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UnitedHealth Has 2,694 Subsidiaries and Affiliates. Is It Too Big to Manage?

UnitedHealth Has 2,694 Subsidiaries and Affiliates. Is It Too Big to Manage?

This behemoth conglomerate might just be too monstrous for its own good.

By Jarod Facundo and Patrick Rucker
The American Prospect, July 16, 2025

UnitedHealth Group executives have long argued that buying rival health care companies was the key to earning long-term profits, and investors who endorsed that strategy were rewarded for years.

Since UnitedHealth announced disappointing earnings in April, though, Wall Street has erased roughly half of the company’s stock value, and its “buy everything” business model has come under scrutiny.

A new report tallies UnitedHealth’s vast holdings and chronicles how the company both spawned new enterprises and went on a prolonged buying spree to grow. In all, UnitedHealth has a whopping 2,694 subsidiaries and affiliates.

The report gives a deal-by-deal accounting of how UnitedHealth ballooned, but it also implicitly asks a key question: Has it become too big to manage?

“United is shaping our health care system, and few people know the company’s scope,” said Wendell Potter, president of the Center for Health & Democracy, which published the Sunlight Report on UnitedHealth Group with financial support from Arnold Ventures.

The report shows how a vast national health care system largely feeds the bottom line of one giant enterprise.

In a statement, UnitedHealth said the company sought to streamline a medical system that is fragmented and inefficient.

“We’re helping to accelerate the transition of the U.S. health care system,” said Dr. Wyatt Decker, a UnitedHealth executive who described the company’s “value-based” model for paying doctors more when their patients become healthy rather than for the number of treatments they give.

UnitedHealth, he said, seeks to move “beyond a transaction-based health system to a model that is designed to be proactive to help keep people healthy over the course of their lifetimes.”

Whatever UnitedHealth’s stated ambitions, the company has become so complex that it is difficult for regulators and enforcers who would rein it in, said Reed Showalter, a senior fellow for the Vanderbilt Policy Accelerator, a think tank within Vanderbilt University. He calls it “weaponized complexity.”

“You end up with this game of whack-a-mole because these companies are so big and they can hide unfairness and harms in so many different ways through their subsidiaries.”

The Prospect has previously detailed UnitedHealth’s relentless, single-minded, half-century search for profits. One industry analyst describes how the company has used its vast store of wealth to pull more and more rivals under its control.

“This is not a care delivery ‘system,’” said Jeff Goldsmith, who has followed the company closely for decades. “United is a profit-mining enterprise. They used profits to buy profitable companies.” But Goldsmith cautioned that this merger spree has stopped, with uncertain implications for UnitedHealth’s future.

Acquiring Profits

Established in 1974 to handle overhead and doctor salaries for then-popular health maintenance organizations (HMOs), UnitedHealth set its sights throughout the 1980s on rival insurers as part of a drive toward horizontal integration, Goldsmith said. More recently, UnitedHealth targeted health care providers and health data systems as a way to vertically integrate.

The company sought out profitable links in the health care delivery chain and avoided low-margin businesses like hospitals.

Roughly 1 in 10 physicians work for UnitedHealth; the company controls about 20 percent of the prescription drug market through pharmacy benefit manager (PBM) Optum Rx, and collected $300 billion last year providing insurance for patients.

Besides the eye-popping number of subsidiaries, UnitedHealth has a staggering 400,000 employees.

“Most patients do not realize their physician might also be employed by their insurer. It raises trust and ethical issues. How does United balance tensions between controlling costs and quality? They don’t say,” said Seth Glickman, a former insurance and health system executive. He now is a researcher and advocate for reform in the health care finance space who helped author the Sunlight Report.

“Can the CEO or the board really understand all that is happening?” asked Lawton R. Burns, a professor of health care management at the Wharton School of Business at the University of Pennsylvania. “When you get to this size, you run into issues of governance.”

In the light of some transactions, UnitedHealth resembles a financial services company more than an insurer. Its Optum Bank lends to independent physician practices and has nearly $15 billion in deposits. Optum Ventures, its venture capital arm, has more than $2 billion in assets.

Potter’s Sunlight Report uncovered UnitedHealth’s disparate holdings by drilling through required filings to state insurance regulators, known as Schedule Y.

Buying Spree

In 2010, the company controlled just 149 individual entities. By 2023, that number had ballooned nearly twentyfold. Nearly 80 percent of the acquisitions over that period were health care providers, according to the report. The remaining 20 percent consisted largely of international acquisitions and administrative enterprises that helped consolidate UnitedHealth’s vast health data system and PBM, and specialty insurance providers offering coverage for everything from workers’ compensation to dental plans.

As the company’s holdings grew, so did revenue, and it seemed like the business plan was working. Beginning in 2010, total revenue increased from $94 billion to $400 billion, while net income rose from $4.6 billion to $15 billion, according to securities filings. Meanwhile, investors saw share prices skyrocket from $30 per share to $530 a decade later.

While the overall growth numbers have been impressive, more and more UnitedHealth revenue has come from the company doing business with its own subsidiaries.

In 2010, roughly $18.3 billion of Optum revenue came from businesses it owns, according to SEC filings. Today, that number has increased nearly tenfold to $151 billion, according to an analysis of securities filings..

