{"id":1579,"date":"2025-12-23T09:00:00","date_gmt":"2025-12-23T10:00:00","guid":{"rendered":"http:\/\/www.dangeladvertising.com\/?p=1579"},"modified":"2025-12-26T15:05:24","modified_gmt":"2025-12-26T15:05:24","slug":"an-arm-and-a-leg-a-few-more-good-things-from-2025","status":"publish","type":"post","link":"http:\/\/www.dangeladvertising.com\/index.php\/2025\/12\/23\/an-arm-and-a-leg-a-few-more-good-things-from-2025\/","title":{"rendered":"An Arm and a Leg: A Few More Good Things From 2025"},"content":{"rendered":"

An Arm and a Leg<\/em> host Dan Weissmann breaks down how two states passed laws aimed at protecting people from things like medical debt, insurance delays and denials, and corporate profiteering.<\/p>\n

In Maine, lawmakers unanimously voted to remove medical debts from credit reports. While a nationwide court ruling has cast doubt on the new law\u2019s future, a consumer rights attorney tells Weissmann why she remains optimistic.<\/p>\n

And a law in Oregon aims to prevent corporations and private equity firms from gobbling up medical clinics, raising prices, and, sometimes, delivering worse care.<\/p>\n

Plus, the team behind An Arm and a Leg <\/em>has some good news of its own to share.<\/p>\n

\tDan Weissmann<\/p>\n

\t\t\t
\n\t\t\t\t@danweissmann\t\t\t<\/a><\/p>\n

\t\t\tHost and producer of “An Arm and a Leg.” Previously, Dan was a staff reporter for Marketplace and Chicago’s WBEZ. His work also appears on “All Things Considered”; Marketplace; the BBC; “99 Percent Invisible”; and “Reveal,” from the Center for Investigative Reporting.\t\t<\/p>\n

\n\t\tCredits\t<\/h3>\n

\tEmily Pisacreta
\n\tProducer<\/p>\n

\tClaire Davenport
\n\tProducer<\/p>\n

\tAdam Raymonda
\n\tAudio wizard<\/p>\n

\tEllen Weiss
\n\tEditor<\/p>\n

\t\t\t\t\tClick to open the Transcript\t\t\t\t<\/p>\n

\t\t\t\t\t\tTranscript<\/strong>: Some more things that didn\u2019t suck in 2025<\/strong><\/strong>\t\t\t\t<\/p>\n

Note: \u201cAn Arm and a Leg\u201d uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.<\/em><\/p>\n

Dan:<\/strong>\u00a0Hey there\u2013<\/p>\n

It has been a long year, and yes, 2026 is shaping up to be a doozy.<\/p>\n

As I record this, it\u2019s looking like any hope that Congress will extend certain \u00a0 \u00a0 Obamacare subsidies for next year are looking like a long shot. Experts say millions of people could lose insurance coverage.<\/p>\n

And\u2013 not to rub it in\u2013 but the federal government actually backtracked this year on another issue we\u2019ve talked about here: Keeping medical debts off of people\u2019s credit reports.<\/p>\n

The Biden administration spent years crafting a rule to establish that protection.<\/p>\n

The Trump administration has actually said recently: those protections are ILLEGAL.<\/p>\n

But states have been enacting laws of their own this year \u2026 which means lots of people are still protected.\u00a0<\/p>\n

And this is where we pick up a series we started a few weeks ago \u2014 looking at things that DID NOT SUCK in 2025.<\/p>\n

Cuz not only did some states fill in holes left by the feds .Other states were staking out new ground.\u00a0<\/p>\n

For example, a new law in Oregon goes hard at a core reason why health care keeps costing more all the time:\u00a0<\/p>\n

Big corporations and investors keep gobbling up more and more medical practices\u2014 jacking up prices and\u00a0 (at least sometimes) delivering significantly crummier care.<\/p>\n

Oregon\u2019s new law aims to slam the brakes on that.<\/p>\n

In fact, lots of states have done lots of things that did not suck this year.<\/p>\n

A few weeks ago, we looked at state laws that push back against some ways insurance companies delay and deny care.\u00a0<\/p>\n

And new state laws that protect people from getting their homes and their paychecks taken away because of medical debt.<\/p>\n

Laws like these passed in lots of states \u2014 red states, blue states, purple states. With bipartisan support.<\/p>\n

So did laws restricting middleman companies like pharmacy benefit managers from jacking up what people pay for drugs. And laws restricting price-gouging by hospitals.<\/p>\n

We\u2019re digging into these few examples to look at how laws like this get made\u2013 and defended.\u00a0<\/p>\n

They take a combination of political work and some hard-core nerding out. And when they pass, laws like Oregon\u2019s become models other states can pick up on.<\/p>\n

So, let\u2019s go.<\/p>\n

This is An Arm and a Leg\u2013 a show about why health care costs so freaking much, and what we can maybe do about it. I\u2019m Dan Weissmann, I\u2019m a reporter, and I like a challenge. So the job we\u2019ve chosen here is to take one of the most enraging, terrifying, depressing, parts of American life and bring you a show that\u2019s entertaining, empowering, and useful.<\/p>\n

