This paper examines a reform of the French healthcare system that aimed to empower patients and improve their access to care but led to various adverse consequences for patients. Specifically, already socio-economically disadvantaged groups of patients found their positions becoming even more precarious. Conceptually, we draw upon Emerson’s power dependence theory and find that, rather than empowering patients, the reform resulted in private health insurance providers emerging as critical actors and primary beneficiaries of power network changes. This healthcare system-level analysis highlights the need for patients to be the direct focus of healthcare system reform and the importance of considering their position within the power network for understanding reform outcomes. This attention to the power network adds to the extant theorisation on the effects of funding mechanism reform on the nature of patient empowerment and access to healthcare.