healthcare

Companies involved: Merck & Co., Inc. (shareholders vote here)

Retail prescription drug spending is measured by the federal government at $467.0 billion in 2024, and the pricing power behind it is described by the company that holds it.

A patent is an exclusive right, and the company holding it sets the price with no competitor able to undercut it. Merck states the mechanism in its own annual report: losing patent protection on a product is promptly followed by generic or biosimilar substitutes that reduce its sales of that product. Retail prescription drugs came to $467.0 billion in 2024. That pricing is a choice rather than a constraint is on the record too, in the supporting statement of the 2019 proposal: Merck had committed to limit average price increases to no more than the rate of inflation. A company that can promise to hold a price is a company that was setting it.

Companies involved: CVS Health Corporation (shareholders vote here); UnitedHealth Group Incorporated (shareholders vote here); The Cigna Group (shareholders vote here); Humana Inc. (shareholders vote here); Prime Therapeutics LLC (privately held, no shareholder vote); MedImpact Healthcare Systems, Inc. (privately held, no shareholder vote)

The share is the Federal Trade Commission's own figure from a Section 6(b) inquiry, not an estimate from the industry.

The Federal Trade Commission found the six largest pharmacy benefit managers handling nearly 95 percent of all prescriptions filled in the United States, and named them: Caremark Rx, Express Scripts, OptumRx, Humana Pharmacy Solutions, Prime Therapeutics and MedImpact. CVS Health runs Caremark inside its Health Services segment and UnitedHealth Group runs Optum Rx as one of its businesses, both stated in their own annual reports. The Commission's finding was not that this is merely concentrated but that the structure lets these firms profit at the expense of patients and independent pharmacists. Ninety-five percent in six hands is a market where the price at the counter is a corporate decision.

Companies involved: UnitedHealth Group Incorporated (shareholders vote here); CVS Health Corporation (shareholders vote here); The Cigna Group (shareholders vote here); Elevance Health, Inc. (shareholders vote here); Humana Inc. (shareholders vote here)

EDGAR full-text search across DEF 14A and PRE 14A filings, for "shareholder proposal" with each of "prior authorization", "denial of care" and "delay or deny", returned no proposal asking an insurer to report on or change how it denies claims. The UnitedHealth proxies returned by a related search carry only a golden parachute proposal and a board chair proposal.

The denial rates come from insurer reporting collected by the government and analysed by KFF, and the range between insurers is what shows the discretion.

Across HealthCare.gov insurers with complete data, nearly 17 percent of in-network claims were denied in 2021, and the denial rate ran from 2 percent at one insurer to 49 percent at another. The spread is the finding. Insurers facing similar patients and similar rules deny wildly different shares of claims, which is not a fact about medicine, it is a fact about companies. Only about 2 percent of those denials rested on medical necessity and 77 percent were reported as all other reasons. Consumers rarely appeal. What a company approves and what it refuses is that company's own conduct, and changing it is not a step towards fixing this obstacle, it is the fix.

Companies involved: HCA Healthcare, Inc. (shareholders vote here); Tenet Healthcare Corporation (shareholders vote here); Universal Health Services, Inc. (shareholders vote here)

Flagged for review. Most hospitals in this obstacle's chain are nonprofit or government owned. The listed companies a vote reaches are the insurers that negotiate rates, the investor-owned chains, and the suppliers, rather than the majority of hospitals themselves.

Hospital care is the largest category of national health expenditure, at $1,634.7 billion in 2024.

Hospital expenditure was $1,634.7 billion in 2024, more than three times the retail drug bill and the largest category in national health spending. Most hospitals are not owned by shareholders: 2,984 of the 5,121 community hospitals are nongovernment not-for-profit and 1,224 are investor-owned. That does not put hospital care beyond a vote, since listed insurers negotiate the rates, and listed suppliers, device makers and staffing firms sit in the same chain. It does lower the answer, because none of those companies sets what a nonprofit hospital charges. Companies have to move here and so do hospitals and the states that regulate them.

The figure covers uninsured adults who were working, and is the reason most often available to a shareholder among the reasons people are uninsured.

Among uninsured adults who were working in 2024, 71 percent were not offered coverage by their employer or were not eligible for it. Whether a job comes with health insurance, and who inside the workforce is eligible for it, is a decision the employer makes. That reaches part of the uninsured population and not all of it: many uninsured people are not working, and a large share of those who are work for small private firms no shareholder vote reaches. Companies have to move and others have to move too.

The rationing figure is carried in a federal competition authority's report rather than in an advocacy document.

Nearly 30 percent of Americans surveyed reported rationing or skipping doses of their prescribed medicines because of cost, a figure the Federal Trade Commission put in its own report on drug middlemen. What somebody pays at the counter is the product of a list price set by a manufacturer with an exclusive right and a benefit design set by a pharmacy benefit manager, both of them corporate decisions covered by the first two obstacles here. It is not only that: a plan's deductible, an income, and whether there is any coverage at all all bear on it. Companies have to move and so do others.

Companies involved: Merck & Co., Inc. (shareholders vote here)

Both the litigation and the programme's scale are documented, one in the company's annual report and one in the analysis of the programme.

Merck's own annual report states that in June 2023 it filed a complaint against the United States government challenging the constitutionality of the Medicare Drug Price Negotiation Program under the First and Fifth Amendments. That is corporate political activity aimed squarely at a price measure, and it is documented by the company rather than alleged about it. What it is not is a blockade. The programme exists and is running: forty drug products have been selected, $125 billion of the $350 billion Medicare spent on drugs in 2024, with the government estimating several billion dollars in net savings. A measure that passed anyway and is taking effect is narrowed and delayed rather than stopped.

The federal survey figures give both the number uninsured and the cause of the 2024 increase.

26.7 million people under 65 were uninsured in 2024, 1.3 million more than the year before, and a decline in Medicaid coverage drove the increase. Eligibility rules, enrolment procedures and the size of a subsidy are set by Congress and by state legislatures. No company makes those decisions and no shareholder vote reaches them. Nothing in the documents read shows corporate political activity for or against this, which is a statement about what we read.