Of the half-dozen states that passed laws to keep medical debts from dinging people\u2019s credit, most of them look \u201cblue\u201d on a political map: New Jersey, Rhode Island, California.<\/p>\n

But Maine is a little more purple. And Maine\u2019s law passed unanimously.<\/p>\n

Here\u2019s State senator Donna Bailey, who sponsored it.<\/p>\n

Donna Bailey:<\/strong>\u00a0I don\u2019t remember a lot of heavy pushback, which was pleasantly surprising to me, quite honestly.<\/strong><\/p>\n

Dan:<\/strong>\u00a0Surprising because it\u2019s not like just saying \u201clet\u2019s help people with medical debts\u201d guarantees success in Maine.\u00a0<\/p>\n

Donna Bailey:<\/strong>\u00a0We did have a bill last session that did not go through and did not have bipartisan support.<\/strong><\/p>\n

Dan:<\/strong>\u00a0Donna Bailey had sponsored that one too.\u00a0This time, she was determined to win. When she campaigned for re-election, she promised to go for it. She says her previous bill had been more complicated. This one had a single focus.\u00a0<\/p>\n

And when it came up in committee, her colleagues heard some compelling testimonies.<\/p>\n

Patty Kidder:<\/strong>\u00a0We pay our mortgage on time every month. But because of unpaid medical bills, we were unable to just go buy a new or used car when the engine blew in our only working vehicle\u2026<\/strong><\/p>\n

Andrea Steward:<\/strong>\u00a0I began accumulating my own medical debt at 17 when I discovered, which I only discovered on my credit report, when I was trying to purchase my first home in 2022\u2026<\/strong><\/p>\n

Dan:<\/strong>\u00a0But legislators also heard hard numbers. Fresh numbers, released that very day<\/p>\n

From a survey showing that almost half of Mainers were carrying medical debt.<\/p>\n

A lot of them wound up with dings on their credit because of it. Which meant \u2014 as they said in the survey \u2014 medical debt on credit reports was causing them real problems.<\/p>\n

Ann Woloson:<\/strong>\u00a0It\u2019s affecting their ability to get jobs. It\u2019s affecting their ability to buy a car. It\u2019s affecting their ability to rent an apartment. Something needs to be done about it.<\/strong><\/p>\n

Dan:<\/strong>\u00a0That\u2019s the person who commissioned the survey.<\/p>\n

Ann Woloson:<\/strong>\u00a0I\u2019m Anne Woloson and I\u2019m executive director for Consumers for Affordable Healthcare, a nonprofit, nonpartisan advocacy organization based in Maine.<\/strong><\/p>\n

Dan:<\/strong>\u00a0How long has the organization been around?<\/strong><\/p>\n

Ann Woloson:<\/strong>\u00a0We\u2019re gonna be celebrating our 40th anniversary next year.<\/strong><\/p>\n

Dan:<\/strong>\u00a0Wow. And you haven\u2019t solved the problem of affordable healthcare in 40 years.<\/strong><\/p>\n

Ann Woloson:<\/strong>\u00a0Nope. Unfortunately. I guess I\u2019m not doing a very good job. Right.<\/strong><\/p>\n

Dan:<\/strong>\u00a0Well, there might be some countervailing forces.<\/strong><\/p>\n

Dan<\/strong>:<\/strong>\u00a0Hearing the story behind this bill, I don\u2019t think Ann Woloson is bad at her job.<\/p>\n

For years, she\u2019s convened a strategy meeting on Thursday mornings at 9am. Consumer advocates, health care advocates.\u00a0<\/p>\n

Ann Woloson:<\/strong>\u00a0We used to meet at the State House pre pandemic, but now we meet over, we meet over Zoom slash telephone. However. Whatever\u2019s easy. Sometimes people are in their car.<\/strong><\/p>\n

Dan:<\/strong>\u00a0She says in fall 2024, the group started looking ahead to the next legislative session.\u00a0<\/p>\n

Ann Woloson:<\/strong>\u00a0We were starting to talk about like what more can we do with medical debt? And somebody probably said, well, I\u2019ve been talking to Senator Bailey and she\u2019s interested in submitting a bill to address the reporting of medical debt to creditors. And we\u2019re all like, oh, that sounds like a great idea. That\u2019s something we can get behind.\u00a0<\/strong><\/p>\n

Dan:<\/strong>\u00a0Ann Woloson found some money in her budget to run a survey \u2014 like twelve thousand dollars.<\/p>\n

Ann Woloson:<\/strong>\u00a0Which maybe doesn\u2019t sound like a lot, but for a small nonprofit, that\u2019s a, that\u2019s a lot of money.<\/strong><\/p>\n

Dan:<\/strong>\u00a0I don\u2019t have it in my pocket. Right? It\u2019s money.<\/strong><\/p>\n

Dan:<\/strong>\u00a0Ann Woloson says: this was a strategic investment.<\/p>\n

Ann Woloson:<\/strong>\u00a0We will frequently hear from industry representatives that such and such. This is not really a problem. I don\u2019t know where this is coming from.<\/strong><\/p>\n

