⚡️ NIMITZ HEALTH NEWS FLASH ⚡️ 

“Lowering the Cost of Healthcare: Technology’s Role in Driving Affordability”

House Oversight Committee

December 10th, 2025 (recording linked here)

WITNESS & TESTIMONY

• Mr. Brian Whorley: Chief Executive Officer, Paytient Technologies, Inc.

• Dr. Darius Lakdawalla: Quintiles Chair in Pharmaceutical Development and Regulatory Innovation and Chief Scientific Officer, Schaeffer Center for Health Policy and Economics, University of Southern California

• Dr. Ziad Obermeyer: Blue Cross of California Distinguished Associate Professor, Health Policy and Management University of California-Berkeley

• Mr. Chris Jacobs: Founder Juniper Research Group

• Ms. Sophia Tripoli: Senior Director of Health Policy Families USA

HEARING HIGHLIGHTS

MEMBER OPENING STATEMENTS

• Rep. Burlison (R-MO) blamed rising costs on Democratic policies and the Biden administration’s regulations, including the Inflation Reduction Act, which he said hindered innovation. Burlison highlighted AI, wearables, 3D printing, and telehealth as tools that could save money and improve care, especially in rural areas. He praised President Trump’s $50 billion rural hospital bill and said he looked forward to hearing from witnesses on how to empower private-sector innovation.

• Rep. Frost (D-FL) criticized holding a hearing on technology while Republicans blocked ACA premium tax credit extensions, warning that 25 million Americans could face 50–300% premium hikes within weeks. He said innovation could not replace affordable coverage and accused Republicans and former President Trump of policies that would strip coverage from millions, including pregnant women and young adults. Frost argued Democrats were fighting to lower prescription costs and maintain ACA benefits, urging Congress to extend the tax credits before pursuing innovation-focused reforms.

• Rep. Grothman (R-WI) said Obamacare had primarily benefited insurers and that the nation faced a choice between spending billions to prop up a failing system or reforming it. He noted that U.S. healthcare spending had grown to nearly $5 trillion annually—18% of GDP—with one-third wasted on administration. He criticized hospitals and insurers for employing more administrators than clinicians and for hiding prices from patients. Grothman said technology and transparency could reduce waste, lower costs, and improve patient access.

• Rep. Krishnamoorthi (D-IL) warned that without extending ACA tax credits, Illinois families could see premiums nearly double, with rural areas hit hardest. He cited hospitals in Chicago and southern Illinois that might cut programs or close due to Republican-backed Medicaid and ACA reductions. Krishnamoorthi argued these cuts would devastate rural economies and drive up uncompensated care costs for everyone. He urged Congress to renew the tax credits and stop what he called preventable harm to hospitals and patients.

WITNESS OPENING STATEMENTS

• Mr. Worley said his company helps employers and patients pay transparent, direct cash prices for healthcare, improving affordability and accountability. He described Patient Technologies’ role in managing the Medicare Prescription Payment Plan for 22 million beneficiaries, which lets seniors spread pharmacy payments across the year. Worley urged automatic enrollment for seniors, expansion of “cost smoothing” to medical expenses and ACA plans, real-time opt-ins at pharmacies, and greater employee control over healthcare funds through HSAs. He said these measures would empower patients and make care more affordable.

• Dr. Lakdawalla called for modernized regulations to speed innovation, citing historical delays in U.S. drug approvals that cost lives. He said Medicare’s Coverage with Evidence Development program limited access and equity, particularly for rural and low-income patients. He urged reforms to risk adjustment and payment models that discourage preventive care, highlighting obesity treatment as a high-return investment. Lakdawalla concluded that price opacity enriched intermediaries and called for transparency to make innovation efficient and equitable.

• Dr. Obermeyer argued that AI could uniquely reduce costs and improve quality by improving decision-making, using cardiac defibrillator placement as an example. He described how his team’s AI tool more accurately predicts sudden cardiac death risk and is being tested in Montana hospitals. Obermeyer said U.S. data-access barriers had forced him to do early research in Sweden and urged streamlined federal processes for de-identified health data. He called on the FDA to evaluate AI based on predictive accuracy and urged CMS to create payment codes for proven, cost-saving tools.