Unmanageable

With its vast and sprawling network of medical interests, it’s not just UnitedHealth’s size that worries Goldsmith, but its unmanageability.

“To create real synergies in this space, you have to make it easier for doctors to practice medicine and improve the patient’s experience. That hasn’t happened,” he said, noting that UnitedHealth has a net negative view among consumers.

“You have all these moving parts,” he said. “But the nerve endings are not reaching all the way to the fingers and toes.”

There is a fine line between a business that operates profitably at a large scale and one that struggles to manage its distinct parts, said Professor Burns at Wharton.

“The country has over 60 years of business history with conglomerates, and that history isn’t very glowing,” he said, noting that health care is particularly difficult to scale nationally.

“There is a reason that the largest hospital groups and provider networks are regional and not national,” he said. “It turns out, when it comes to health care, people prefer a local-based culture.”

Goldsmith put it more bluntly. “United does a terrible job providing services,” he said. “If you can’t meet my needs as a patient and if you can’t connect with all those talented docs that you acquired, you don’t have anything. You just have a bunch of assets that are depreciating in value. That is a recipe for a shrinking company.”

In response, UnitedHealth’s Dr. Wyatt Decker said, “Optum aligns with and employs physician practices to advance solutions to expand access to care, improve affordability, enhance the care experience and achieve better health outcomes.”

Medicare Profits

Regulators and investors are beginning to ask whether UnitedHealth’s vast provider network wrongly boosted its popular insurance program for seniors.

UnitedHealth controls roughly 30 percent of the Medicare Advantage market, and it enrolls more seniors than any other operator. Many of UnitedHealth’s acquisitions have solidified the company’s power to not only treat ailing seniors but also determine how sick they are for the purposes of reimbursement.

Roughly one-third of the acquisitions tallied in the Sunlight Report are related to a single deal: UnitedHealth’s $5.4 billion acquisition of home health provider LHC Group in 2022.

UnitedHealth has used home wellness visits and medical codes in health records to exaggerate the poor health of seniors, which boosts payout from the government, The Wall Street Journal reported last year. Medicare Advantage patient evaluations are known as “risk adjustments,” and UnitedHealth has defended the integrity of the practice and its Medicare Advantage program generally.

The company continues to do so. “[Medicare Advantage] plans are regularly audited for accuracy and compliance, and we consistently perform at the industry’s highest levels. We have advocated that CMS conduct audits for every plan, every year, and remain supportive of that proposal,” said UnitedHealth’s Dr. Decker.

The Journal followed up with a report in May of this year that the Justice Department is now investigating whether UnitedHealth engaged in criminal Medicare fraud. On July 9, the Journal reported that federal agents interviewed former UnitedHealth doctors and a nurse practitioner about the training and software used to capture lucrative medical conditions.

If UnitedHealth did use its vast provider network to boost its Medicare Advantage revenue, that business model could now be under threat. For now, UnitedHealth must try to squeeze efficiencies out of a disparate provider network and try to mollify doctors who might chafe under UnitedHealth’s control.

“You can try to get all these doctors on the same reporting system and have them help develop a business strategy,” Goldsmith said. “But United is still dealing with a pretty disaffected workforce.”

Bigger Is Better?

Some investors who are unfazed by UnitedHealth’s stock sell-off said they still believe in the company’s strategy, particularly the practice of acquiring health care providers.

“If you own providers, you have more touch points to keep the patient out of hospitals. That’s how you can control spend,” said one hedge fund manager whose portfolio is 20 percent health insurers, including UnitedHealth.

Insurers have traditionally paid doctors for the care they deliver, a model called fee-for-service. UnitedHealth has been a proponent of value-based care, which pays providers more when they can prove the patient got better after the treatment.

“These guys are positioned for the adaptation of value-based care,” said the hedge fund manager, who declined to be named discussing investment strategy.

Value-based care has principally been limited to Medicare Advantage plans. “But it will increasingly be adopted on the commercial side,” the hedge fund manager said, referring to employer-funded health insurance.

Some analysts disagree and argue that UnitedHealth’s buying binge has only created a bloated, unmanageable company. Yet UnitedHealth’s strategic vision remains the same.

“Our strategy and structure are the right ones for this era,” Stephen Hemsley told investors on the day he took over for his second stint as CEO this May, after Andrew Witty stepped down. “We have made meaningful progress through value-based care approaches 
 I believe and expect we can also be in the forefront of modernization and innovation across the health system.” (Hemsley, while UnitedHealth’s chair, reportedly sold tens of millions of dollars in stock right after the Justice Department informed the company of an antitrust investigation in 2023, and right before it was disclosed in the media.)

Future Unclear

One reason for UnitedHealth’s earnings shock was a sudden uptick in medical expenditures among Medicare Advantage members. “The medical costs of many Medicare Advantage beneficiaries new to UnitedHealthcare remained higher than expected,” the company acknowledged in May.

“It’s unclear whether United simply mispriced their insurance book or made other correctable errors, or whether there are more structural issues from a business perspective,” said Hayden Rooke-Ley, a senior fellow at the Brown University School of Public Health and the American Economic Liberties Project. UnitedHealth’s drive to control more health care providers might not lower costs for consumers or improve health outcomes, but it can still be profitable, he said.