Dan:<\/strong>\u00a0And they dismiss individual testimony as a few isolated hard-luck stories.<\/p>\n

Ann Woloson:<\/strong>\u00a0Well, here we have this survey that shows, yeah, medical debt is a problem. So it\u2019s not just something that we\u2019re pulling out and saying is a problem.<\/strong><\/p>\n

Dan:<\/strong>\u00a0Nobody voted against the bill. Not in committee. Not on the Senate floor, not in the House. It was a better return on investment than Ann Woloson had hoped for.\u00a0<\/p>\n

Ann Woloson:<\/strong>\u00a0So there was, I would say, almost a unanimous feeling out there that something needed to be done about this. I wasn\u2019t really expecting that.<\/strong><\/p>\n

Dan:<\/strong>\u00a0State Senator Donna Bailey says she thinks \u2014 along with the survey \u2014 the Biden administration\u2019s push on the issue helped. Partly because it raised the issue\u2019s profile.<\/p>\n

And partly because the actual rule\u2013 finalized just before Biden left office \u2014 may have left opponents thinking the stakes were lower.\u00a0<\/p>\n

Donna Bailey:<\/strong>\u00a0Some politicians who may have been opposed, were just like, well, it doesn\u2019t matter if we pass something on the state level. It\u2019s already, you know, forbidden at the federal level, so going to put their energies elsewhere.<\/strong><\/p>\n

Dan:<\/strong>\u00a0On the other hand, advocates like Ann Woloson were looking at something else: The 2024 election results. Joe Biden may have pushed through this rule before leaving office, but he was still\u2026 leaving office.\u00a0<\/p>\n

Ann Woloson:<\/strong>\u00a0It was in the back of my mind and probably several other people\u2019s minds, that were working on this um, that we needed to codify something in Maine in case something changed at the, at the federal level.\u00a0<\/strong><\/p>\n

Dan:<\/strong>\u00a0Which of course, something did. Within weeks of taking office, the Trump administration effectively shuttered the agency behind the rule: the Consumer Financial Protection Bureau.<\/p>\n

By that time, the collections industry had already sued to invalidate Biden\u2019s medical-debt rule.<\/p>\n

The Trump administration ?didn\u2019t do much to fight that lawsuit, and over the summer a federal judge found the rule illegal. Donna Bailey and her allies were definitely watching.\u00a0<\/p>\n

Donna Bailey:<\/strong>\u00a0We\u2019re like, wow. You know, thank goodness we put something in law at the state level.<\/strong><\/p>\n

Dan:<\/strong>\u00a0But there was a new potential threat. The judge who zapped the federal rule went farther.<\/p>\n

In his ruling, he wrote that not only did the Biden rule violate a law called the Fair Credit Reporting Act\u2013 but that same federal law would pre-empt state laws like Maine\u2019s, and nullify them.<\/p>\n

Then, a few months later, in October, Trump\u2019s CFPB issued its own legal opinion \u2014 basically elaborating on the judge\u2019s reasoning, arguing that, yep: State laws like Maine\u2019s should be tossed.<\/p>\n

Which definitely sounds like it sucks.<\/p>\n

But here\u2019s where things get good and nerdy.<\/p>\n

I don\u2019t think anybody\u2019s been pushing on this issue of medical debts and credit reports longer \u2014 or nerding out harder \u2014 than Chi Chi Wu. She\u2019s an attorney with the National Consumer Law Center. You\u2019ve heard from her before on this show.<\/p>\n

She\u2019s not thrilled about the judge\u2019s ruling, but she says it did not suck as much as news reports at the time suggested.\u00a0<\/p>\n

Chi Chi Wu:<\/strong>\u00a0The judge did not quote, unquote, rule that state laws were preempted.\u00a0<\/strong><\/p>\n

Dan:<\/strong>\u00a0She uses a nerdy legal word to describe the judge\u2019s statement about pre-emption: Dicta. Meaning, if I\u2019ve got this right, just talking. Not actually making law on this issue of pre-empting state measures.<\/p>\n

Chi Chi Wu:<\/strong>\u00a0It wasn\u2019t central to the ruling. It wasn\u2019t briefed. He didn\u2019t do any analysis. I mean, preemption under the Fair Credit Reporting Act is really complicated. A little bit head spinning. There\u2019s some case law out there and he didn\u2019t consider any of it because frankly the issue wasn\u2019t really before him. So, that\u2019s the part that didn\u2019t suck as bad as you might think.<\/strong><\/p>\n

Dan:<\/strong>\u00a0Basically, Chi Chi Wu says, to get rid of those state laws, plaintiffs would have to challenge them in court, one at a time. For the record, she thinks the arguments against those laws are weak.<\/p>\n

Chi Chi Wu:<\/strong>\u00a0But they push it. I mean, they push it and they see if a court will buy their arguments. They often push theories that aren\u2019t supported even by the text of the statute. And sometimes they get away with it, unfortunately. I mean, they have very expensive lawyers that, you know, this is how they earn their big bucks by pushing the law as much as they can in favor of their clients.<\/strong><\/p>\n

