Imagine you’re a patient named Kate.
You have health insurance through Aetna. You visit an Oak Street Health clinic. Your doctor sends your prescription to CVS Pharmacy, and your prescription benefits are managed by CVS Caremark.
At first glance, those may seem like separate healthcare companies.
They’re not.
They’re all part of CVS Health.
During a House Energy and Commerce Health Subcommittee hearing in early 2026, Representative Alexandria Ocasio-Cortez used this example, taken from one of CVS Health’s own investor materials, to ask a simple question.
If one company can insure a patient, manage their prescription benefits, employ their physician, own the pharmacy, and provide other healthcare services, how much influence should that company have over a patient’s healthcare journey?
It’s a question that reaches far beyond CVS Health.
As some of the nation’s largest healthcare companies continue expanding across insurance, pharmacy benefit management, physician practices, pharmacies, and other healthcare services, lawmakers, regulators, and patient advocates are taking a closer look at what that level of consolidation could mean for competition, patient choice, and the future of healthcare.
What Is Vertical Integration
One Company, Multiple Parts of Care
Vertical integration occurs when one company owns or controls multiple parts of the same industry.
In healthcare, that can include health insurance, pharmacy benefit management, retail pharmacies, physician practices, home health services, specialty pharmacies, and healthcare technology platforms.
Rather than independent organizations working together, more of a patient’s care takes place within the same corporate family.
Why It Isn’t Always Obvious
Most patients don’t choose their care thinking about corporate ownership.
The insurance company paying for care, the pharmacy filling prescriptions, the physician providing treatment, and the pharmacy benefit manager deciding how medications are covered may all be connected through the same parent company.
Why Are Healthcare Companies Expanding
The Patient Care Argument
Healthcare is one of the largest industries in the United States, representing trillions of dollars in annual spending. As healthcare has grown, companies have expanded beyond their traditional roles.
Healthcare companies often argue that vertical integration improves coordination between providers, reduces unnecessary duplication, allows health information to move more efficiently, and creates a smoother experience for patients.
The Business Incentive
There are also significant financial incentives.
By owning multiple parts of the patient journey, companies can generate revenue from more than one stage of care, keep patients within their own network of services, and diversify how they generate income.
Instead of relying on a single business line, integrated healthcare organizations participate in multiple parts of how healthcare is delivered, managed, and paid for. Investors often view these diversified business models as more stable and better positioned for long-term growth.
Who’s Building These Systems
Major Healthcare Companies
Several of the country’s largest healthcare organizations have expanded well beyond their original roles.
CVS Health includes Aetna health insurance, CVS Caremark pharmacy benefit management, CVS Pharmacy, MinuteClinic, Oak Street Health, and additional healthcare businesses.
UnitedHealth Group has expanded through UnitedHealthcare and Optum, which includes physician practices, pharmacy services, healthcare technology, and data analytics.
The Cigna Group has grown through Evernorth, combining insurance, pharmacy benefit management, specialty pharmacy services, and care management.
Humana has expanded through CenterWell, which includes primary care, pharmacy services, and home health.
Each company has taken a different approach, but the trend is the same. More healthcare services are becoming part of a handful of large, integrated organizations.
Why It’s Being Debated
Growing Questions About Consolidation
As healthcare companies have expanded, policymakers have begun asking whether one company should have so much influence over a patient’s healthcare journey.
Supporters believe integrated systems can improve communication between providers, simplify the patient experience, and make healthcare more efficient.
Critics argue that increased consolidation may reduce competition, limit patient choice, influence where patients receive care, and give large corporations greater control over both the delivery and financing of healthcare.
Congress Takes Notice
Those concerns reached a national stage during a House Energy and Commerce Health Subcommittee hearing in early 2026.
Members of Congress questioned CVS Health CEO David Joyner about the company’s ownership across insurance, pharmacy benefit management, retail pharmacies, physician practices, and other healthcare services.
Representative Alexandria Ocasio-Cortez argued that when a single company can insure patients, manage their prescription benefits, employ physicians, own pharmacies, and participate in other parts of healthcare delivery, it raises broader questions about market concentration and who ultimately benefits from that level of integration.
CVS defended its model, arguing that it improves coordination and delivers a better experience for consumers.
The hearing reflected a much larger national conversation about how healthcare should be structured and how much influence any one company should have over a patient’s care.
The Bigger Question
Why This Matters
For most people, healthcare isn’t a policy debate.
It’s finding a physician you trust.
Filling a prescription you can afford.
Getting the care you need when you need it.
As more healthcare services become concentrated within a small number of large organizations, the conversation extends beyond corporate strategy. It becomes a discussion about competition, affordability, patient choice, accountability, and who ultimately benefits from the way healthcare is organized.
For attorneys, healthcare professionals, and expert witnesses, understanding these relationships is becoming increasingly important as healthcare delivery, reimbursement, and corporate ownership continue to evolve.
Looking Ahead
Some believe larger, integrated systems represent the future of a more coordinated healthcare experience. Others worry that when the same company profits from insuring patients, managing their benefits, employing their physicians, and filling their prescriptions, financial incentives can become increasingly intertwined with decisions about patient care.
That is why lawmakers, regulators, healthcare professionals, and patient advocates continue to examine the growing consolidation of the healthcare industry. The debate isn’t simply about whether companies should grow. It’s about how to encourage innovation and efficiency while preserving competition, transparency, and patient choice.
Kate’s story was never just about one patient or one company.
It was about the future of healthcare.
As healthcare continues to evolve, perhaps the most important question isn’t how many services one company can own. It’s how we ensure the healthcare system remains centered on the people it was built to serve.