“Whether this playbook will continue to be successful will have a lot to do with whether policymakers and regulators continue to encourage this vertical consolidation—or start to question it.”

https://prospect.org…

Immigrants and Health Care

The Trump White House is emphatically pursuing a policy of massive immigrant detention and deportation that is both inhumane and unpopular. It is also profoundly harmful to our well-being: it threatens the backbone of our health care workforce.

Who Will Care for America? Immigration Policy and the Coming Health Workforce Crisis, The New England Journal of Medicine, July 5, 2025, by Patricia Mae G. Santos, et al.

As the federal government seeks to curb immigration of all forms, immigrant health care workers and their patients will inevitably find themselves caught in the dragnet, which will have serious consequences for the system at large. The United States already has been grappling with severe health care worker shortages, which are projected to worsen over the next few years. For aging populations the forecast is especially dire.

The physically demanding nature of direct care work (home health aides, personal care aides, and certified nursing assistants), combined with low pay and high susceptibility to exploitation, makes these roles unattractive to U.S.-born and highly skilled foreign-born workers. Indiscriminate mass-deportation policies not only infringe on basic civil liberties but may also exacerbate existing worker shortages.

Immigration policy must therefore protect the dignity of people who dedicate their lives to caring for others, The recent deportation of immigrant health care workers is our canary in the coal mine: policymakers must act swiftly, or risk endangering the health of us all.

What a $178 billion gift means for the immigration police state, The Washington Post, July 8, 2025, by Catherine Rampell

Trump’s new mega-law invests $178 billion in additional immigration enforcement over the next decade. To be clear, this is not merely about “border security.” It’s largely for more detention centers and boots on the ground within the U.S. interior. This means spending more dollars to round up gardeners, home health aides, grad students, nannies, construction workers, etc.

In other words, the administration is going after your family, neighbors and friends, regardless of how long they’ve been here, whether they present any “safety” threat or how much they’ve contributed to their communities.

With daily arrest quotas to meet, agents are filling detention centers not with criminals and gangbangers, but people with no criminal history whatsoever.

Trump is not merely siccing immigration forces upon those who had been undocumented (with or without criminal records), under the stewardship of Deputy Chief of Staff Stephen Miller, this administration has also been working to “de-document” hundreds of thousands of immigrants who are here legally.

The Justice Department recently announced plans to prioritize revoking citizenship from naturalized U.S. citizens. The administration is also still trying to strip birthright citizenship from babies born in the United States, including those born to both undocumented and many authorized immigrant parents.

Comment:

By Don McCanne, M.D.

Stephen Miller has been working with President Trump to advance immigration policies that are opposed by most of the American public. Perhaps foremost amongst these is his effort to dramatically reduce legitimate immigration into the United States, much of which is beneficial because most of these individuals improve our national productivity, not only in menial occupations but often in professional roles as well. Yet Miller distorts his pronouncements to provide a rhetorical basis for obstructing US residence of these qualified individuals.

Listening to his framing induces a “thought experiment” that places him as the object of similarly distorted thought processes:

“To repair a problem you must first define it. Stephen Miller defines immigration as a broad negative. This implies the need to expel foreigners whom he considers to be undesirable, even if they are upstanding, contributing to our health and economy. A prominent medical journal offers a more positive and honest view of immigration as implied in the title, “Who Will Care for America? Immigration Policy and the Coming Health Workforce Crisis.”

“The growing dislike of Miller for his disruption of the valuable contributions made by immigrants to US prosperity creates a new proposition: How can we neutralize Miller’s harmful actions? Removing him from his current White House role seems the logical path. Some say his own immigrant origins should be investigated, to scrutinize the legitimacy of his claim to be in the US. That seems fair. However, we reject drastic measures, as suggested by some, because we value humanity, which we’re unsure Stephen Miller does.”

The ”oust Stephen Miller” path should have far greater appeal to the public than the despicable ideas and actions he is foisting off on us. In removing him, our society would achieve a trifecta: more humane, healthier, and wealthier.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Trump-GOP Budget: 17 Million Americans Lose Health Insurance; 51,000 Preventable Deaths Expected Annually

Interview with Dr. Phil Brewer

Counterpoint, July 7, 2025

PNHP past president Dr. Adam Gaffney discusses the expected overall health care impact of the Trump-GOP federal budget bill just passed by Congress that cuts $1 trillion from Medicaid and Medicare, will take away millions of poor families’ access to food and nutrition programs, and will close hundreds of community and rural hospitals.

Dr. Gaffney also addresses viable alternatives to America’s current failed for-profit health care system—notably a single-payer national health program aka improved Medicare for All.

https://btlonline.org…

July 4 protesters in Midtown sound the alarm against Trump’s ‘Big Beautiful Bill,’ now the law of the land

By Gabriele Holtermann
AMNY, July 5, 2025

As President Donald Trump signed his “Big Beautiful Bill” into law at a White House military family picnic on July 4, around 75 demonstrators gathered across from Trump Tower in Midtown Manhattan sounding the alarm that the new legislation would harm the most vulnerable Americans.

