Health insurance CEOs faced questions on healthcare costs, vertical integration and prior authorization from the House Energy and Commerce Committee and the House Ways and Means Committee on Thursday.
The insurer witnesses included Stephen Hemsley, CEO of UnitedHealth Group; David Joyner, president and CEO of CVS Health; Gail Boudreaux, president and CEO of Elevance Health; David Cordani, president, CEO and chairman of the board of The Cigna Group; and Paul Markovich, president and CEO of Ascendiun (parent of Blue Shield of California).
Ellen Allen, executive director of West Virginians for Affordable Healthcare, also testified to the Energy and Commerce Committee, while ReShonda Young, an Iowa resident and small business owner, testified to the Ways and Means Committee.
Esperion Sets Its Sights on New Areas While Maintaining Commitment to Cardiovascular Health
In a recent interview, Esperion president and CEO, Sheldon Koenig talks about the reality of statin intolerance and his company’s expansion into new diseases
Here are four key takeaways from the hearings:
1. Everyone agrees healthcare affordability is a problem: Across both hearings, lawmakers emphasized that healthcare has become too expensive and that Americans are struggling with rising premiums, deductibles and out-of-pocket costs.
For example, Rep. Morgan Griffith (R-Virginia), chairman of the Energy and Commerce Committee, argued that a “lack of competition and consolidation within the insurance marketplace has led us to higher healthcare costs as a whole.” Ranking Member Rep. Diana DeGette (D-Colorado) stated that “Americans know that healthcare is far too expensive, as it takes up a greater percentage of our economy than any other developed country.”
The health insurance CEOs agreed that healthcare costs are a major issue.
MedCity News Pivot Podcast: How Emergency Departments Are Using Real-Time Data to Improve Outcomes
How can AI benefit and improve patient outcome in the emergency department? Watch the latest episode to find out.
“Our healthcare system is bankrupting and failing us,” Markovich said in his opening statement. “It’s way too expensive, it’s too impersonal. It doesn’t cover everybody. It has inferior quality scores relative to other countries, and it’s mistrusted by far too many Americans. This is unacceptable.”
2. Everyone has different ideas for addressing the affordability problem: While there is broad agreement that healthcare is too expensive, consensus quickly falls apart on how to fix it. Republicans largely blamed a lack of competition, consolidation and the structure of the Affordable Care Act for healthcare costs. Democrats pointed to the need to extend ACA enhanced premium tax credits, which expired at the end of 2025.
This divide was exemplified during the opening statements of the Ways and Means Committee hearing. Chairman Rep. Jason Smith (R‑Missouri) criticized Democrats for failing to address affordability and accused them of protecting insurance corporations and enabling market consolidation.
“After 15 years of a Democrat-created health system under Obamacare, prices have only gone up, not down,” he said. “They have only gone up. I’d also like to remind my Democrat colleagues that these same corporations have exploited market power and vulnerabilities in federal programs to consolidate control, steer patient care and maximize revenue.”
Ranking Member Rep. Richard Neal (D‑Massachussetts) turned the blame back on Republicans for allowing the ACA tax credits to expire.
“Our Republican friends have no interest in strengthening healthcare or protecting patients. … They’ve refused to extend the tax credits that we’ve asked for time and again, causing millions to forgo health coverage this year, and they’ve been silent as the Trump administration wages an all out-war on public health and yes, on science as well,” Neal said.
Insurers, meanwhile, largely pointed to hospitals and pharma for rising costs.
“The cost of healthcare insurance fundamentally reflects the cost of healthcare itself,” Hemsley said. “It is more an effect than a cause. If insurance costs are going up even as we compete aggressively against other companies, it signals rising costs of health services, drugs and rising volumes of care activity. And it is a fact, hospital and drug spending has soared at three times the rate of inflation since before 2000.”
3. Vertical integration: Insurers faced a lot of questions from both sides of the aisle about their vertical integration with PBMs, pharmacies and clinics. During the Ways and Means Committee hearing, Rep. Greg Murphy (R-North Carolina) stated that vertical integration “has destroyed competition in this country.”
“I don’t agree with Mark Cuban often, but we do agree that what needs to happen is that you guys need to be broken up. … If I had my way, I’d turn all of you guys into dust. We’d start back from scratch. We’d have competition,” he said.
Rep. Alexandria Ocasio-Cortez (D-New York) focused her questioning on CVS Health, noting that the company owns the insurer Aetna, the PBM CVS Caremark and medical clinics Oak Street Health. She asked Joyner if he would agree that this is “quite a bit of market concentration,” to which he responded that he doesn’t agree and that it’s a “model that works really well for the consumer.”
4. Prior authorization and denials: Insurers were also grilled about their prior authorization practices and denial rates. A key moment came during the Energy and Commerce Committee hearing, in which Rep. Buddy Carter (R-Georgia), who practiced pharmacy, asked Hemsley if he ever looked a patient in the eye and explained why UnitedHealthcare denied their medication.
Hemsley responded that he has looked patients in the eyes many times, but doesn’t recall whether it’s regarding prior authorization.
“I’m the one who had to look the patient in the eye,” Carter countered. “I’m the one who had to tell them that, on your behalf, it’s not fun.” He went on to give a story about a single mother in Kentucky who was diagnosed with cancer and is being denied her medication by UnitedHealthcare.
Photo: Valerii Evlakhov, Getty Images