deb Patterson, the main proponent of the bill.
The theory behind the corporatization of medical practices was that business guys could rein in excessive costs from those pesky medical professional.
This was never going to happen. The finance guys can't fix things, they can only loot and defraud.
For a good reason.
