Big health care
09/16/2025
Big health care
"As UnitedHealth Group faces government investigations and changes in federal payments that have hurt its results, it is turning to an increasingly common Washington playbook: hiring Donald Trump’s allies and trying to plead its case directly with top officials in his administration," reports The Wall Street Journal.
This article reminds me that I’ve been meaning to write about the recent Sunlight Report on UnitedHealth Group. The report is an analysis by the Center for Health and Democracy, whose president, Wendell Potter, is a former health insurance executive turned whistleblower. You may recall items by him in this blog over the years when he was a columnist at The Center for Public Integrity.
The Sunlight Report "is a first-of-its-kind look at the nearly 2,700 subsidiaries that make up UnitedHealth Group, the largest health care conglomerate in the world," Potter says in his "Health Care un-covered" newsletter on Substack.
"Clinical subsidiaries, including physician groups, ambulatory surgery centers and home care organizations (including palliative care and hospice) now comprise the majority of these entities," the report says.
"We suspect few consumers are aware that their doctors could be part of a broader enterprise that, as a publicly traded company, has a legal obligation, first and foremost, to maximize shareholder value. The tension between care and profits comes into stark contrast in areas such as hospice care, which can benefit from limiting treatment and maximizing revenue," the report says.
In a webinar last week by Potter and his colleagues on the report, one of the slides read, "United owns or has close contractual ties with one in 10 doctors in the U.S."
Potter says in his newsletter: "Last year, UnitedHealth took in more than $400 billion in revenues and ranked #4 on the Fortune 500 of U.S. companies. Only Walmart, Amazon and Apple are bigger."
He cites some of the takeaways from the report:
— "UnitedHealth now owns such big chunks of the U.S. health care system that it can influence whether millions of us can get the care we need, where we will get it, and how much we’ll have to pay for it, including for our medications – even if we are not enrolled in a UnitedHealthcare plan – from our cradle to our grave.
— "The nearer we get to our graves, the more likely UnitedHealth will be in our lives – or what is left of it. Many of the company’s most recent acquisitions have been in the home health and hospice space.
— "The company increasingly even controls much of the information we have available to us online about medical care and health insurance. One of its transactions created RVO Health, which is now a massive, privately held digital media and marketing company that reaches more than 300 million people every month and manages more than 100 news and information sites [including healthline.com and medicalnewtsoday.com, the report says].
— "It owns and operates numerous companies in the insurance agent and brokerage space, including online outfits like Healthmarkets that appear to be independent resources for health insurance plans in the individual and group markets.
— "Most of UnitedHealth’s acquisitions by far have occurred since 2010, and most by far have been in the clinical category [which includes primary care and home care], not the insurance category.
"That is likely at least partly because of a well-intended provision of the Affordable Care Act, which was passed in 2010, that requires insurers to spend no less than 80-85 percent of our premiums on our medical care (80 percent in the small group market and 85 percent in the large group market).
"If an insurer doesn’t spend that much, it must send rebate checks to its customers. Because that ACA provision applies to health insurance but not health care delivery, owning physician practices, clinics and other clinical operations provides a way to work around that requirement and the need to issue rebate checks.
— "UnitedHealth is now about as multinational as a company can get, with operations of one nature or another in just about every country. It even owns and operates hospitals abroad, something it doesn’t do in the U.S. – at least not yet."
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