Physicians for a National Health Program NY Metro, Indivisible, and Rise and Resist organized the Independence Day protest. Julie DeLaurier, a member of the political action group Rise and Resist, said the protesters were gut-punched and horrified at what she described as Republicans’ “gleeful” cruelty.

She joined the protest, which also included a die-in outside of Trump Tower, on the Fourth of July because it was “better than sitting at home and crying.”

“We’re going to fight this,” DeLaurier vowed. “We’re only six months into [the Trump administration]. We’ve got a long way to go, and we are here for the duration. We are never, ever going to sit down and take this. Other countries made the mistake. Other generations made that mistake. We will not make that mistake.”

Feeling ‘run over’ by Trump

DeLaurier also expressed her frustration with the Democratic leadership, like Senate Minority Leader Chuck Schumer, for believing that they did not explore and use every possible avenue to stop the bill and Trump’s agenda. Republicans hold razor-thin majorities in both the House and Senate.

“They have unanimous consent. They have the filibuster. They used nothing to stop or stall these appointments [and] these bills,” DeLaurier said. “They’ve let Trump and the MAGAs run over them like Panzer tanks.”

The massive tax and spending bill cleared its final hurdle in the House on July 2 and calls for $4.5 trillion in tax cuts, mostly benefiting the top 1% earners, as well as $350 billion for national security, including $30 billion for Immigration and Customs Enforcement (ICE) and $45 billion for 100,000 migrant detention facility beds.

The legislation also raises the national debt limit by $5 trillion, according to the nonpartisan Congressional Budget Office, which also projected it will add another $3 trillion to the national deficit — already at over $37 trillion and counting — over the next decade.

Losses to Medicaid and SNAP

Meanwhile, the new law cuts funding to programs such as the Supplemental Nutrition Assistance Program (SNAP) by nearly $300 billion, as well as to Medicaid, the Affordable Care Act, and the Children’s Health Insurance Program, by approximately $930 billion. The law imposes work requirements of at least 80 hours per month to be eligible for Medicaid coverage, and states offering Medicaid to undocumented immigrants would also lose federal funding.

Dr. Steve Auerbach, a retired pediatrician and public health doctor, told amNewYork that the United States is the only capitalist democratic country without universal healthcare, and cutting Medicaid would add more stress to an already fragile healthcare system, putting the lives of Americans at further risk.

Auerbach, who also serves on the board of directors of Physicians for the National Health Program New York Metro chapter, said every physician had stories about patients who didn’t have the money to fill prescriptions or tried to make a dose spread out that it didn’ take care of their health condition, people who were afraid to call the ambulance because of the bills and died because of a heart attack, or couldn’t afford to check out the lump in their breast and died of cancer.

“And now it’s going to get worse for the first time in American history, we’re actually going backwards on our already dysfunctional, limited health care,” Auerbach said. “As a patriot, why can’t the United States do this as well as every other rich capitalist democracy around the world? [Universal healthcare] is not a lefty fringe socialist commie thing.”

In a statement, Gov. Kathy Hochul said the big “ugly” bill would make life harder for working families and worked closely with the NY legislature to “brace for the impact and protect as many New Yorkers as possible.”

“There’s nothing beautiful about this bill,” Hochul said. “It’s a big, ugly betrayal — stripping health care, hiking costs, and slashing food assistance for millions. And it was made possible by New York’s seven Republican members of Congress. They wrote it. They endorsed it. Now they’re cheering it on, selling out the very people they were sent to Washington to represent.”

https://amny.com…

Premier Medical Journal Scrutinizes Corporatization of US Health Care

The highly regarded New England Journal of Medicine just launched a series on the corporatization of US health care. Today’s for-profit health care conglomerates combine insurance, care delivery, and pharmaceuticals to serve the interests of shareholders over patients. On July 4th, it is appropriate to envision our independence from corporate control.

Defining Health Care “Corporatization”, The New England Journal of Medicine, June 28, 2025, by Erin C. Fuse Brown

In Paul Starr’s seminal 1982 work, “The Social Transformation of American Medicine,” he observed the corporatization of health care proceeding along five dimensions: the shift from non-profit and government organization to for-profit companies; horizontal consolidation of locally controlled entities to nationally or regionally controlled corporations; the shift from state single-unit and single-market firms to conglomerate enterprises; vertical consolidation among levels of care delivery and payers; and increasing concentration, size, and scope of organizations. In the four decades since the publication of this work, the U.S. health care system has progressed further along every one of these dimensions toward greater corporatization.

Insurance conglomerates, such as UnitedHealthcare and CVS-Aetna, now control physicians, home care, pharmacies, and pharmacy benefit managers. Vertical consolidation was spurred by the rise of managed care and its value-based progeny, particularly as private insurance companies have assumed a growing role in publicly financed health programs. The term “corporatization” now refers to the general trend throughout the health care industry toward higher levels of integrated control by consolidated profit-seeking enterprises.

