Category: Blog

The Patients Over Profits Act: What It Could Mean for Patients and Providers

The Patients Over Profits Act (“POP Act”) was introduced in both Houses of Congress this fall. The proposed Act addresses vertical integration in the healthcare system, specifically covering various stages of insurance coverage. Vertical integration, as opposed to horizontal integration, is when multiple stages of a certain industry are all controlled by the same company. For example, vertical integration in the healthcare industry happens in various situations, but in this context happens when a certain company owns or controls both the insurer and the physician. 

Multiple industries have been trending towards vertical integration, and the healthcare industry is no exception. The Supreme Court has stated that any sort of integration is “highly relevant” in deciding whether anticompetitive effects exist. The Patients Over Profits Act seeks to address the effects of vertical integration in the healthcare industry on patients. 

Specifically, the supporters of the POP Act argue that insurers can now control physician practices, and then set their own policies regarding insurance. Supporting documents explain that these financial incentives surrounding insurance companies can in turn affect the care and treatment patients receive from providers who are owned by companies who control both the physicians and the insurance payouts. Proponents of the Patients Over Profits Act not only argue that the financial incentives can influence clinical decision-making, but they also have the ability and desire to increase costs and drive up profits for their company.  Recently, many insurance conglomerates have purchased clinics and other physician-groups, resulting in vertical integration. For example, UnitedHealthcare purchased a large physician-owned clinic in Oregon, after they had already purchased other similar medical groups in Oregon. This type of integration is not unique to Oregon, it is happening throughout the United States.  

Specifically, the Patients Over Profits Act addresses physicians and insurers participating in Medicare and Medicaid. Medicare and Medicaid protect our most vulnerable citizens. Medicare provides healthcare assistance through a federally funded insurance program to people who are sixty-five or older, and others who qualify or have certain disabilities. Medicaid similarly provides insurance assistance through federal and state funding for low income citizens. The POP Act addresses these concerns in many ways. First, it seeks to prohibit ownership of both a health insurance company and a medical provider who participates in Medicare and Medicaid. Further, it seeks to control Management Services Organizations  (MSOs) through their Management Service Agreements (MSAs). MSOs provide non-clinical services to medical providers, and they use their MSAs, which are contractual agreements, to govern these services. The POP Act seeks to restrict the mechanisms these entities can use to control the medical services the MSOs provide. Further, the Act seeks to enable federal enforcement through the Department of Justice, Federal Trade Commission, and the Department of Health and Human Services regarding those insurance companies engaging in vertical integration, especially those participating in Medicare and Medicaid. 

In short, the Patients over Providers Act seeks to protect patients, rather than providers of healthcare services and insurance companies receiving all of the benefits. By requiring these entities to disclose their information and subject them to strict enforcement through federal agencies, the Act hopes to ensure patients receive care with fair payment. If the POP Act passes, health insurers will need to disclose interests they have in medical practices, or they will be subject to high financial penalties or suspension from federal health programs, such as Medicare and Medicaid. 

The ‘Elder’ Medical-Legal Partnership and Caregiving from an Interdisciplinary Lens

New frameworks, interdisciplinary collaborations, and models of health care may need to emerge to address the impending “caregiving crisis,” or growing strain on the elder caregiving workforce with our aging population. The medical-legal partnership (MLP) model is one potential approach in addressing elder well-being, health, and the caregiving crisis. Medical legal partnerships are an established interdisciplinary framework, combining the legal and medical worlds to holistically serve a population’s needs. Within MLP clinical sites, attorneys are placed directly onsite to work with healthcare providers in identifying and remedying health-harming legal needs.

The model is based on the understanding that health issues are seldom solvable by addressing medical needs. For instance, an elder patient and their caregiver may need assistance in accessing incapacity plans or safe housing for an elder at risk for falls at home. By utilizing the MLP model, clinics can assist older adults and caregivers in navigating the multidimensional, overlapping legal and health issues that elders face, potentially reducing some of the burden on the caregiving population. Addressing common elder issues in one clinic with the expertise of two professions can help streamline access to other resources like public benefits, support the dignity and autonomy of elders, and address a variety of unmet financial, housing and legal needs. The MLP can also assist with the fact that elders have specific barriers to legal and healthcare related to mobility, transportation, and isolation by acting as a “one stop shop” for holistic support. Contributors to elder law also point out that medical providers and attorneys are well-positioned to collaborate so that providers can identify elder abuse.

