Dana Gibbon was 18 weeks pregnant together with her first child when her OB-GYN informed her at an appointment that she wouldn’t be her physician anymore.
OB-GYN providers have been ending on the clinic in Corvallis, a school city of 60,000 in Oregon’s Willamette Valley. The physician stated all the Corvallis Clinic’s OB-GYNs have been resigning.
“We now have appreciated the chance to take part in your care and apologize for any inconvenience this will likely trigger,” the clinic stated in a subsequent letter to sufferers.
The closure of the Corvallis OB-GYN observe got here two years after a subsidiary of UnitedHealth Group, the nation’s largest medical insurance firm, purchased the clinic. The subsidiary, Optum Oregon, cited a nationwide scarcity of physicians that made it laborious to exchange medical doctors who left and elevated the workload for individuals who remained.
Gibbon frantically seemed for one more physician. Buddies beneficial two different obstetrics practices, however each had closed. Gibbon settled on a small hospital near dwelling with 4 devoted maternity beds — all of which have been full when she was attributable to ship in April, delaying her induction thrice. Her wholesome child boy was ultimately born on April 29 by cesarean part, a process she’d hoped to keep away from.
“It’s inconceivable to not marvel if issues might have gone in a different way if there had been extra labor and supply beds within the space,” she stated.
Corvallis sufferers like Gibbon confronted this disruption regardless of a singular Oregon legislation meant to forestall it.
In 2021, the state grew to become the primary within the nation to give its state well being division the broad energy to dam acquisitions and mergers of hospitals, hospices and medical practices, an effort to counteract the consolidation that analysis reveals is slicing competitors and driving up prices nationwide.
Lawmakers stated Oregon’s novel oversight energy would cease multibillion-dollar offers from decreasing care and growing prices. State regulators bought the authority to reject transactions or so as to add circumstances and levy fines if corporations disregarded them. The legislation was hailed as a nationwide mannequin.
5 years later, Oregon has not formally blocked a single transaction or issued any fines. Whereas the brand new oversight is credited with resulting in the withdrawal of two high-profile transactions — a merger of two Portland-area hospital techniques and the acquisition of a nonprofit that gives Medicaid advantages to half one million Oregonians — some individuals who supported the legislation say it has not been practically as efficient as hoped.
Dr. John Santa, a retired doctor and former member of the Oregon Well being Coverage Board, which oversees the state company liable for implementing the brand new legislation, stated his interactions with this system have been “so disappointing and fell so in need of what I anticipated. I by no means imagined it might carry out as poorly because it has.”
Of the 9 healthcare offers for which regulators have accomplished follow-up critiques, at the very least three had outcomes the legislation was meant to forestall, ProPublica’s examination of state data discovered.
UnitedHealth Group acquired a house well being supplier, LHC Group, for $5.4 billion in 2023. It shuttered a rural hospice company in Central Oregon two months later, funneling employees and sufferers to a location practically 30 miles away. The state later stated the transfer raised issues a few potential discount in entry. A UnitedHealth spokesperson stated the closure didn’t cut back providers as a result of sufferers and employees have been reassigned and it continued to serve the identical areas.
After Amazon purchased One Medical for $3.9 billion that very same yr, it closed the group’s downtown Portland observe whereas slicing $100 million in working bills nationwide. It noticed a drop in Oregon affected person satisfaction scores, as measured by an out of doors group, a state assessment famous. Amazon declined to touch upon the One Medical deal.
Oregon in 2022 accredited the acquisition of a hospice supplier by a personal fairness agency, Clayton, Dubilier & Rice. The agency informed regulators that it wouldn’t change places or staffing. Oregon took the corporate at its phrase — then watched it shut a Salem hospice after the deal closed.
In a follow-up report, the state famous the closure and alluded to “some adjustments” in Oregon staffing; it might not disclose whether or not this referred to including staff or slicing them, saying the businesses concerned had designated the knowledge confidential.
A spokesperson for Clayton, Dubilier & Rice didn’t deal with the closure however stated in a press release that its hospice acquisition was “premised on the corporate delivering high-quality care.” The agency’s hospice suppliers in 2024 and 2025 obtained larger scores than some other nationwide supplier in standardized shopper surveys, the spokesperson stated, and the corporate improved its ratio of nurses to sufferers by 5.5% over its possession interval.
Clare Pierce-Wrobel, the well being coverage and analytics director for Oregon’s well being division, the Oregon Well being Authority, acknowledged that the state held some mergers to a decrease customary whereas this system was simply getting began.
“I believe if these notices have been obtained when this system was totally up and operating, there might have been a unique end result,” she stated.
