At the 2025 AANS Annual Meeting, Ms. Charlotte Pineda, MPP, Vice President of Health Policy and Advocacy for the AANS/CNS Washington Committee, participated in two high-profile panels focused on the structural forces reshaping neurosurgical practice.
In her presentation, “Why is Optum Not Treated as a Monopoly?” delivered under the Randall Smith Keynote session, Ms. Pineda examined how UnitedHealth Group’s subsidiary Optum has quietly amassed market dominance across insurance, PBM, and provider sectors. She explained how gaps in current antitrust tools, designed for horizontal mergers, fail to capture the competitive harms posed by vertically integrated healthcare giants. Despite these legal and regulatory shortcomings, Ms. Pineda noted growing bipartisan concern in Congress, with lawmakers beginning to intensify scrutiny of consolidation and its impact on physician autonomy and patient access.
Later that afternoon, Ms. Pineda joined a multidisciplinary session addressing ethical billing and organized labor in medicine. Her presentation, “Unions in Neurosurgery: Current Law,” offered an overview of the National Labor Relations Act and the rules of the road on how to comply with the law. She also emphasized that recent organizing activity often stems from broader systemic challenges including hospital consolidation, a lack of due process protections, and more.