• Mr. Jacobs argued that the Affordable Care Act had failed to deliver on its promise to reduce premiums, which doubled in its first four years. He said bipartisan critics, including Sen. Elizabeth Warren, agreed the law’s rules encouraged insurer consolidation and inflated costs. Jacobs opposed extending temporary COVID-era premium subsidies, citing exchange fraud and strong enrollment despite pending expirations. He urged Congress to let the subsidies lapse and focus on policies that improve portability and transparency.

• Ms. Tripoli testified that the U.S. faced a full-blown affordability crisis caused by corporate health systems, not overuse or immigrant care. She said technology could improve efficiency but could not replace affordable insurance, accusing Congress of cutting safety-net programs and failing to extend ACA tax credits for 22 million Americans. Tripoli cited stories of patients who depend on those credits for life-saving treatments and said voters overwhelmingly want Congress to lower costs and hold corporations accountable. She urged lawmakers to extend tax credits, implement site-neutral payments, expand drug negotiation, and curb private equity’s influence on healthcare prices.

QUESTION AND ANSWER SUMMARY

• Rep. Burlison (R-MO) asked what the greatest obstacle was to scaling his payment technology and whether federal regulations propped up the status quo and hindered innovation. Mr. Worley replied that the main barrier was inertia in the existing system and said his company needed flexibility, not prescriptive rules, to give patients simple, dignified ways to pay for care, highlighting that the new Medicare Prescription Payment Plan in 2025 had helped tens of millions better afford prescriptions.

  Rep. Burlison asked how the Affordable Care Act had contributed to unaffordable healthcare. Mr. Jacobs responded that the ACA’s medical loss ratio rules encouraged consolidation and vertical integration among insurers, PBMs, and hospital systems, creating “oligopolies” with greater leverage to raise prices.

  Rep. Burlison asked how to balance data security with the need for AI-ready health data, noting the failures of past health information exchanges. Dr. Obermeyer answered that the perceived tradeoff between access and safety reflected outdated data systems, and he argued that modern architectures plus strict enforcement could deliver both strong privacy and timely de-identified data for research.

• Rep. Frost (D-FL) asked how demand for services in 2025 compared with prior years, whether rising deductibles and worse plans increased demand, and whether a truly affordable, single-payer system would reduce the need for his product. Mr. Worley said demand had risen sharply with the Medicare Prescription Payment Plan and as insurers sought lower-cost plans with better patient payment tools, and he argued that “affordability” was about people’s ability to manage costs rather than eliminating the need for payment-smoothing tools.

  Rep. Frost asked what would happen to doctor visits, illness severity, and medical debt if ACA premium subsidies expired, and whether Congress should let the “countdown” run out while searching for a new plan. Ms. Tripoli replied that some families—especially older couples just above 400% of poverty—would see premiums double or triple and spend up to a quarter of their income on coverage, leading many to drop insurance, skip care, and rely on emergency rooms, and she urged an immediate clean extension of the tax credits as a lifeline for roughly 22–24 million people before broader reforms.

• Rep. Grothman (R-WI) asked why a third of healthcare spending is waste. Mr. Jacobs cited poor incentives and lack of transparency.

  Rep. Grothman then asked the panel how they had experienced rising costs and what Congress should do. Dr. Lakdawalla urged Congress to measure and reduce low-value care, citing unwanted intensive end-of-life treatment as misaligned with patient preferences; Dr. Obermeyer said diagnostic uncertainty and malpractice fears led him to order many negative tests and argued AI could better target who truly needed tests and procedures; Mr. Jacobs endorsed site-neutral payment reform to stop hospitals from charging more for identical outpatient services and noted his own higher specialist bill on exchange coverage; and Ms. Tripoli agreed incentives now reward high-priced volume and consolidation but emphasized that extending ACA tax credits to 22–24 million people was the urgent first step before tackling deeper payment reforms.

• Rep. Krishnamoorthi (D-IL) cited a mother whose ACA-subsidized plan keeps her children insured and said ending credits would double premiums. Ms. Tripoli said her case was common and warned new Medicaid work rules worsen gaps.