Dan:<\/strong>\u00a0I actually talked with one of those high-priced lawyers recently. Who was not ready to claim victory\u2013 or accept defeat in advance. She was like, \u201cThese things have to be litigated.\u201d<\/p>\n

Which of course has started. Actually, in Maine.\u00a0<\/p>\n

But Donna Bailey says \u2014 based on early proceedings in that case\u2013 she\u2019s not worried:\u00a0<\/p>\n

Donna Bailey:<\/strong>\u00a0The interesting part was that the court did not put any stay on the legislation, so it was still allowed to go into effect.<\/strong><\/p>\n

Dan:<\/strong>\u00a0That is, the court hasn\u2019t granted a preliminary injunction, which would have prevented Maine from enforcing the law while the case plays out. Which will take \u2026 a while.<\/p>\n

And if courts do eventually rule against states like Maine, Chi Chi Wu has legislative tweaks to suggest that could make state laws more lawsuit-proof.\u00a0<\/p>\n

If you want to nerd out, we\u2019ll have links in our First Aid Kit newsletter.<\/p>\n

But now, we\u2019ll look at a state that came out swinging this year in a big new fight:<\/p>\n

Oregon passed a law to prevent big corporations and investors from taking over medical clinics and basically strip-mining them for profits.<\/p>\n

That\u2019s next.\u00a0<\/p>\n

This episode of An Arm and a Leg is produced in partnership with KFF Health News. That\u2019s a nonprofit newsroom covering health issues in America. These folks are amazing journalists. Their reporting wins all kinds of awards every year. We are honored to work with them.<\/p>\n

Dan:<\/strong>\u00a0In the spring of 2024, a news story broke in Oregon that eventually drew national attention.\u00a0<\/p>\n

News anchor:<\/strong>\u00a0You called and we listened. We have been getting all kinds of calls and emails from patients who were dropped without any warning. It is our top story tonight. KEZI 9\u2026<\/strong><\/p>\n

Dan:<\/strong>\u00a0These were patients at Oregon Medical Group, a chain of clinics in the Eugene area. And these patients had just gotten letters in the mail<\/p>\n

News reporter:<\/strong>\u00a0telling them their primary care provider is leaving the medical group and the need to find care somewhere else.<\/strong><\/p>\n

Dan:\u00a0<\/strong>Other patients only got the news when they called to make an appointment.\u00a0<\/p>\n

Over the course of a couple years, more than thirty doctors had quit Oregon Medical Group \u2014 and left thousands of patients stranded.<\/p>\n

A doctor at one area hospital told a local news outlet more and more Oregon Medical Group patients were starting to show up at the ER.\u00a0<\/p>\n

Some of them just needed refills on prescriptions, since that their regular doctors were gone. Not fired, it turned out. Quit.\u00a0<\/p>\n

Ben Bowman:<\/strong>\u00a0Those doctors left because they didn\u2019t agree with the way the practice was being run. This wasn\u2019t what they signed up for when they went into medicine.<\/strong><\/p>\n

Dan: That\u2019s Ben Bowman. He\u2019s a democratic state rep from the Portland suburbs.\u00a0<\/p>\n

He says he\u2019s talked with some of those doctors personally. Others talked with reporters.\u00a0<\/p>\n

They said they\u2019d quit because the practice changed after a takeover by Optum. That\u2019s a name that may sound familiar. Optum is a giant subsidiary of the even-more-giant UnitedHealth Group.\u00a0<\/p>\n

We\u2019ve talked about Optum more than once on this show because it\u2019s got tentacles in just about every part of healthcare.\u00a0<\/p>\n

Including running medical practices. These days more than 10 percent of ALL doctors in the US work for Optum. More than for anyone else by huge margins.\u00a0<\/p>\n

Optum took over Oregon Medical Group in 2020, and \u2014 as doctors later told reporters\u2013 it ended up making big changes. Doctors said dictates from Optum had them spending less time with each patient, with more patients to see, and, after Optum cut staff, with a ton more paperwork to grind through themselves.\u00a0<\/p>\n

To top it off, at least some of them said they got socked with pay cuts.<\/p>\n

But quitting their jobs meant truly leaving their patients behind. Their contracts had non-compete clauses, so they couldn\u2019t just see their patients somewhere else nearby.<\/p>\n

Ben Bowman:<\/strong>\u00a0Some of them went to work in other areas. Some of them left the state of Oregon. Some of them were so burned out. They said they\u2019re done with medicine.<\/strong><\/p>\n

Dan:<\/strong>\u00a0News reports say as many as 10,000 patients got left behind. And here\u2019s why Ben Bowman was talking with those doctors \u2014 and why he\u2019s the guy you\u2019re hearing from:<\/p>\n

By the time those stories hit the news, Ben Bowman and some allies had already been fighting for more than a year to fix what he and others say is the root cause of what happened in Eugene.\u00a0<\/p>\n

Which is probably going to sound familiar.<\/p>\n

Ben Bowman:<\/strong>\u00a0Over the last 10 to 15 years, there\u2019s been a rapid acceleration of corporate and private equity ownership over medical clinics.\u00a0<\/strong><\/p>\n