Two key elements of this definition are worth highlighting. First is the elevation of profit generation as the primary goal of health care enterprise. Embedded in the term “corporatization” is the concept of shareholder primacy, advanced by neoliberal economists, that the primary duty of the corporation is to maximize shareholder profits. Shareholder primacy subordinates the interests of other stakeholders, such as patients, the health care workforce, or the community.

The second key element of corporatization is consolidation. The sheer size of conglomerate health entities makes them systemically critical and “too big to fail.”

Recently, the term “financialization” has been used to describe the growing involvement of financial institutions, such as private equity firms, using financial tactics to extract wealth from health care companies for investors.

Although profit motive has always existed in medicine, the control that large profit-seeking conglomerates have over the people and entities engaged in health care delivery has intensified and spread to every corner of the health care system. Corporatization has produced a system that is incredibly profitable for investors but increasingly unaffordable, inaccessible, and uncaring for everyone else.

Public satisfaction with the health system is low. Future health policy efforts must confront the fundamental question of whom our health care system is meant to serve: corporate giants or the members of our society as a whole.

Comment:

By Don McCanne, M.D.

The New England Journal of Medicine just released the first article in its series on the corporatization of US health care. Excerpts appear above. Since you, as a reader of Health Justice Monitor, are well-informed on health policy, you likely are unsurprised for corporatization to be described as a scourge for health care.

In an accompanying editorial, Debra Malina et al state, “Despite the fact that the United States leads the world in health care expenditures, American life expectancy at birth is 4 years lower than the average life expectancy in peer countries.”

Tweaking the corporate model will not be adequate to fix this problem. We not only need to replace our private insurance model with a publicly financed and administered model (single payer), we also need to shift the expenditures for health care away from private investors and into financing the health care system itself. We can do this through mechanisms such as public provisioning of health care (i.e. public and truly non-profit ownership of the health care delivery system), and by adopting regulatory oversight that prevents diversion of our health care dollars through nefarious financial gimmickry such as private equity usurpation of the delivery system.

How are we doing? This week we witnessed the passage and signing of federal legislation that will immediately produce massive tax benefits for the most affluent members of our society while mandating reduction or elimination of medical care and other social programs desperately needed by low-income and indigent individuals. These measures will exacerbate the negative effects of corporatization on health care. The GOP knows the cuts are unpopular, and hopes to elude electoral repercussions by deferring implementation until after the 2026 mid-terms.

It is fine to follow the monthly NEJM series, but don’t wait until the end of the series to begin thinking about what we need to do. Begin immediately with the transformation of the insurance system from private to public, and start on the long and arduous path to shifting our health care dollars away from wealth creation for the intermediaries to paying for the legitimate costs of the services and resources that are needed to provide an optimal health care system for all of us.

Unfortunately, our political system has just demonstrated, once again, that we need to select our leadership based on beneficial public policies that we support rather than on whether or not you enjoy leadership led by arrogant, pompous, blowhard personalities who value their personal wealth far above the fate of the rest of us.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

Atlanta doctors: We can’t let Washington gut Medicaid

By Toby Terwilliger, M.D. and Dhaval Desai, M.D.
The Atlanta Journal-Constitution, July 3, 2025

As physicians, we use the term “Against Medical Advice” when a patient rejects our recommendations. We use it to convey a belief that they are making a decision that puts their health and safety at risk. But what happens when it’s not a patient ignoring our advice, but the government itself?

That’s exactly what the so-called “One Big Beautiful Bill” (HR-1) does — it ignores doctors’ warnings and endangers millions.

This week, physicians throughout Atlanta, throughout Georgia and throughout the country took to the streets and sounded an alarm — Code Red. Just like a Code Blue for a medical emergency, we called this Code, rallied with unified values of humanity in opposition to this bill.

We are sounding the alarm because HR-1 threatens to strip health coverage from about 11.8 million Americans by 2034. According to analysis in the Annals of Internal Medicine, these cuts will lead to as many as 24,000 preventable deaths every year. They would force dozens of rural hospitals to close and worsen our existing crises in maternal health and primary care access. Every health care system and American would feel the aftermath and consequences of this bill because of the challenges that would be imposed on an already over-saturated and fragile infrastructure. Health care systems would be challenged and burdened to keep doing more with less.

We see Medicaid for what it is: a lifeline. It keeps the child with asthma breathing comfortably. It helps grandparents stay safe and independent. It ensures pregnant mothers get lifesaving prenatal care. It supports people with disabilities in a world not designed for them. And it helps working Americans manage chronic conditions so they can stay employed and support their families.

Time and time again, physicians see the deadly consequences when patients go without health insurance. From cancers caught too late, vital medications skipped, chronic, controllable diseases spiraling into preventable crises, families crushed by unpayable medical bills. Knowing that stories like these will become exponentially more common is beyond disheartening; it is utterly sickening.

Physicians have taken the Hippocratic Oath, which stands by “First, do no harm.” This bill will do nothing but harm. That’s why we, as physicians, are united in speaking out. We know that cuts to Medicaid will jeopardize the lives and livelihoods of patients. We cannot remain silent while politicians pursue policies that will do irreparable harm to an already compromised health care system. Let’s remember that Medicaid is not charity, but it’s essential and lifesaving care. Our patients need more access, not less. We need to expand Medicaid, not eliminate it.