Dr. Nicole Kruppa had a thriving OB-GYN observe on the Corvallis Clinic earlier than it was taken over by Optum. She informed ProPublica that she stop after the sale as a result of her workload grew unsustainable. She stated burnout grew to become so intense that she fearful she would both make a medical mistake or get in a late-night automotive accident whereas driving to ship a child.
Optum didn’t fill vacancies when medical employees went out on deliberate go away, she stated. Annual medical exams needed to be postponed so the remaining OB-GYN employees may attend to emergencies, she stated.
“I felt I may now not present my sufferers the care that they deserved,” Kruppa stated.
A UnitedHealth spokesperson, Tyler Mason, stated Optum helped hold the Corvallis Clinic’s doorways open. “Our focus has been stabilizing practices, increasing entry, and strengthening medical providers to protect native care, keep vital providers and guarantee sufferers can proceed receiving the care they rely upon near dwelling,” Mason stated.
When Oregon lawmakers created the merger and acquisition oversight program in 2021, they stated they weren’t attempting to cease each healthcare deal — simply to make sure that these transactions made sense.
Consolidation within the healthcare business is rife. About 50% of the nation’s medical doctors have been employed by a hospital system in 2024, analysis has proven, up from lower than 30% in 2012. As competitors narrows, research present, costs can enhance, the standard of care can decline and remedy will be more durable to entry, particularly in rural areas.
Following Oregon’s instance, 5 states final yr accredited legal guidelines that expanded their authorities over healthcare consolidation. One among them, Maine, adopted a invoice this April that requires state assessment and approval of the sale of healthcare amenities when non-public fairness corporations are concerned. New Mexico in 2024 additionally adopted a invoice much like Oregon’s.
Pierce-Wrobel, the well being authority official, stated Oregon is clearly a nationwide chief. “Folks in Oregon are fortunate to have a program like this in place,” she stated.
“The power to really see how these selections are made and the way it’s really impacting your healthcare earlier than it occurs is novel and addresses an actual, urgent challenge,” she stated, “which is affordability in healthcare, which impacts all of us.”
Though Oregon hasn’t blocked any of the 65 transactions it has evaluated, it has imposed circumstances on 15. It has required medical doctors to proceed serving sufferers lined by Medicare, the federal insurance coverage program for seniors and the disabled. It has required reproductive and gender-affirming healthcare to proceed and ordered detailed annual reporting.
The state additionally has required a deeper six-month assessment in seven instances, three of that are nonetheless underway. The opposite 4 offers have been withdrawn, notably: the proposed merger of Oregon Well being & Science College and Legacy Well being, two main Portland-area hospital techniques; and a proposed merger involving CareOregon, which administers Medicaid plans for greater than 500,000 low-income folks. Going through a public outcry, the healthcare organizations canceled their offers.
Dr. Jane Zhu, a major care doctor and affiliate professor of drugs at Oregon Well being & Science College who research healthcare entry, stated packages like Oregon’s add sorely wanted transparency to medical dealmaking.
However they “don’t essentially change the equation” in the case of the pattern towards consolidation, she stated in an electronic mail. Particularly in rural areas, the very fact stays that “regulators can approve the merger and costs go up and consolidation worsens, or they’ll block a merger and perhaps there’s a direct impact on the clinic’s solvency or sustainability.”
Based on Larry Kirsch, a well being economist, one drawback is that Oregon regulators have sometimes chosen the quickest possibility for reviewing acquisitions allowed underneath the legislation, 30 days. Kirsch stated that’s not sufficient time to adequately research what a transaction will do to medical care.
“I used to be gobsmacked by how superficial, how inconclusive, how nonrobust the investigation was,” stated Kirsch, who has examined dozens of Oregon’s oversight critiques. “A few of them have been so outrageous, you’d need to say that their eyes have been completely closed.”
Pierce-Wrobel stated Oregon welcomes “public enter to tell our assessment of particular person transactions — in addition to alternatives to enhance how we implement this new program — to be able to advance Oregon’s targets of well being fairness, decrease prices, elevated entry and higher care. That stated, this system should function inside its statutory limits.”
Nowhere are the constraints of the assessment course of extra evident than within the metropolis of Corvallis, dwelling to each Oregon State College and the Corvallis Clinic, which had operated as an unbiased, doctor-owned observe since 1947.
Maybe mockingly, one of many clinic’s executives testified in opposition to the legislation in 2021 on behalf of the Oregon Impartial Medical Coalition, a lobbying group for personal practices. Scott Shollenbarger stated that the group’s members have been dedicated to remaining unbiased.