While MLPs have become increasingly popular, they have scarcely been tailored to elder populations. The Medical-Legal Partnership for Seniors (MLPS) in San-Francisco, a law school clinic that trains medical providers on the legal needs of elders, is one example of an MLP tailored to the elder populations. But for the most part, MLPs have been utilized at the pediatric level where pediatricians are trained to identify the causes of their patient’s health conditions, which often stem from social determinants of health (SDOH) like poor housing conditions. Research has suggested that SDOHs are more important to individual health than genetic predisposition, where SDOHs such as socioeconomic resources, working conditions, housing, environment, race, and gender may be “fundamental causes” of health outcomes. These same SDOHs shape elder health, independence, and overall wellbeing, where intersecting factors and elder social identities may compound poor legal and health outcomes for elders. For example, a low income, older woman of color experiencing housing instability may face intersecting barriers that healthcare nor legal interventions alone can adequately address. Recognizing this, MLP interventions should be multi-pronged to address underlying social factors like structural racism and critically assess their own role in reinforcing systemic inequities. Elders are not a monolithic group, and ‘non-essentializing’ this population is critical in delivering equitable care.

Overall, the MLP framework could be more widely utilized to benefit the elder population and promote their health and justice. Having stronger societal supports like numerous MLPs tailored to elder needs may furthermore assist incrementally in the caregiving crisis, given that elder issues are only becoming increasingly relevant as our population continues to age. The MLP model thus may be a promising method to expand on caregiver and elder supports in the United States.

COVID-19 Tests: Who’s Paying?

The COVID-19 pandemic was a time of turmoil across the nation. During the course of the public health emergency, one unlikely source of controversy: how to provide and pay for COVID-19 tests for uninsured individuals.

From February 20, 2020 to June 23, 2022, 912.77 million COVID-19 tests were administered in the United States alone. Over the course of the pandemic, the federal government sent many of these tests to American households for free. Private insurers covered additional tests. However, there has been controversy over payment and administration of these tests, including a civil fraud suit against providers and an ongoing fight in the United States Court of Federal Claims over who is responsible for paying for the tests that have already been administered.

During the course of the pandemic, the federal government introduced a free COVID-19 test distribution program. The program allowed each U.S. household to order four free at-home COVID tests shipped for free to the consumer via USPS. However, the government website stopped accepting orders March 10, 2025. Some insurers still cover the cost of at-home tests, but they may require a finding of medical necessity. It is now unclear how individuals can seek payment assistance or free tests.

In addition to the test distribution program, the federal government reimbursed claims under a claims reimbursement program for COVID-19 test administration. The government reimbursed claims for healthcare providers and facilities that tested individuals without insurance. However, the program has received its fair share of problematic billing. In June 2024, The U.S. Attorney General filed a civil fraud suit on behalf of the Department of Health and Human Services (HHS) against LabQ for fraudulently billing the federal government for COVID-19 tests. The lab submitted claims for COVID-19 testing where the testing had or would be reimbursed by another source or had been provided to someone with healthcare coverage.

In other cases, the federal government is being accused of failure to reimburse testing. On October 17, LabQ Clinical Diagnostics LLC, Dart Medical Laboratory Inc., and Community Mobile Testing Inc. filed a breach of contract claim against the U.S. government alleging they failed to reimburse $543 million worth of COVID-19 tests on uninsured individuals in New York City. They also filed claims for breach of the Coronavirus Aid, Relief, and Economic Security Act (CARES) Act and other pandemic-era statutes designed to provide relief. The CARES Act, signed into law March 27, 2020, was passed to provide $2 trillion in economic relief and established the Coronavirus Relief Fund to provide $150 billion of direct assistance to states and local governments. The providers submitted claims through a portal established by the program, and the U.S. Department of Health and Human Services states it would reimburse generally at 100% of the eligible Medicare rates for eligible tests. The complaint alleges a premature depletion of funds and termination of the program before plaintiffs were reimbursed.