Dan:<\/strong>\u00a0These are businesses that owe it to their investors to put profits first. But health care providers are supposed to put patients first.\u00a0<\/p>\n

Ben Bowman:<\/strong>\u00a0Those two things are inherently in conflict sometimes and we get to decide as a state: how are we going to resolve that tension? And in Oregon, we want the answer to be that the doctors are making the decision that\u2019s in the best interest of their patient.<\/strong><\/p>\n

Dan:<\/strong>\u00a0Ben Bowman\u2019s saying \u201cwe get to decide as a state\u201d and here\u2019s what \u201cwe in Oregon want the answer to be\u201d because this year he and his allies won a big legislative fight.<\/p>\n

He talked about how they did it with this show\u2019s senior producer, Emily Pisacreta.\u00a0<\/p>\n

Ben Bowman:<\/strong>\u00a0This is probably a much longer story than you\u2019re asking for, but,<\/strong><\/p>\n

Emily:<\/strong>\u00a0No, I love it. I love it. It\u2019s great.<\/strong><\/p>\n

Dan:<\/strong>\u00a0Emily? Really long?<\/p>\n

Emily:<\/strong>\u00a0I promise not too long. It starts with an intellectual puzzle.\u00a0<\/p>\n

Bowman could see that big corporations and private-equity \u2014 PE for short \u2014 were taking over more and more medical practices. All over, including Oregon.\u00a0<\/p>\n

Ben Bowman:<\/strong>\u00a0Now, here\u2019s where it gets weird. Oregon, like many states, most states, has long had a corporate practice of medicine law on the books.<\/strong><\/p>\n

Emily:<\/strong>\u00a0\u2026that basically says, to own a medical practice, you have to have a medical license. A corporation or group of investors can\u2019t get one of those.\u00a0<\/p>\n

Ben Bowman:<\/strong>\u00a0But at the same time, we\u2019re seeing this rapid increase in corporations and PE firms buying clinics. How is that possible if we have a law that says you can\u2019t do that?<\/strong><\/p>\n

Emily:<\/strong>\u00a0In 2023, Bowman read an article in the New England Journal of Medicine that seemed to offer some answers \u2014 and maybe a blueprint for building stronger guardrails.\u00a0<\/p>\n

One of its authors is Erin Fuse Brown.\u00a0<\/p>\n

Erin Fuse Brown:<\/strong>\u00a0\u2026and I am a Professor of Health Services, Policy, and Practice at the Brown University School of Public Health.<\/strong><\/p>\n

Emily:<\/strong>\u00a0I met Erin back in 2022, when we looked at how private equity firms were buying up gastroenterology practices and raising the prices on colonoscopies. One investor was calling it \u2018The Golden Age of Older Rectums.\u201d<\/p>\n

Dan:<\/strong>\u00a0I still love that you found that quote. And Erin helped us with your next story about private equity. Where ER doctors in California were suing to kick a private-equity backed company out of emergency rooms there.\u00a0<\/p>\n

Emily:<\/strong>\u00a0The big issue in that case: California\u2019s corporate practice of medicine law. Erin\u2019s a lawyer by training. She was already chewing on this question\u00a0<\/p>\n

Erin Fuse Brown:<\/strong>\u00a0We have all these laws in the books. Well, why doesn\u2019t the corporate practice of medicine prevent this?<\/strong><\/p>\n

Emily:<\/strong>\u00a0And what I love is: That case in California helped her start to crack that question.\u00a0<\/p>\n

Because she knew that the answers\u2013 what Erin calls the nitty gritty stuff \u2014 that\u2019s all buried in contracts. Contracts she didn\u2019t have access to.\u00a0<\/p>\n

Erin Fuse Brown:<\/strong>\u00a0They tend to be confidential. Um, they\u2019re private contracts. It\u2019s very difficult to see them.<\/strong><\/p>\n

Emily:<\/strong>\u00a0But now those California contracts were evidence in a lawsuit. So she could study them.<\/p>\n

Erin Fuse Brown:<\/strong>\u00a0That litigation allowed us to get a, a sense of how these contracts are structured.\u00a0<\/strong><\/p>\n

Emily:<\/strong>\u00a0And here\u2019s the basic structure.<\/p>\n

Erin Fuse Brown:<\/strong>\u00a0An entity like a hospital or one Medical or Optum, stands up something called a management service organization.<\/strong><\/p>\n

Emily:<\/strong>\u00a0A management service organization \u2014 MSO for short .<\/p>\n

The MSO is ostensibly just there to take care of \u201cback office\u201d stuff \u2014 like billing or HR or compliance \u2014 to make the business run better. Here\u2019s how they end up actually running the show.\u00a0<\/p>\n

Erin and others call this the \u201cfriendly physician model.\u201d<\/p>\n

The MSO brings in a figure-head doctor \u2014 the friendly physician\u2013\u00a0 who works for them as an executive.\u00a0<\/p>\n

Then the MSO fronts this friendly physician money to buy a majority stake in the practice, which puts the friendly physician in charge of the medical side.\u00a0<\/p>\n

