Opinion: The Break Up Big Medicine Act, sponsored by Sens. Elizabeth Warren and Josh Hawley, would bar common ownership between providers and insurers, PBMs, or certain wholesalers and force divestitures within a year for violators. The author argues the bill departs from conservative principles by imposing industry‑wide structural mandates rather than addressing specific anticompetitive behavior. Recommended alternatives include price transparency, tort reform, payment redesign, interstate insurance reforms, and targeted pharmaceutical policy changes.
Break Up Big Medicine Act: Why Hawley’s Bipartisan Support Conflicts With Conservative Principles
(Tatsiana Niamera/Dreamstime.com)
By Charlie Kolean — Opinion
Sens. Elizabeth Warren (D‑Mass.) and Josh Hawley (R‑Mo.) have introduced the Break Up Big Medicine Act, a bipartisan proposal that would bar common ownership between medical providers (including management services organizations) and insurers, pharmacy benefit managers (PBMs), or specified drug and device wholesalers. Companies found in violation would face mandatory divestiture within one year, automatic penalties, disgorgement of profits, forced asset sales, and vigorous enforcement by the FTC, DOJ, HHS, state attorneys general, and private plaintiffs empowered to seek treble damages.
What The Bill Proposes
The bill’s stated aim is to reduce conflicts of interest in vertically integrated healthcare conglomerates and thereby lower costs for patients. Its approach is structural: instead of prosecuting specific anticompetitive conduct on a case-by-case basis, it forbids particular ownership arrangements across an entire industry and prescribes mandatory breakups for violators.
Why This Troubling For Conservatives
While the goal of lowering healthcare costs is broadly popular, the Break Up Big Medicine Act represents a significant departure from core conservative principles: limited government, respect for private property and contracts, and reliance on competitive markets rather than top-down restructuring. Conservatives have historically cautioned that government-imposed structural separations—echoing Glass‑Steagall-era thinking—often reduce efficiency and innovation without fixing the underlying causes of market failure.
Vertical integration is not inherently anticompetitive. In healthcare and other sectors, combining stages of delivery or distribution can lower transaction costs, improve coordination of care, strengthen data sharing, and reduce administrative duplication. Economic evidence shows the effects of vertical integration are context-dependent: sometimes it harms competition, and sometimes it benefits patients and payers.
Enforcement And Unintended Consequences
The bill’s aggressive enforcement regime multiplies concerns. Broad authority given to multiple agencies and private litigants, strict timelines for divestiture, and steep financial penalties shift decision-making from market participants to regulators and courts. That increases the risk of politicized enforcement and unintended outcomes—such as short-term disruptions to care, higher transitional costs, and compliance burdens that may advantage the largest firms.
Early state-level restrictions on PBM ownership of pharmacies, for example, have in some places been associated with reduced access and closures in rural communities—outcomes directly at odds with the law’s purported pro-competition rationale.
Root Causes The Bill Doesn’t Address
America’s affordability crisis in healthcare stems from deeper, long‑standing policy choices: third‑party payment systems that blunt price signals, regulatory barriers that raise entry costs, distortions in Medicare and Medicaid reimbursement, and a litigation environment that incentivizes defensive medicine. The Break Up Big Medicine Act does not reform these drivers; it layers structural limits on top of them and risks fragmenting integrated systems that can deliver better coordinated care.
Conservative Alternatives
A conservative reform agenda can address root causes without forfeiting property rights or imposing sweeping ownership mandates. Practical alternatives include completing price-transparency rules to empower consumers, enacting meaningful tort reform to reduce defensive medicine, redesigning reimbursement to reward value over volume, lowering barriers to interstate insurance sales and expanding association health plans, and pursuing targeted patent and importation reforms where evidence shows they harm competition.
Bottom Line
The Break Up Big Medicine Act is not a conservative solution to rising healthcare costs; it is regulatory overreach that substitutes government decree for market outcomes. Senator Hawley—who has cultivated a populist reputation for challenging corporate power—would better serve conservative principles and his constituents by withdrawing support and pushing for market-focused reforms that expand choice, transparency, and competition without forced corporate breakups.
Charlie Kolean has worked as a senior policy adviser for state legislators, corporations, and think tanks. He has been active in politics for over a decade.
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