The payment saga of the COVID-19 pandemic and the resulting lack of clarity in whether providers and hospitals will get tests covered is ongoing. It is one more result of the chaos that occurred across the globe. The United States’ disproportionately high death toll demonstrates that it is critical that better response plans to public health emergencies of this scale are developed and implemented.

The ADHD Medication Shortage: DEA Regulations and Limitations to Addressing the Public Health Crisis

The United States is facing an attention-deficit/hyperactivity disorder (ADHD) crisis with issues arising out of the great demand for first-line pharmacotherapy amid widespread shortages. Concerns about overmedication, particularly in children and young adults, qualify the necessity of strategic industry regulations and practices. Enforcing a balance of proper access and production of ADHD pharmacotherapy while mitigating risks of substance abuse in this line of drug treatment is vital to the health and well-being of the public.

More than 3.4 million children are currently prescribed ADHD medications, leading to federal concern about overmedication for chronic conditions in pediatric populations. Further, the American Psychiatric Association reported that adult ADHD diagnoses rose annually from 2020 to 2023, adding additional pressure to a strained healthcare infrastructure.

Pharmacy supply shortages have resulted in patients often driving long distances to pick up their prescription, particularly impacting rural and underserved communities. Lacking medication as prescribed leads to patients experiencing detriments in managing their daily life, and severe physical and mental withdrawal symptoms.

Despite these robust demands, patients are facing widespread prescription treatment shortages. As of late 2025, the Drug Enforcement Agency (DEA) has acknowledged that the existing national inventory of Schedule II substances, including d-amphetamine and methylphenidate, is inadequate to meet “legitimate patient needs.” In response, the DEA increased the Aggregate Production Quotas (APQs) for these active ingredients of first-line ADHD treatments for 2025. This action allows manufacturers to increase production and pharmacies to increase inventory, better meeting medication demand.

The DEA is responsible for enforcing regulations governing ADHD medication dispensing under the Controlled Substances Act (CSA). Stimulant medications containing the active ingredients falling under the APQ increase are typically recognized by their brand names of Adderall, Vyvanse, Concerta, and Ritalin. These medications are allocated to the Schedule II class for their associated risks with “misuse, addiction, overdose, and diversion.”

Limitations to the authority of the DEA in addressing the stimulant pharmacotherapy access crisis intersect with the market. Despite the DEA increasing the quota, the inventory of this class of products is not expanding to the capacity allocated for production. An analysis by the DEA in 2022 found that manufacturers sold only 70 percent of the volume allocated by the quota, excluding one billion additional doses from production that could have gone to the market.

In another study between 2001 and 2023 analyzing derivatives for prescription amphetamine shortages, 58 percent of manufacturers did not disclose a reason for the shortage. Other manufacturers reporting on the shortage have cited a mismatch in supply and demand, and manufacturing problems and delays.

Anticompetitive actions by manufacturers have also created structural barriers to market access. The class action Barbara et al. v. Shire brought forth allegations that brand-name manufacturers were paying rival drug makers to delay releasing generic versions of Adderall XR. This lawsuit exposed violations of the Sherman Act which bans monopolies and unreasonable trade restraints, risking supply shortages and price inflation.  

The DEA works in conjunction with the FDA to regulate prescription stimulants. Recognizing the supply issues with the drugs, the two agencies issued a letter asserting their intention to understand, prevent, and reduce the impact of the shortages in pharmaceutical supply chains. However, neither agency manufactures drugs nor can they require pharmaceutical companies to increase production. While recognizing the importance of responsible prescribing practices, the agencies have called on pharmaceutical manufacturers to increase production to meet the quotas and help mitigate the stimulant drug shortage crisis the United States is facing.

Criminalizing Miscarriage: How the Law Penalizes Grieving Mothers

Miscarriage—pregnancy loss prior to twenty weeks gestation—occurs in as many as one in five known pregnancies. Most of these occur in the first thirteen weeks, with chromosomal abnormalities accounting for nearly half of the miscarriages that occur in the first trimester. Treatment options include expectant management, medication, and surgical intervention, with 70-80% of mothers being able to pass a miscarriage naturally without medication or surgery. That means, with up to one million mothers experiencing miscarriage annually in the U.S. alone, over 700,000 of them are managing that loss from their own homes. Studies accounting for race have shown that black women are disproportionately affected with almost twice as much risk of miscarriage as other ethnic groups.