So on the one hand, they\u2019re an OWNER. They own the practice \u2014 thanks to money from the corporate MSO.<\/p>\n

And on the other hand, they\u2019re an EMPLOYEE \u2014 working for the same corporate MSO.\u00a0<\/p>\n

Which Erin says is a conflict of interest.?<\/p>\n

Erin Fuse Brown:<\/strong>\u00a0The conflict of interest is that they\u2019re taking all of their marching orders from their ultimate boss, who is the MSO, right? They hit their numbers, then their compensation goes up from the MSO. So they\u2019re really sort of like a business manager who happens to have an MD behind name.\u00a0<\/strong><\/p>\n

Emily:<\/strong>\u00a0I think of it as kinda like\u2026 the CIA covertly installing its favored leader in a foreign country Except the leader openly, publicly taking a salary from the CIA. Oh, and maybe has maybe never even been to the country.<\/p>\n

Erin Fuse Brown:<\/strong>\u00a0Like the owner\u2013 who has an MD, who has a license and is therefore eligible to own the practice \u2013 they may live in a different state. They may never have stepped foot in the practice<\/strong><\/p>\n

Emily:<\/strong>\u00a0And they start changing the way the practice is run in a way that makes the corporate entity the most money. Even if it\u2019s not great for clinicians and patients.\u00a0<\/p>\n

Erin Fuse Brown:<\/strong>\u00a0You\u2019re gonna see patients not in, you know, 15 minute appointments. You\u2019re gonna see them in nine minute appointments.<\/strong><\/p>\n

Emily:<\/strong>\u00a0And she says they ratchet up the pressure to do things like \u201cupcode\u201d \u2014 assign diagnoses with higher-priced billing codes.\u00a0<\/p>\n

Erin Fuse Brown:<\/strong>\u00a0The MSO can send sort of notices to, it\u2019s like high performing clinicians saying like, congrats, you get a bonus. Or reminders, like, you\u2019re on the bottom of the list, you\u2019re not hitting your targets. We need you to upcode more. Basically make us more money. And if you don\u2019t, then we\u2019re gonna punish you either by giving you worse scheduling times, we\u2019re gonna dock your pay or, you know, or do other things.<\/strong><\/p>\n

Emily:<\/strong>\u00a0And then\u2026 maybe there\u2019s a non-compete, making it harder to leave, like at Oregon Medical Group.<\/p>\n

So Erin and a pair of other researchers published that paper that said \u2014 and I\u2019m oversimplifying a bit \u2014 that if you want a real ban on the corporate practice of medicine \u2014 you need take on these MSOs, and this friendly physician set-up.<\/p>\n

After Ben Bowman read that paper, he got in touch with Erin and her colleagues, and eventually they sat down to work together.\u00a0<\/p>\n

Going into the 2024 legislative session, Bowman had the blueprint. And he had allies \u2014 like former Oregon governor John Kitzhaber. Who used to be an ER doc himself.<\/p>\n

He got co-sponsors from both parties. And they had a powerful coalition of outside supporters.\u00a0<\/p>\n

Ben Bowman:<\/strong>\u00a0We had patient advocacy groups, we had labor unions. We had the Oregon Medical Association. We had the Oregon Nurses Association.<\/strong><\/p>\n

Emily:<\/strong>\u00a0Of course there were opponents.<\/p>\n

Ben Bowman:<\/strong>\u00a0You can imagine the interests who didn\u2019t wanna see this happen, like basically any large corporation, which includes four of the six largest corporations in America\u2026<\/strong><\/p>\n

Emily:<\/strong>\u00a0Like UnitedHealth Group. Obviously. But also CVS. Amazon. Not to mention dozens of private equity firms you\u2019ve never heard of.\u00a0<\/p>\n

He says the bill looked like it would pass \u2014 but Republicans blocked it with a last-second parliamentary trick. So it didn\u2019t get a vote. That was March, 2024.<\/p>\n

Then, a few weeks later, Oregon Medical Group hit the headlines.\u00a0<\/p>\n

Ben Bowman:<\/strong>\u00a0You can imagine the feeling in Eugene. Ten thousand people who get this piece of mail saying you don\u2019t have a doctor anymore, including elderly people who were relying on that primary care doctor to fill their prescriptions and to keep them healthy.<\/strong><\/p>\n

Emily:<\/strong>\u00a0A few months later, a neighborhood group in Eugene hosted a town hall.\u00a0<\/p>\n

Ben Bowman:<\/strong>\u00a0It included legislators. It included leadership of the Oregon Medical Group. It included Optum Oregon leadership,<\/strong><\/p>\n

Emily:<\/strong>\u00a0Yep, Optum Oregon showed up.\u00a0And handed Ben Bowman and his allies a talking point.\u00a0<\/p>\n

Ben Bowman:<\/strong>\u00a0The head of Optum, Oregon said in that, in that town hall, this quote:\u00a0<\/strong><\/p>\n

Dr. Phil Capp, Optum Oregon: \u2026the experiment of having physician directed healthcare in this country over the last 50 or 70 years didn\u2019t work. It didn\u2019t work. So we have to try a new way.\u00a0<\/strong><\/p>\n

