Insurer-owned clinics are increasingly competing with hospitals and physicians for patients, the Wall Street Journal reports.

The big picture: Doctor groups and hospitals have invested heavily in purchasing physician practices, and are worried about insurers steering patients toward their own clinics.

The problem of surprise medical billing — which Congress failed to solve last year — is about to get worse, thanks to a feud between an insurance giant and a company that employs thousands of doctors.

The big picture Parents who have babies in intensive care, women with high-risk pregnancies and people who need anesthesia could receive unexpected bills in the mail as a result of the fight between Mednax, the physician-staffing firm, and UnitedHealth Group.

UnitedHealth Group will be ending contracts with Mednax anesthesiologists, neonatologists and obstetricians in four states this year, affecting $70 million of revenue, Mednax said Thursday. Mednax and UnitedHealth did not immediately respond to questions.

Why it matters: If the two sides don't strike a new deal, Mednax doctors will be out-of-network for all people who have UnitedHealth insurance, regardless if those doctors work at in-network hospitals — putting patients at risk of receiving surprise medical bills from those Mednax doctors. Congress has not resolved surprise billing.

An estimated 50 million Americans have donated to crowdfunding campaigns for medical expenses, according to a new study.

The big picture: People without insurance often have to shoulder enormous bills all on their own, and out-of-pocket expenses are a burden even for people with insurance. Friends and family are a big part of the unofficial health care system.

Yet again, the 2020 Democrats debated last night without devoting much attention to their very interesting ideas for controlling health care costs. But whether they talk about it or not, they've laid out a broad range of ideas for this incredibly pressing issue.

The big picture: Democrats' ideas run the gamut, from taking control over all health care purchasing to plans that would directly regulate a slice of the market, attempting to put pressure on the rest of it.

Employers, workers and families continued to spend a lot more on health care in 2018, but that wasn't because people used more services, according to the latest annual spending report from the Health Care Cost Institute, which analyzes commercial health insurance claims.

The bottom line: Higher prices remain the main culprit for exploding spending among those with private health insurance.

Doctors' extensive lobbying on surprise medical bills is partly to blame for Congress' inaction on the issue, reports Kaiser Health News.

Why it matters: "As Congress begins its 2020 legislative session, there is evidence the doctors' message has been received: The bills with the most momentum are making more and more concessions to physicians."

The three drug companies that control the insulin market have seen their net sales climb over the past 12 years even as they have had to agree to bigger discounts, according to an Axios analysis of insulins sold by Eli Lilly, Novo Nordisk and Sanofi.

The big picture: Drug manufacturers have largely blamed the broken insulin market — where many people with diabetes are rationing their medication — on other actors within the supply chain. But insulin makers have still been able to collect more money overall and retain their power over the market.

Senate Majority Leader Mitch McConnell told reporters Tuesday that Senate Republicans are divided on bipartisan bills to address both drug costs and surprise bills, The Hill reports.

The big picture: The White House vocally supports the bipartisan drug pricing bill by Sens. Chuck Grassley and Ron Wyden.

The number of people struggling to pay medical bills has fallen by 5.5 percentage points since 2011, but more than 14% of Americans still had problems in 2018, according to a new report by the Centers for Disease Control and Prevention.

Why it matters: "Families with problems paying medical bills may experience serious financial consequences, such as having problems with paying for food, clothing, or housing, and filing for bankruptcy," the report's authors write.