“We passionately imagine that healthcare is greatest delivered in an unbiased enterprise mannequin that’s owned and ruled by the house owners of the enterprise that are also liable for the supply of medical providers to our respective populations,” he wrote on the time.
However by 2023, the clinic’s funds had deteriorated and it struck a deal to be acquired by Optum Oregon. Kruppa, the previous Corvallis worker and shareholder, stated the clinic was dropping as much as $1 million a month on the time.
With tons of writing to the state to oppose the acquisition, regulators developed circumstances to guard sufferers. They drew up necessities for the brand new proprietor to protect present medical packages and settle for an unbiased monitor to make sure compliance.
As Oregon reviewed the deal, the clinic’s funds worsened, Kruppa informed ProPublica. Docs went with out paychecks within the month earlier than the deal went via, she stated, to be able to hold the clinic’s doorways open till the transaction was accredited.
Then a Russian-linked ransomware hack focused Change Healthcare, a UnitedHealth subsidiary that gives cost and claims processing to hospitals and medical doctors’ places of work. The assault disrupted medical practices throughout the nation, together with the Corvallis Clinic. Kruppa stated the clinic was getting ready for a chapter submitting, fearful that the hack would additional delay closing the deal.
UnitedHealth stated after the hack that it prolonged $9 billion in no-interest loans to hospitals and medical practices nationwide. In testimony to the U.S. Senate Finance Committee, then-CEO Andrew Witty stated: “I would like this committee and the American public to know that the folks of UnitedHealth Group is not going to relaxation — I cannot relaxation — till we repair this.”
Two weeks after the hack, the clinic informed the state it was vulnerable to going underneath and requested for an emergency exemption from the continued assessment of the sale. Clinic attorneys assured the state the transaction was “anticipated to take care of important providers at or above present ranges.” By making a extra secure operation, they wrote, the sale would additionally “enhance the Clinic’s capability to draw and retain high-quality candidates for open positions.”
Oregon’s oversight program agreed to dispense with its assessment — the one exemption it has granted — in simply 5 days. The state jettisoned the guardrails it proposed beforehand.
Pierce-Wrobel stated the state can’t apply circumstances to emergency requests that meet exemption standards specified within the statute, nor can it assessment the offers afterward to measure their impacts.
“I perceive and listen to the criticism, however we’re liable for implementing the legislation that established this program, and that’s what was accomplished,” she stated.
A UnitedHealth spokesperson stated the corporate prolonged a zero-interest mortgage to the Corvallis Clinic inside three weeks of the hack.
The observe was “going through critical operational and monetary challenges that put affected person entry in danger” earlier than the hack, the spokesperson stated. For the reason that buy, “we’ve been working to stabilize practices, recruit clinicians, increase providers and enhance techniques to assist guarantee sufferers proceed to get the care they want.”
The Corvallis Clinic’s adjustments grew to become obvious quickly after the sale.
ProPublica spoke to greater than 10 present or former sufferers. They described generally in depth disruptions to their care after the observe was offered: procedures delayed, longer waits for appointments and a gentle stream of medical doctors leaving.
One lady stated her scheduled pap smear on the Corvallis Clinic was delayed greater than six months.
One other stated she misplaced a health care provider she trusted so deeply to deal sensitively together with her historical past of trauma that she had no want to search out one other physician, regardless that she’s purported to get frequent most cancers screenings.
Rebecca Geier, 67, stated she has misplaced 4 medical doctors on the clinic within the final yr.
“It wasn’t simply an inconvenience, it was disruptive to my continued care with these medical doctors,” she informed ProPublica in an electronic mail. “The dreaded letters from Optum informing me that my physician had left or was quickly leaving the clinic simply saved coming, one after one other.”
Three medical doctors at Mid-Valley Gastroenterology, a neighborhood observe, wrote to state regulators in March 2025 to say that two of the Corvallis Clinic’s gastroenterologists had withdrawn from a pool of space physicians who dealt with on-call look after emergencies at a serious regional hospital system. They stated Optum made the specialists choose out to save cash.
Optum “prioritized company revenue and doctor comfort over the well-being of each the sufferers they serve and the opposite medical professionals they work alongside,” the medical doctors wrote.
Mason, the UnitedHealth spokesperson, stated Optum didn’t intrude with or direct the physicians’ selections. “Physicians make their very own selections about taking part in on-call protection primarily based on what they’ll fairly handle alongside caring for his or her sufferers,” Mason stated.
If Oregon hadn’t exempted the transaction from its oversight, it’s the kind of impression that might have confronted regulatory scrutiny throughout a follow-up assessment.
The state convened a public discussion board concerning the deal, listening to testimony about what had occurred. However regulators stated they couldn’t examine any additional.