  Rep. Krishnamoorthi then asked about AI chatbots giving self-harm guidance. Ms. Tripoli confirmed reports, and Dr. Obermeyer agreed he did not endorse federal preemption of state AI safeguards

• Rep. McGuire (R-VA) spoke in favor of tariffs and free-market healthcare, arguing that tariffs were strengthening the U.S. economy and energy independence. He said government inefficiency, Obamacare, and Certificate of Public Need (COPN) rules created monopolies and higher costs by limiting competition. McGuire said innovation and market forces—not regulation—lower prices, and he urged a preventive, data-driven health system.

  Rep. McGuire asked if witnesses agreed that preventive care, competition, and reduced government involvement would shrink costs; all witnesses agreed, with Mr. Worley and Dr. Lakdawalla emphasizing prevention, Dr. Obermeyer agreeing, and Ms. Tripoli noting that affordability and access were prerequisites to prevention.

• Rep. Randall (D-WA) said refusing to extend ACA tax credits would worsen affordability and endanger rural hospitals, contrasting congressional inaction on healthcare with quick bipartisan action on corporate tax breaks. She defended the ACA as an imperfect but essential system that expanded access for women and people with preexisting conditions, citing Washington’s work on universal coverage and price transparency. Randall warned against unchecked AI in healthcare and raised concerns about the Wiser model used in Medicare, asking Dr. Obermeyer whether AI systems require independent oversight. Dr. Obermeyer agreed and supported stronger safeguards to ensure patients aren’t denied necessary care.

• Rep. Donalds (R-FL) said the ACA was designed to move the U.S. toward single-payer healthcare, which he argued would never reduce costs. He asked about fraud on the exchanges. Mr. Jacobs cited GAO data showing improper enrollments tied to “zero-premium” plans and said eliminating those incentives would reduce abuse.

  Rep. Donalds then asked how AI would affect the healthcare workforce. Dr. Obermeyer said it would change, not eliminate, jobs by augmenting clinicians’ decision-making.

  Rep. Donalds asked whether the ACA supports innovation, and Dr. Obermeyer said incentives are weak but CMS’s new Access Program was a step forward.

  Rep. Donalds asked if centralized healthcare could lower costs. Ms. Tripoli said universal systems can work if consolidation and pricing incentives are reformed but reiterated that Congress must first extend ACA tax credits.

• Rep. Bell (D-MO) criticized Republicans for years of repeal efforts without offering improvements to the ACA and urged bipartisan work to strengthen it, comparing its evolution to Social Security’s expansion. He cited data showing the ACA’s critical role in assisting 95% of marketplace enrollees in Missouri and said GOP opposition had only deepened healthcare inequities. Bell called for both parties to collaborate on practical reforms rather than ideological fights to reduce costs and expand access.

• Rep. Gill (R-TX) said Social Security and healthcare were not comparable and warned that a single-payer model would import inefficiencies. He sought common ground on price transparency and consolidation, confirming with Ms. Tripoli that transparency, site neutrality, and limits on hospital markups could reduce costs. Mr. Jacobs added that Obamacare failed to lower premiums and had doubled marketplace costs due to regulatory mandates and consolidation. Jacobs added that subsidies were “inherently inflationary” since insurers have no incentive to control premiums when increases are federally subsidized, and he opposed extending enhanced ACA tax credits.

• Rep. Simon (D-CA) shared her personal story as a widow whose family incurred massive cancer treatment costs despite insurance, emphasizing the urgency of extending ACA credits to prevent millions from losing coverage. She praised the potential of AI and biotech innovation—especially in her Bay Area district—for early disease detection and treatment breakthroughs but said funding cuts under the Trump administration had slowed progress. Rep. Simon closed by urging bipartisan cooperation on both near-term affordability and long-term innovation to give patients more time and better outcomes.

• Rep. Frost (D-FL) closed by reiterating that 738,000 constituents in Republican districts rely on ACA tax credits, with premiums projected to rise up to 300% if they expire. He urged immediate extension of the credits to prevent mass loss of coverage, saying that only after addressing the “crisis in front of us” should Congress debate broader reforms.

• Rep. Burlison (R-MO) closed by arguing that Obamacare had failed to reduce costs and that government bureaucracy was driving inefficiency. He announced plans to introduce the MAHA Act, which would create portable tax-free health wallets, promote price transparency, expand residency slots, and increase competition through a free-market approach.

• Chairman Grothman (R-WI) said both parties agreed too much spending went to administration and overuse. He called for reducing waste, standing up to special interests, and using technology to create transparency and lower costs for patients.