In the first year after the Dobbs decision, the U.S. saw criminal charges for at least 210 pregnant people related to pregnancy, pregnancy loss, and birth. This number represents a single-year high since researchers began documenting cases. For reference, only around 1,800 pregnancy-related charges were documented in the entire forty-nine years that Roe v. Wade held precedent. Since Dobbs, fetal personhood laws have expanded considerably, with seventeen states now granting fetuses the same level of legal protection as living humans. Lawmakers opposed to these measures have tried to sound the alarm about the risk of criminal charges for miscarrying mothers.

In March of this year, what began as a 911 call for a medical emergency ultimately led to the arrest of Selena Maria Chandler-Scott, a 24-year-old Georgia mother. At 19-weeks pregnant, Chandler-Scott suffered a miscarriage. First responders took her to the hospital after they discovered her unconscious and bleeding in her apartment, but a witness also reported having seen her dispose of fetal remains in the dumpster of their apartment complex. At a time when she was likely experiencing intense grief, Chandler-Scott also had to navigate criminal charges in the days following her pregnancy loss. Though they were ultimately dropped, Chandler-Scott was initially charged with concealing a death and abandonment of a dead body. She was cleared only after the autopsy report showed the miscarriage was naturally occurring.

Brittany Watts, an Ohio woman, faced charges similar to Chandler-Scott’s after miscarrying in October 2023. After hours waiting for the hospital to determine the legality of inducing labor after her water broke prematurely, Watts went home, where she ultimately miscarried naturally. When she returned for further medical treatment after miscarrying a pregnancy that the hospital had already determined was both a significant risk to Watts’s health and nonviable, the hospital reported Watts to the local police department. Unlike Chandler-Scott, however, the determination that the miscarriage was naturally occurring did not clear Watts of criminal charges for abuse of a corpse.  The county prosecutor’s office pressed forward, and Watts was cleared only after a Grand Jury declined to indict her for the fifth degree felony.

In addition to criminal charges, miscarrying mothers also face an increased risk of negative health outcomes in post-Dobbs America. Because of fetal personhood laws, doctors in many states are barred from medically intervening so long as the fetus still has a heartbeat. Under the federal Emergency Medical Treatment & Labor Act (EMTALA), doctors are legally protected for abortion care provided during emergency circumstances. The Supreme Court in 2024 held that state laws cannot preempt this legal protection for preventing “grave harms.” Doctors, however, remain fearful of legal repercussions and often wait before treating pregnant patients.  Kyleigh Thurman was discharged from a Texas hospital without treatment for her ectopic pregnancy, which ruptured days later, resulting in the loss of her fallopian tube and permanent damage to her reproductive system. Neveah Crain died after doctors failed to treat her for sepsis when she was six months pregnant.

In contradiction of the Court, the Department of Health and Human Services rescinded its letter of support for EMTALA compliance in June 2025, further complicating access to medical care for pregnant patients in fetal personhood states. To improve access to essential healthcare, we must address the underlying legal issues that threaten doctors and pregnant patients. In doing so, It is imperative that these discussions address the devastating reality of pregnancy loss experienced by hundreds of thousands of American women every year and the consequences of post-Dobbs policies on those losses.

From Protests to Policy Change: Applying the AIDS Activist Playbook to Future Pandemics

Early in the U.S. AIDS epidemic, government inaction allowed the crisis to escalate, leaving affected communities without support. In response,  AIDS activists organized to force national attention on the epidemic and reshape public awareness, treatment development, and federal policy.

The history of AIDS activism demonstrates how marginalized communities can turn a stigmatized public health emergencies into a playbook for overcoming institutional resistance. This analysis highlights the history of AIDS activism, the AIDS activism playbook, and strategies that can continue to serve as effective health advocacy in future pandemics.