Congress: Stop playing politics with people’s lives. This time, listen and act on the medical advice from thousands of concerned physicians around the country. Do no harm.

Dr. Toby Terwilliger is an Atlanta-based physician who serves as co-chair of Georgians for a Universal Health Program and sits on the Board of Directors of Physicians for a National Health Program.

Dr. Dhaval Desai is an Atlanta-based Internist and Pediatrician, as well as an author passionate about mental health and burnout among healthcare workers.

https://ajc.com…

Physicians call for health care for all West Virginians

By Kenneth Wright, M.D.; John Aldis, M.D.; Agnes Franz, M.D.; Mike Schroering, M.D.; Dan Doyle, M.D.; and Joseph Golden, M.D.
The (Beckley, WV) Register-Herald, July 2, 2025

We are members of the WV chapter of Physicians for a National Health Program. We treat West Virginians of all income levels: low, middle, and upper income. Low and middle income people are struggling to find a stable and financially secure home life. These are people in our communities, people with whom we work, worship, and play. Our children and theirs attend school together.

Physicians for a National Health Program advocates that high quality health care be available to all people in the United States, without regard to socio-economic status, race, or gender.

We believe this should be a public right, as it is in Canada and European countries.

Right now, we are concentrating on the attempt by the Republican majority in Congress and the President to decrease funding for Medicaid and SNAP (food assistance), as they are currently administered. This attempt is through HR1, what the President calls the “One Big, Beautiful Bill.”

If this measure passes and is implemented, it will have devastating effects here in West Virginia, one of the poorest states in the country. In W.Va. 75,000 of those receiving Medicaid, and 65,000 getting SNAP (Food Stamps), will lose this support. One in three West Virginians rely on Medicaid for their health care. Many elderly in nursing homes rely on Medicaid funding for their care. And those nursing homes rely on that income to remain open. And the nursing employees rely on those jobs to feed their own families.

The drafters of HR1 have no idea what it feels like to be poor, what it feels like to be hungry, what it feels like to choose between food or medicines, what it feels like to have a loved one rejected by a nursing home because Medicaid no longer covers this treatment.

These massive cuts to Medicaid and SNAP are being done to offset tax breaks that mostly benefit well to do families. If a family earns $556,000 or more, they get approximately $50,000 extra income for which they have no survival need. People at this level can afford health insurance, and no problem providing food for their meals. In contrast families earning $55,000 or less in West Virginia will get little or no extra income from the “tax breaks” in HR1.

Many hospitals in West Virginia, especially in rural areas, rely on Medicaid funding to pay their operating expenses, including paying their employees. Seven more rural hospitals in West Virginia risk closure if this proposed shrinkage in Medicaid funding occurs. Not only will low-income people not be able to get health care, but many current employees of hospitals and other health care organizations would be laid off.

As members of PNHP-WV, we ask all citizens to think about how loss of Medicaid or SNAP food assistance will affect their families.

Contact our two U.S. Senators Capito and Justice, and two Representatives Miller and Moore in Washington. Tell them the concerns about the consequences for themselves and their families. We look for the day of improved Medicare for All when everyone will be covered with no exclusion from needed primary care, specialist care, hospital care, or medications.

But now we must fight against going backwards. Against adding more than 11 million nationwide to the 28 million already uninsured. Against 7,000 preventable deaths per year due to lack of medical care. Against severe economic harm to our fellow citizens and our state.

Dr. Kenneth Wright is the chair of PNHP-WV; Dr. John Aldis is the treasurer; Dr. Agnes Franz is the secretary; Dr. Mike Schroering is past-chair; and Dr. Dan Doyle and Dr. Joseph Golden are active members.

https://register-herald.com…

Recent Experience Shows National Medicaid Work Requirements Would Create Enormous Administrative Inefficiencies

By Adam Gaffney, M.D., M.P.H.; David U. Himmelstein, M.D.; Danny McCormick, M.D., M.P.H.; and Steffie Woolhandler, M.D., M.P.H.
Health Affairs Forefront, July 2, 2025

The “One Big Beautiful Bill Act” (OBBB) — passed by the House on May 22 and yesterday in the Senate — would make Medicaid coverage for adults contingent on enrollees’ regularly documenting that they are working, are actively seeking work, or qualify for an exemption. The Congressional Budget Office (CBO) estimates that this “work requirement” provision would push 5.2 million people off Medicaid, including many who were already working or should be eligible for exemptions, but who would fail to properly document their circumstances. We and others have projected that those coverage losses would inflict substantial health harms, including thousands of medically-preventable deaths.

Repetitively documenting and monitoring whether Medicaid enrollees have met the work requirements (or are eligible for exemptions) would also require significant administrative expenditures by states’ Medicaid programs — red-tape costs that deserve greater scrutiny as legislation approaches the desk of the President.

Looking Back: Administrative Costs Of Medicaid Work Requirements In 6 States

The first Trump Administration encouraged states to seek Section 1115 Medicaid waivers that would — for the first time in Medicaid history — require enrollees to document work or face disenrollment. CMS ultimately approved 13 states’ applications, although only Arkansas actually disenrolled noncompliant enrollees; disenrollments in other states were stalled either by court orders or the COVID-19 pandemic. Subsequently, the Biden administration rescinded approval of all work-requirement waivers, although a federal court order later reinstated Georgia’s waiver which is now in operation.