Emily:<\/strong>\u00a0Bowman says that line\u00a0helped make\u00a0the stakes really clear\u00a0when he brought his bill back in 2025.<\/p>\n

Ben Bowman:<\/strong>\u00a0What is at stake in the corporate practice of medicine debate is do you want your healthcare decisions when you\u2019re in an exam room being made by a doctor? Or do you agree with what Optum\u2019s stated position was? Which is we think somebody else should be making that decision. Not physicians.<\/strong><\/p>\n

Emily:\u00a0<\/strong>And when the 2025 session started, he had another new advantage: his party tapped him to be majority leader.<\/p>\n

Ben Bowman:<\/strong>\u00a0I think that was really helpful, that this was no longer just like a freshman legislator\u2019s bill. This was the house majority leader saying, this is really important to me and my constituents.<\/strong><\/p>\n

Emily:<\/strong>\u00a0This time the bill passed by more than two-thirds. The final language has limits. It doesn\u2019t apply to hospitals \u2013 which also gobble up tons of medical practices. It doesn\u2019t apply to telehealth providers.\u00a0 And doesn\u2019t totally ban MSOs. But it makes really clear what MSOs are allowed to do\u2013 what kind of decisions they can make. For instance, they can\u2019t limit how long a doctor spends with a patient.<\/p>\n

Ben Bowman:<\/strong>\u00a0a corporate owner, a non-physician, cannot dictate to a doctor \u201cyou can only see this patient for 15 minutes.\u201d<\/strong><\/p>\n

Emily:<\/strong>\u00a0And they can\u2019t make clinicians sign non-compete clauses. Those doctors can fly free if they want.\u00a0<\/p>\n

And crucially \u2014 the new law addresses the conflict of interest in that \u201cfriendly physician\u201d figurehead setup. It limits how much control they can have in the medical practice if they\u2019re really working for the MSO.<\/p>\n

Erin Fuse Brown says this provision got the most pushback from the industry\u2013\u2013 and it\u2019s the one lobbyists are working to prevent in other states.<\/p>\n

Erin Fuse Brown:<\/strong>\u00a0And that\u2019s telling, right? If the industry is most concerned about the dual compensation, dual ownership then that is where the rubber hits the road.<\/strong><\/p>\n

Emily:\u00a0<\/strong>And based on what she learned from Oregon, she\u2019s put together model legislation for other states.\u00a0<\/p>\n

Which, Ben Bowman says, is something his opponents were afraid of\u00a0all along. He says out of state companies sent lobbyists to Oregon to fight his bill.<\/p>\n

Dan:<\/strong>\u00a0Whoa. Emily, thank you so much for that story. I love the idea that companies outside of Oregon are already scared that other states will adopt a version of this law.\u00a0<\/p>\n

We\u2019ll be watching both of these stories in 2026, and others \u2014 including stuff we just didn\u2019t get to.\u00a0<\/p>\n

I mentioned earlier that states moved to restrict pharmacy b\u00a0 enefit managers, and to restrict price gouging by hospitals. But I don\u2019t think I mentioned that the most aggressive laws on those topics were from two states that show up bright red on political maps: Arkansas and Indiana.\u00a0<\/p>\n

We\u2019ve gotta get around to that.\u00a0<\/p>\n

Meanwhile, it was SO heartening to report these stories. Because that meant meeting advocates and legislators from around the country \u2014 folks I\u2019d never heard of before, people I\u2019m so glad to have met, because they\u2019re doing so much smart, dedicated work to make things suck less.<\/p>\n

Emily:<\/strong>\u00a0100% and I will add that I also got to talk with people in states like Colorado and California who have been doing incredible work to lower drug prices on things like insulin and the rheumatoid-arthritis drug Enbrel.\u00a0<\/p>\n

Following up on what they\u2019ve accomplished and getting those stories on the show is one of the things I\u2019m especially looking forward to in 2026.<\/p>\n

Dan:<\/strong>\u00a0I am so looking forward to having you do that \u2014 and speaking of what you\u2019ll be doing in 2026, Emily, I think we\u2019ve actually saved the best news for last.<\/p>\n

Anybody who\u2019s been listening to our show recently knows: Like a lot of people, we\u2019ve been SWEATING health insurance for 2026.\u00a0<\/p>\n

Emily:<\/strong>\u00a0I mean, I\u2019ve been sweating bullets. I moved to an Obamacare plan this year, and without the enhanced subsidies that are set to expire, I didn\u2019t know how I was supposed to afford those premiums.<\/p>\n

Dan:<\/strong>\u00a0I\u2019ve been sweating too. Because if that happened: Could you afford to actually keep working here part-time?\u00a0<\/p>\n

We\u2019ve been exploring an alternative: Could you get insurance through An Arm and a Leg? It would be less expensive, and better insurance.\u00a0<\/p>\n

But we\u2019d need to increase your hours \u2014 from 20 hours a week to 30 or more.<\/p>\n

