Who's taking your money in healthcare, and how. Free markets, independent physicians, receipts. Read by physicians who refuse to be last to know.
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Affordable Care Act Celebrates Second Consecutive Year of Double-Digit Affordability
Proposed ACA premiums for 2027 increased by a median of 14%. Benchmark premiums could rise more than one-third between 2025 and 2027.
Washington can restore affordability by sending insurers enough taxpayer money to conceal the price.
Congress stopped physicians from building new hospitals in 2010.
The knee replacements kept happening anyway.
The patient still needed surgery. Someone still supplied the operating room, the staff and the equipment. Someone still collected the facility payment and kept what remained after expenses.
Section 6001 removed one class of owner from that transaction: the physician. It placed no requirement on the incumbent hospital to give up the margin those physicians would have earned. Block the entrant, and the business stays with the incumbent.
Frank Pallone spent years building toward that outcome. He called physician-owned hospitals overutilized in 2008, then helped write the law that ended new ones two years later.
Physicians can still do the work. What they lost was the right to own the hospital, control its operations and share in its earnings. The established system kept something far more valuable than a statute: protection from a physician-owned competitor.
Nobody passed a law against the profit. They passed a law against who could earn it.
Full piece in The Rojas Report.
Frank Pallone thinks a surgeon who owns the operating room is a conflict of interest.
A hospital that owns the surgeon is apparently a business model.
In 2007, Pallone took the gavel of the House health subcommittee and cosponsored CHAMP, which would have frozen physician-owned hospitals in place.
In 2008, he called those hospitals "overutilized." In 2010, Section 6001 of the ACA shut the door on new ones and froze the beds and operating rooms of the ones already built.
Meanwhile, hospital systems kept buying physician practices. Prices for services from acquired physicians rose an average of 14.1%. Nobody in Washington froze anything.
Ownership in one direction met a federal barrier; ownership in the other remained an ordinary business strategy.
The conflict of interest Pallone described never disappeared.
A hospital that employs the surgeon, owns the operating room and collects the facility payment holds every incentive he accused physicians of having. The difference is who gets to keep the money.
New in The Rojas Report. Link below.
The Rojas Report retweeted
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Owning hospitals apparently wasn’t enough. Vermont’s largest health system also owned the organization distributing money to hospitals.
The University of Vermont Health Network owned OneCare, which managed more than $500 million in hospital payments in 2025, its final year of operations.
Think about that arrangement. The hospital system delivering the care also owned the organization helping distribute the payments.
Vermont abandoned its single-payer proposal. It continued concentrating control over the care and the money.
You can learn quite a bit about healthcare reform by checking who owns the reform.
Non Profit Hospitals qualified for cheap insulin because patients needed it.
Being diabetic was not enough to get the same price.
Our upper estimate puts Pennsylvania’s 340B hospital tax breaks at $2 billion annually.
Reported charity care: $529 million.
Before the next lecture about generosity, let’s establish who’s donating to whom.
Owning hospitals apparently wasn’t enough. Vermont’s largest health system also owned the organization distributing money to hospitals.
The University of Vermont Health Network owned OneCare, which managed more than $500 million in hospital payments in 2025, its final year of operations.
Think about that arrangement. The hospital system delivering the care also owned the organization helping distribute the payments.
Vermont abandoned its single-payer proposal. It continued concentrating control over the care and the money.
You can learn quite a bit about healthcare reform by checking who owns the reform.
UnitedHealth's proudest number this quarter is the one you were not meant to notice.
Its medical care ratio dropped to 88.4 percent.
That means less of your premium paid for care and more of it stayed with them.
They booked it as a win. Yours or theirs?
Same company. Same week. Sued over insulin prices, and posted a record profit.
OptumRx sets drug prices for millions. UnitedHealth owns OptumRx. UnitedHealth just made $4 billion in a quarter.
The spread a state is calling a scheme is the margin the shareholders are calling a beat.
A $50,000 private school bill requires $83,333 in earnings if taxes take 40%.
Plus property taxes for the school the family left.
The government can fail to deliver the education. It still collects the taxes.
Parents get the bill for both.
UnitedHealth cleared more than $4 billion in 90 days.
In a market with real competition, a margin that fat is already gone. Someone prices under you and it vanishes.
Nobody priced under them. It grew.
Three firms hold 80 percent of the drug-pricing chokepoint. That is a moat, not a market.
There’s a business in helping hospitals find drug discounts their other businesses haven’t found yet.
8 Bridge Group acquired a majority stake in 340BIntel, software that recovers additional 340B savings. It works alongside hospitals’ existing administrators.