These requirements impose new administrative costs on states, which must develop, upgrade, and maintain electronic eligibility and enrollment systems; hire and train staff to process and monitor documentation; and educate beneficiaries. In a 2019 report, the US Government Accountability Office (GAO) assessed the administrative costs associated with implementing (or preparing to implement) work requirements in 5 states: Kentucky, Wisconsin, Indiana, Arkansas, and New Hampshire. Exhibit 1 displays the GAO’s estimates of new administrative costs in each state, the number of beneficiaries subject to work requirements, and our calculations of costs per beneficiary. Administrative spending for implementation ranged from $6.1 million (New Hampshire) to $272 million (Kentucky). Administrative costs per beneficiary subject to work requirements averaged $267, ranging from $84 (in Indiana) to $463 (in Wisconsin). …

Looking Ahead: Work Requirements In The One, Big Beautiful Bill Act And New Section 1115 Waivers

Congress and President Trump look set to impose billions in new bureaucratic costs on Medicaid in order to disenroll 925,000 people not meeting the work requirements, along with 4.3 million others who would likely meet those requirements but be unable to navigate the thicket of red tape required to enroll in or maintain coverage.

Even before the OBBB, the Trump Administration has been approving Section 1115 waivers that would impose work requirements in 3 states, and encouraging waiver applications from other states. Such work requirements will harm the health and finances of millions of low-income Americans, but an even larger share of Americans will pay for the bureaucratic costs needed to operate these programs. …

full analysis: https://healthaffairs.org


Dr. Adam Gaffney on “Democracy Now”

PNHP past president Dr. Adam Gaffney appeared on “Democracy Now” on June 30, 2025. He discussed the dire implications of the Republican budget bill making its way through Congress.

“Nearly 12 million people would lose health coverage,” he said. “We estimate [in a recently published Annals of Internal Medicine study] this translates to 1.9 million Americans losing their doctor, 1.3 million Americans going without needed medications, 1.2 million Americans being saddled with medical debt, and 380,000 women going without their needed mammograms.

Biggest of all, we estimate more than 16,500 deaths annually as a result of the coverage losses that would be inflicted by the so-called Big, Beautiful Bill Act.”

Laying out the Ill-Effects of Medicaid Cuts in the Congressional Budget Bill

A new analysis reviewing all evidence regarding the likely impact of proposed Congressional Medicaid cuts quantifies the dire consequences of slashing coverage. About 7 million individuals will become uninsured, >2 million will skip care, and annual deaths will increase by 8-24 thousand.

Projected Effects of Proposed Cuts in Federal Medicaid Expenditures on Medicaid Enrollment, Uninsurance, Health Care, and Health, Annals of Internal Medicine, June 17, 2025, by Adam Gaffney, David U. Himmelstein, and Steffie Woolhandler

From the Abstract:


 Enactment of the House bill [Medicaid cuts] advanced in May 2025 would increase the number of uninsured persons by 7.6 million and the number of deaths by 16,642 annually 


Policy makers should weigh the likely health and financial harms to patients and providers of reducing Medicaid expenditures against the desirability of tax reductions, which would accrue mostly to wealthy Americans.

Comment:

By Jim Kahn, M.D., M.P.H. and Don McCanne, M.D.

Drs. Gaffney, Himmelstein, and Woolhandler perform a critically important service: they compile and summarize the voluminous evidence that 
 health insurance provides access to care, improving health and extending life. And taking away health insurance has the opposite effects, harming health and increasing deaths. Of course we know that. But when these health policy leaders quantify what to expect with the specific proposed Medicaid cuts in the Congressional budget reconciliation bill, even the two of us – seasoned health policy analysts – are stunned. The accumulated empirical evidence is persuasive, and the anticipated harms are shocking.

We’ve taken the liberty of creating a summary table with the core findings (see above). Uninsured numbers rise by 6.8 million among adults (plus about 1 million among children), with 8 – 24 thousand added deaths. For more detail, especially about reductions in access to care and general health status, check out the article. And also see the PNHP press release here and NBC coverage here.

As we’ve reported previously, most voters oppose Medicaid cuts, even among Trump supporters. And in the last couple of days, the Senate parliamentarian deemed up to 40% of the cuts unacceptable by Senate budget bill rules. So we have some hope that these efforts to slash Medicaid will wither on the vine.

But they won’t wither on their own. It is essential for opponents to speak up.

Share this information widely. People need to know.

https://healthjusticemonitor.org…

Stay informed! Subscribe to the McCanne Health Justice Monitor to receive regular policy updates via email, and be sure to follow them on Twitter @HealthJustMon.

How To Make America Sick

The Trump administration’s plan to “Make America Healthy Again” will make Americans’ health worse.