Could An Arm and a Leg afford to do that? I didn\u2019t know.<\/p>\n

But I ran some numbers last week \u2014 looking especially at the donations people have been making since our fundraising season started in November.<\/p>\n

And the answer is: YES. People have been so generous so far, I\u2019m ready to make that commitment.\u00a0<\/p>\n

Emily:<\/strong>\u00a0We have the all-time greatest community of listeners.<\/p>\n

Dan:<\/strong>\u00a0Seriously. Don\u2019t get me wrong: The numbers so far do not mean we are ALL SET for 2026.\u00a0<\/p>\n

So, if you\u2019re listening to this, and you\u2019ve been considering making a gift \u2014 PLEASE DO IT. We are counting on you.\u00a0<\/p>\n

Not only so Emily gets better, more-affordable health insurance. But so WE GET FIFTY PERCENT MORE EMILY.<\/p>\n

Now, you\u2019ve just heard Emily\u2019s reporting right here. You\u2019ve been hearing it. You know how amazing her work is.<\/p>\n

But you may not know: Emily\u2019s also the reason for a lot of OTHER stuff you\u2019ve noticed.\u00a0<\/p>\n

Like, we brought back our First Aid Kit newsletter this year, and made it weekly?\u00a0<\/p>\n

You don\u2019t see Emily\u2019s byline on it\u2013 because she\u2019s the EDITOR. You don\u2019t wanna hear all the backstage work \u2014 on that project and others \u2014 but it\u2019s been huge.<\/p>\n

Having fifty percent more of Emily\u2019s time is gonna power SO much new work in 2026. You\u2019re going to absolutely love it.<\/p>\n

And we definitely need your help to make it happen.\u00a0<\/p>\n

To make that gift, just go to arm and a leg show dot com, slash support.<\/p>\n

Arm and a leg show dot com, slash support.<\/p>\n

You may be asking: Hey, Dan, will my gift be MATCHED? I\u2019ve heard you talk about the NewsMatch campaign from the Institute for Nonprofit News. Is that still in effect?<\/p>\n

And the answer is: Maybe, if you act fast.\u00a0You all gave a lot more in November than we expected \u2014 which was AMAZING\u2026\u00a0and it means we have fewer matching dollars\u00a0left at this point.There are still SOME \u2014 but they\u2019re going fast. If you want your gift doubled, head NOW to arm and a leg show dot com, slash, support.<\/p>\n

But no matter what, to make this plan work \u2014 fifty percent more Emily \u2014 every dollar you give us this month counts more than ever.\u00a0<\/p>\n

Thank you SO much to everybody who\u2019s already given, who\u2019s allowed us to get here, to make this commitment.\u00a0<\/p>\n

If you haven\u2019t yet, now\u2019s your time: The place to go is arm and a leg show dot com, slash support.<\/p>\n

Thank you SO much! We\u2019ll be back with one more episode before the end of the year.<\/p>\n

Till then, take care of yourself.<\/p>\n

This episode of An Arm and a Leg was produced by me, Dan Weissmann along with Emily Pisacreta \u2014 and edited by Ellen Weiss.\u00a0<\/p>\n

Adam Raymonda is our audio wizard.<\/p>\n

Our music is by Dave Weiner and Blue Dot Sessions.\u00a0<\/p>\n

Claire Davenport is our engagement producer.<\/p>\n

Sarah Ballema is our Operations Manager. Bea Bosco is our consulting director of operations.\u00a0<\/p>\n

An Arm and a Leg is produced in partnership with KFF Health News. That\u2019s a national newsroom producing in-depth journalism about health issues in America and a core program at KFF, an independent source of health policy research, polling, and journalism.<\/p>\n

\u00a0Zach Dyer is senior audio producer at KFF Health News. He\u2019s editorial liaison to this show.<\/p>\n

An Arm and a Leg is distributed by KUOW, Seattle\u2019s NPR news station.<\/p>\n

And thanks to the Institute for Nonprofit News for serving as our fiscal sponsor.<\/p>\n

They allow us to accept tax-exempt donations. You can learn more about INN at INN.org.<\/p>\n

Finally, thank you to everybody who supports this show financially.<\/p>\n

You can join in any time at arm and a leg show, dot com, slash: support.<\/p>\n

\u201cAn Arm and a Leg\u201d is a co-production of KFF Health News and Public Road Productions.<\/em><\/p>\n

For more from the team at \u201cAn Arm and a Leg,\u201d subscribe to its weekly newsletter,\u00a0First Aid Kit<\/a>. You can also follow the show on\u00a0Facebook<\/a>,\u00a0Instagram<\/a>,\u00a0LinkedIn<\/a>, and\u00a0Bluesky<\/a>. And if you\u2019ve got stories to tell about the health care system, the producers would love to\u00a0hear from you<\/a>.<\/em><\/p>\n

To hear all KFF Health News podcasts, click here<\/a>.<\/em><\/p>\n

And subscribe to \u201cAn Arm and a Leg\u201d on Spotify<\/a>, Apple Podcasts<\/a>, Pocket Casts<\/a>, or wherever you listen to podcasts.<\/em><\/p>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n

USE OUR CONTENT<\/h3>\n

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