Medical insurance CEOs confronted questions on healthcare prices, vertical integration and prior authorization from the Home Vitality and Commerce Committee and the Home Methods and Means Committee on Thursday.
The insurer witnesses included Stephen Hemsley, CEO of UnitedHealth Group; David Joyner, president and CEO of CVS Well being; Gail Boudreaux, president and CEO of Elevance Well being; David Cordani, president, CEO and chairman of the board of The Cigna Group; and Paul Markovich, president and CEO of Ascendiun (mother or father of Blue Defend of California).
Ellen Allen, government director of West Virginians for Reasonably priced Healthcare, additionally testified to the Vitality and Commerce Committee, whereas ReShonda Younger, an Iowa resident and small enterprise proprietor, testified to the Methods and Means Committee.
Listed below are 4 key takeaways from the hearings:
1. Everybody agrees healthcare affordability is an issue: Throughout each hearings, lawmakers emphasised that healthcare has develop into too costly and that People are fighting rising premiums, deductibles and out-of-pocket prices.
For instance, Rep. Morgan Griffith (R-Virginia), chairman of the Vitality and Commerce Committee, argued {that a} “lack of competitors and consolidation throughout the insurance coverage market has led us to greater healthcare prices as an entire.” Rating Member Rep. Diana DeGette (D-Colorado) acknowledged that “People know that healthcare is much too costly, because it takes up a higher proportion of our economic system than some other developed nation.”
The medical health insurance CEOs agreed that healthcare prices are a significant subject.
“Our healthcare system is bankrupting and failing us,” Markovich mentioned in his opening assertion. “It’s manner too costly, it’s too impersonal. It doesn’t cowl all people. It has inferior high quality scores relative to different nations, and it’s mistrusted by far too many People. That is unacceptable.”
2. Everybody has completely different concepts for addressing the affordability drawback: Whereas there’s broad settlement that healthcare is simply too costly, consensus rapidly falls aside on the right way to repair it. Republicans largely blamed an absence of competitors, consolidation and the construction of the Reasonably priced Care Act for healthcare prices. Democrats pointed to the necessity to lengthen ACA enhanced premium tax credit, which expired on the finish of 2025.
This divide was exemplified throughout the opening statements of the Methods and Means Committee listening to. Chairman Rep. Jason Smith (R‑Missouri) criticized Democrats for failing to handle affordability and accused them of defending insurance coverage companies and enabling market consolidation.
“After 15 years of a Democrat-created well being system beneath Obamacare, costs have solely gone up, not down,” he mentioned. “They’ve solely gone up. I’d additionally wish to remind my Democrat colleagues that these similar companies have exploited market energy and vulnerabilities in federal packages to consolidate management, steer affected person care and maximize income.”
Rating Member Rep. Richard Neal (D‑Massachussetts) turned the blame again on Republicans for permitting the ACA tax credit to run out.
“Our Republican buddies have no real interest in strengthening healthcare or defending sufferers. … They’ve refused to increase the tax credit that we’ve requested for again and again, inflicting tens of millions to forgo well being protection this yr, and so they’ve been silent because the Trump administration wages an all out-war on public well being and sure, on science as nicely,” Neal mentioned.
Insurers, in the meantime, largely pointed to hospitals and pharma for rising prices.
“The price of healthcare insurance coverage essentially displays the price of healthcare itself,” Hemsley mentioned. “It’s extra an impact than a trigger. If insurance coverage prices are going up whilst we compete aggressively in opposition to different firms, it alerts rising prices of well being providers, medicine and rising volumes of care exercise. And it’s a truth, hospital and drug spending has soared at thrice the speed of inflation since earlier than 2000.”
3. Vertical integration: Insurers confronted plenty of questions from each side of the aisle about their vertical integration with PBMs, pharmacies and clinics. Through the Methods and Means Committee listening to, Rep. Greg Murphy (R-North Carolina) acknowledged that vertical integration “has destroyed competitors on this nation.”
“I don’t agree with Mark Cuban typically, however we do agree that what must occur is that you simply guys have to be damaged up. … If I had my manner, I’d flip all of you guys into mud. We’d begin again from scratch. We’d have competitors,” he mentioned.
Rep. Alexandria Ocasio-Cortez (D-New York) centered her questioning on CVS Well being, noting that the corporate owns the insurer Aetna, the PBM CVS Caremark and medical clinics Oak Avenue Well being. She requested Joyner if he would agree that that is “fairly a little bit of market focus,” to which he responded that he doesn’t agree and that it’s a “mannequin that works rather well for the buyer.”
4. Prior authorization and denials: Insurers had been additionally grilled about their prior authorization practices and denial charges. A key second got here throughout the Vitality and Commerce Committee listening to, by which Rep. Buddy Carter (R-Georgia), who practiced pharmacy, requested Hemsley if he ever appeared a affected person within the eye and defined why UnitedHealthcare denied their remedy.
Hemsley responded that he has appeared sufferers within the eyes many instances, however doesn’t recall whether or not it’s concerning prior authorization.
“I’m the one who needed to look the affected person within the eye,” Carter countered. “I’m the one who needed to inform them that, in your behalf, it’s not enjoyable.” He went on to provide a narrative a couple of single mom in Kentucky who was identified with most cancers and is being denied her remedy by UnitedHealthcare.
Photograph: Valerii Evlakhov, Getty Photographs