340BIntel targets another 120 nonprofit hospitals by late 2027. Its buyer calls the acquisition phase one of a broader healthcare technology initiative projected to generate more than $2 billion over a decade.
I understand the investment thesis. Build software that finds money, then sell it to organizations that want more money.
The same program makes two rather different sales pitches. To the public, 340B is a fragile safety net. To investors, it offers expansion, software revenue and recoverable dollars.
Both can be true. But a hospital collecting more money doesn’t automatically mean a patient pays less.
The patient needs a line in the investment presentation somewhere besides the mission statement.
Imagine your insurance company settling a payment dispute by explaining that it has consulted itself.
That is our objection to Rep. Frank Pallone’s proposal to replace independent arbitration under the No Surprises Act with payments based on median in-network rates calculated by insurers.
The bill is called “Lower Premiums, Faster Payments.”
Lovely packaging.
We would still like to inspect the contents.
Independent dispute resolution gives physicians somewhere to challenge an insurer’s payment.
Remove it and you change the negotiation before anyone submits a claim.
The insurer knows the physician has lost an independent avenue of appeal.
We are particularly concerned about it finding its way into a lame-duck package after the election, when physicians are treating patients and Congress is trying to get home.
If a proposal can withstand scrutiny, give it a hearing and a separate vote.
A change this consequential deserves more than a boarding announcement…
It was an excellent weekend for discovering that reputation is no substitute for performance.
The White House appears to have outsourced its reference checks to the press.
Katie Zacharia lasted five days as press secretary. After questions about calling herself a lawyer without passing the bar, she said nobody asked about that before hiring her.
That’s quite an arrangement. Hire the person, announce the appointment, then let the journalists conduct the interview.
A law license isn’t required for the job. Checking a public claim before handing someone the microphone seems reasonably affordable.
Meanwhile, Ole Miss beat Missouri 31–3, and Georgia, Alabama, Texas and Notre Dame all lost. Wow!
Hotty Toddy.
A tax exempt corporation’s drug discount and a patient’s drug discount are two different numbers.
Tracking the first does not establish the second.
The tax payer funded corporation may use the money to reduce a patient’s bill.
It may finance a clinic, extend service hours, or retain it for future spending.
Those choices deserve separate reporting because they produce different benefits, for different people, at different times.
My proposal: pair 340B transaction reporting with comparable figures for patient assistance and services financed.
That would let institutions demonstrate what the discounts accomplished beyond lowering their purchase expenses.
A patient identifier proves we can find the patient.
It does not prove we helped them.
Eli Lilly wants to see the receipts before it hands over a discount.
In any normal market, that's called doing business.
Some manufacturers now ask tax exempt corporations aka “hospitals” for claims data before honoring 340B pricing, to confirm they aren't paying the same discount twice.
The tax payer funded businesses sued.
On October 8, the industry split into dueling amicus briefs.
Here's what the fight exposes.
When a price is mandated instead of negotiated, no one trusts the numbers, so you get permanent audit warfare instead of a transaction.
A seller that can verify what it's paying for isn't the villain.
It's the one party in this program still acting like a business…
I wonder whether anyone has ever opened a hospital bill and felt better after discovering the hospital was a nonprofit?
The amount due remains remarkably unmoved by the organization’s tax status.
A nonprofit can deliver extraordinary care.
It can also collect a fee that leaves a family staring at the kitchen table long after dinner.
The designation tells us something about the organization.
It does not tell the patient whether the bill is reasonable.
I’d be more impressed by a hospital that introduced itself with its prices.
“We’re a nonprofit” is an interesting opening line for an organization about to ask how you intend to pay.
Humana plans to eliminate Medicare Advantage plans covering roughly 600,000 people. Then it wants to “recapture” a significant share of those people in other Humana plans.
Recapture. Lovely word for someone who bought health insurance.
Management described the objective plainly: retain members while making changes that improve margins.
The company gets to redesign the product. The senior gets to check whether the replacement still covers her physician, her prescriptions and the care she expects to need.
Imagine your insurer canceling your plan and then counting your return as a sales achievement.
Some businesses generate their own leads.
A free market doesn't need a law firm on retainer.
340B does.
On October 9, the American Hospital Association and four hospitals sued HHS to stop the revised rebate pilot.
They filed in the District of Maine, the same court that blocked version one last December.
Think about what the lawsuit is really protecting.
Not patient care.
The timing of a government-mandated discount, and who floats the cash in between.
When your business model lives or dies on a court ruling about a subsidy's mechanics, you’re just a thieving grifter…