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Former insurer executive warns vertical integration and MLR loopholes let insurers shift profits into owned providers
Summary
At a Senate HELP Committee hearing, Wendell Potter, president of the Center for Health and Democracy and a former insurance executive, testified that insurers' vertical integration and accounting workarounds are contributing to consolidation, higher prices and reduced patient choice.
At a Senate HELP Committee hearing, Wendell Potter, president of the Center for Health and Democracy and a former insurance executive, testified that insurers' vertical integration and accounting workarounds are contributing to consolidation, higher prices and reduced patient choice.
Why it matters: Witnesses argued that insurer‑owned provider entities and insurer‑owned PBMs allow companies to record intercompany transfers as medical spending under the Affordable Care Act's medical loss ratio (MLR) rules, enabling higher…
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