  1. History of AIDS Activism & Its Impact On Policy

The AIDS epidemic first gained national attention in 1981, when the CDC reported five cases of a rare pneumonia in young gay men. As cases and deaths rapidly increased, the federal government remained largely silent, influenced by the political conservatism and homophobia. This denial, paired with labels like “gay cancer,” deepened public stigma and delayed research funding and education campaigns.

Anger and grief sparked the rise of activism, through groups like ACT UP, demanding treatment access and government accountability. The 1988 FDA headquarters protest— pressured agencies to adopt accelerated drug approval processes. Activists shaped clinical research by pushing for patient inclusion, alternative trial designs, and the use of surrogate markers like CD4 counts. Activism assisted in redefining AIDS, pressuring executive orders, influenced policy change, and national public education campaigns. AIDS activism transformed the nation’s response to AIDS and established a lasting playbook for public health activism.

  1. The AIDS Activist Playbook

The AIDS activist playbook shows how affected communities can drive policy change through seven key strategies.

  1. Humanize Marginalized Community

AIDS activists countered stigma by humanizing those affected. Early messages urged people to reject “othering,” while visibility events like the 1983 Candlelight March and the AIDS Memorial Quilt transformed grief into collective power and reframed people with AIDS as loved ones—not outsiders.

  1. Self-Educated Experts

Activists became self-educated experts to advocate and educate their communities and challenged institutions. ACT UP’s committees trained non-scientists to understand medical literature, FDA procedures, and trial design. They became indispensable in policy discussions and helped accelerated access to lifesaving treatments, proving knowledge can be a powerful form of activism.

  1. Offer Solutions

Instead of demanding action, AIDS activists proposed research-based solutions. ACT UP developing the “parallel track” for drug approvals, proposing this to the FDA to adopt faster drug approval processes. Solution-driven advocacy demonstrated the power of mastering science to influence policy change within agencies.

  1. Community Education and Engagement

AIDS activists engaged and educated communities to reduce risk, dispel myths, increase awareness, and provide update treatment options. Activists guided communities on harm-reduction through safe-sex education and illicitly operated clean-needle exchanges—deliberately risked arrest so they could challenge New York’s laws in court and establish a legal precedent for their constitutionality.

  1. Use Inside/Outside Strategies

ACT UP paired disruptive “outside” protestors demanding the “inside” group speak with officials to present detailed policy proposals. This dual strategy pressured agencies to speed up drug approvals, revise trial protocols, and include patients in decision-making, illustrating how confrontation with negotiation can drive policy change.

  1. Nonviolent, Media-Savvy Protests

Activists used nonviolent, media-savvy protests to raise awareness and pressure policymakers. Theatrical demonstrations—like the St. Patrick’s Cathedral protest featuring a condom balloon, a “Jesus” news anchor, and activists lying on the floor to symbolize death from inaction—captured national attention and underscored the message that safe-sex saves lives. By coordinating with journalists, issuing press releases, and covering damages, activists avoided being dismissed as extremists.

  1. Inserting Activists Into Decision-Making

Guided by the Denver Principles, activists insisted on full inclusion in research, treatment, and prevention decisions. ACT UP developed the National AIDS Treatment Research Agenda to influence every level of clinical trial design and national research priorities, proving that community expertise and inclusive decision-making are essential to effective public health responses. Their involvement helped shaped approvals of drugs like AZT, DDI, and later combination therapies.

  1. Applying the Activism Playbook to Future Pandemics

The strategies of AIDS activism provided a playbook for responding to future pandemics, particularly during political division and stigmatization that leads to government inaction. Even adopting select elements can help ensure marginalized communities shape meaningful policy change. Although not every tactic transfers directly, the core principles have already strengthened other movements, such as breast cancer awareness. Contemporary politicized health movements—including reproductive rights and gender affirming care—facing escalating restrictions at the federal and state level, make them well positioned to draw on lessons from the AIDS activism playbook. By humanizing the individual stories making it a family issue, expanding community education around medical care access, and using the inside/ outside activism strategies to assist with public pressure, these movements can better resist politicization and drive meaningful reform to healthcare access.

Ultimately, the central lesson is clear: when affected communities become empowered partners in the response, activism can catalyze scientific progress and lasting policy reform.