By Donald Berwick, M.D., M.P.P., F.R.C.P.
Center for American Progress, June 26, 2025

It might seem obvious that the United States, the wealthiest country on earth, would have the best health and health care. But we do not. Not even close. So when President Donald Trump, Secretary of Health and Human Services Robert F. Kennedy Jr., and their allies in Congress propose to “Make America Healthy Again,” it’s easy to get on board. The trouble is that their plan won’t work. In fact, it will make Americans’ health worse. They are currently proposing to cut Medicaid and Medicare, decimate public health structures, withdraw support for food security and other basic needs, and harm the environment—all of which is dead wrong from a scientific viewpoint.

There is no disputing that America’s health care system needs a dramatic overhaul. U.S. life expectancy ranks 49th globally at more than four years lower than that of world’s healthiest countries. Our children’s health ranks 36th among the 38 richest nations. Not a single U.S. state has an average life expectancy longer than that of comparably wealthy nations. If the goal is to make America as healthy as other wealthy nations, it would be hard to do worse than we are doing right now. And for that terrible performance, the United States spends twice as much per capita on health care as the average wealthy country—with more than 110 million Americans struggling with medical debt.

So, yes, by all means, let’s “make America healthy.” However, unlike how the Trump administration and RFK Jr. are going about it, doing so requires following the science.

In 2015, the revered British epidemiologist Michael Marmot wrote “The Health Gap,” arguably the best playbook for making any country healthier. The book summarizes decades of research on why health varies enormously among places with ostensibly similar conditions. The gap in health outcomes can be between nations, between subgroups within nations, and even across the tracks in a single city. For example, Black Americans had a lifespan six years shorter than that of white Americans in 2021; residents of west Chicago live 14 years less than residents of the Chicago Loop; and across the city of Boston, lifespan varies by more than two decades.

Marmot sorts known causes of health gaps into buckets including early childhood experiences, education, workplace conditions, supports to the elderly, and community “resilience”; he also looks at the impact of attributes such as food security, housing security, transportation systems, clean air, compassionate criminal justice systems, and recreational opportunities. Through that lens, a scientifically guided plan for “making America healthy” is simple to devise: Invest in what drives health.

This is why what RFK Jr. and the Trump administration are doing makes no sense. Watch the administration, and it would be hard to find a better way to “make America sick.” It’s like “opposite day”: Every single component of the Marmot playbook is being not only neglected but controverted through the administration’s actions. Let’s run the list.

Kids

Healthy societies tend to place their bets on safe perinatal care, strong supports for the early years—say, from birth to age 3—and school readiness, which means not only helping children but also their parents. Contrast that with the House-passed One Big Beautiful Bill Act that instead cuts food stamps by nearly $300 billion and enacts a historic $793 billion cut to Medicaid and the Children’s Health Insurance Program, which cover 50 percent of the children in America.

Education

People in countries and regions with strong educational systems, especially those that include girls and women, tend to live longer. Overall, the U.S. education system ranks 31st in the world, and it varies widely, with many schools performing poorly and many students underachieving. This is neither the teachers’ fault nor the students’. It boils down to ensuring that all children and youth, regardless of where they live or how wealthy their families are, have access to the highest quality education. The proper response would be to pour resources into delivering on that promise. On the contrary, the Trump administration’s plan calls for slashing funding for the Department of Education, cutting support to K-12 programs, and eliminating federal subsidies for student loans.

Workers

Job security is also foundational to national health. Unionization, which has been backwatered in the United States, is one straight shot to improving worker power. So is raising the federal minimum wage far above its embarrassingly low level of $7.25 per hour, instituting stronger legal protections for workers’ rights, and establishing more equity in tax and compensation policies. The Trump administration, meanwhile, seeks to abolish the Consumer Financial Protection Bureau, hamstring the Department of Labor, reduce bargaining rights for federal workers, weaken worker protections, and cut the essential food assistance and health care programs that the working class relies on, all to give massive tax cuts to the wealthiest Americans.

Seniors

How a nation supports its aging and elderly population affects not only how long and well its older citizens live, but also the health and well-being of a country’s entire population. The Trump administration claims to want to protect Medicare—a mainstay of security for those age 65 and older in the country—but study the details of what the president and his congressional allies are doing so far, and you will find steadily weakening protections for coverage, reduced access to care, and thousands of dollars more in out-of-pocket costs. For example, Medicaid, which would be torpedoed by the House-passed reconciliation bill, is the primary payer for 63 percent of people in nursing homes. Where are the elderly Americans who rely on that care supposed to go?

Communities

Healthy communities help ensure access to nutrition, housing, safety, mobility, and opportunity for everyone. The Trump administration is already weakening every one of those things and is poised to damage them further. The administration is hurting public transportation systems and rolling back environmental controls for particulate air pollution. It is also publicly in favor of coal and against wind power, against public housing expansion, against mental health supports to help reduce violence, and has backpedaled on criminal justice reform.

Conclusion

President Trump and Secretary Kennedy can preach all they want about making us healthy again, but their rhetoric is no substitute for facts. The right way to “Make America Healthy Again” is to invest in the infrastructure, programs, and priorities that we know, based on scientific evidence, will actually improve health—the very same ones that the Trump administration seems intent on destroying.

Dr. Donald M. Berwick is a former administrator of the Centers for Medicare and Medicaid Services and a senior fellow at the Center for American Progress.

https://www.americanprogress.org…