An Open Letter to RFK Kennedy Jr., Secretary of Health and Human Services

Breaking Up UnitedHealth Group: A Blueprint for Restoring Competition in the U.S. Healthcare Market

Dear Secretary RFK Kennedy Jr.,

The U.S. healthcare system stands at a crossroads. As the largest and most influential player in the industry, UnitedHealth Group (UHG) wields unparalleled power, commanding 14-15.7% of the market with revenues exceeding $215 billion. UHG’s dominance has raised significant concerns about monopoly practices, limited competition, and the escalating costs of healthcare services. With your leadership as the Secretary of Health and Human Services (HHS), and the potential intervention of the Department of Justice (DOJ), there is an unprecedented opportunity to address these issues and foster a more equitable and competitive healthcare landscape.

Current Landscape of the U.S. Healthcare Market

The top five players in the U.S. healthcare market collectively hold a substantial share:

1. UnitedHealth Group: Market share 14-15.7%; revenue $215 billion.
2. Elevance Health (formerly Anthem): Market share 9.7-12%; revenue $133 billion.
3. CVS Health (Aetna): Market share 11%; pioneering accessible healthcare.
4. Cigna: Market share 10%; a leading insurance provider.
5. Kaiser Permanente: Market share 6-7%; known for its integrated care model.

While these organizations contribute to the delivery of healthcare services, UHG’s vertical integration—spanning insurance, pharmacy benefits, care delivery, and healthcare technology—poses significant anti-competitive risks. Addressing this requires a strategic and thoughtful break-up plan.

Proposed Break-Up of UnitedHealth Group

1. Separate UnitedHealthcare (Insurance) from Optum Businesses

• Rationale: UHG’s insurance arm, UnitedHealthcare, directs patients toward its subsidiaries like Optum Health and OptumRx. This vertical integration stifles competition and creates conflicts of interest.
• Action: Spin off UnitedHealthcare into a standalone entity to eliminate its ability to favor in-house services.

2. Divest OptumRx (Pharmacy Benefits Manager)

• Rationale: Pharmacy Benefit Managers (PBMs) like OptumRx face criticism for opaque pricing and rebate practices. Divesting OptumRx would increase transparency and competition among PBMs.
• Impact: Lower drug prices and fairer access to PBM services for smaller insurers.

3. Spin Off Optum Insight (Healthcare Technology)

• Rationale: Optum Insight’s dominance in healthcare analytics provides UHG with a competitive edge by restricting data access for competitors.
• Action: Establish Optum Insight as an independent entity that offers analytics services to all healthcare players on equal terms.

4. Regionalize Optum Health (Care Delivery)

• Rationale: Consolidation of care delivery systems results in regional monopolies. Fragmenting Optum Health into independently managed regional entities would dilute UHG’s local dominance.
• Impact: Improved patient choice and fair competition among care providers.

5. Divest Non-Core Businesses

• Examples: Specialty practices, home care, or niche technology acquisitions.
• Rationale: Reducing UHG’s involvement in ancillary businesses ensures focus and prevents undue vertical integration.

Benefits of the Break-Up

1. Encourages Competition: Smaller, independent entities can thrive without being overshadowed by UHG’s scale.
2. Improves Transparency: Clear pricing and operations across PBMs, insurance, and healthcare services.
3. Minimizes Conflicts of Interest: Independent units avoid favoring in-house services over competitors.
4. Supports Innovation: Levels the playing field for smaller healthcare providers and technology firms.

Challenges and Considerations

Breaking up UHG requires navigating:

• Regulatory Complexity: Coordinating with the Federal Trade Commission (FTC), DOJ, and healthcare regulators.
• Market Stability: Ensuring the transition does not disrupt healthcare access or service quality.
• Financial Implications: Managing impacts on shareholders and maintaining investor confidence.
• Global Competitiveness: Preserving the competitiveness of U.S. healthcare firms internationally.

The DOJ’s Role Under Your Leadership

The DOJ, in collaboration with HHS, can lead the charge in ensuring fair competition in the healthcare industry. By leveraging antitrust laws and working closely with regulators, we can dismantle monopolistic structures, set new standards for transparency, and foster a competitive environment that benefits all Americans.

A Call to Action

Secretary Kennedy, your tenure marks a pivotal moment in U.S. healthcare history. The systemic issues created by UHG’s dominance can no longer be ignored. We urge you to champion this cause, working alongside the DOJ and FTC to break up UnitedHealth Group and set a precedent for a fairer, more competitive healthcare market.

Together, we can create a healthcare system that prioritizes patients, innovation, and equitable access. The American people deserve nothing less.

Sincerely,

An Advocate for Transparent and Competitive Healthcare