Caught in the Crossfire: Big-Medicine Breakup Bill Imperils Long-Established Integrated Health Systems
A new bipartisan bill, the "Break Up Big Medicine Act," takes aim at the ownership structures fueling health care's vertical integration, but ambiguities in its text risk forcing divestitures beyond the conglomerates it targets.
On February 10, 2026, Senators Elizabeth Warren (D-MA) and Josh Hawley (R-MO) introduced the "Break Up Big Medicine Act," which, if it were to become law, would prohibit common ownership of health plans and providers. The bill also would bar parent companies of prescription drug or medical device wholesalers from directly or indirectly owning or controlling providers or management services organizations.
The bill aims to make it unlawful for any person to directly or indirectly own, control, or operate a provider or management services organization and an "insurance company" or pharmacy benefit manager. While the press release announcing the bill explicitly references "pharmacy benefit managers" and "health care conglomerates," the bill's text, in its current form, is ambiguous. By failing to define "insurance company" (while defining "health plans"), it may capture all common ownership of providers and health plans, including health systems and physician groups with subsidiary health plans. If enacted, this could disrupt operations for many health systems who have long committed to integrated care settings and operate health plans.
The bill would mandate divestment within one year of its enactment. Affected entities would have to choose between owning: (i) a provider or management services organization or (ii) an insurance company or pharmacy benefit manager. Failure to divest would trigger penalties, including profit disgorgement and forced asset sales.
The bill also would provide for multiple enforcement mechanisms:
- The Federal Trade Commission and the Antitrust Division of the Department of Justice would each have enforcement jurisdiction.
- The United States Department of Health and Human Services' Office of Inspector General or any state attorney general would have the ability to bring a civil action in United States District Court.
- A private cause of action would allow private citizens to allege harm as a result of noncompliance and recover treble damages, attorneys' fees, and equitable relief.
As of the date of this Alert, the bill has been referred to the Judiciary Committee. We recommend continued monitoring of the bill's progress.
