⚡️ NIMITZ HEALTH NEWS FLASH ⚡️ 

“Making Health Care Affordable Again: Healing a Broken System”

Senate HELP Committee

December 3rd, 2025 (recording linked here)

WITNESS & TESTIMONY

• Joel White: President, Council for Affordable Health Coverage

• Marcie Strouse: Owner and Partner, Capitol Benefits Group

• Claudia M. Fegan, MD: National Coordinator, Physicians for a National Health Program

HEARING HIGHLIGHTS

MEMBER OPENING STATEMENTS

• Chair Cassidy (R-LA) said Americans in the individual and small-group markets were paying more for less and argued that enhanced premium tax credits mainly funneled money to insurers while hiding true premium costs and raising prices for unsubsidized enrollees. He urged a bipartisan “American solution” before the 2026 cliff, proposing to shift some subsidy dollars from insurers into pre-funded HSAs paired with bronze plans so money goes directly to patients. He acknowledged deep divisions over abortion but insisted Congress should still find a workable compromise rather than let both parties’ bills fail and leave older exchange enrollees with unaffordable premiums.

• Ranking Member Sanders (I-VT) said the health system was “completely broken,” designed to enrich insurance and drug companies while leaving tens of millions uninsured or underinsured despite very high per-person spending. He warned that many ACA enrollees were seeing premiums double or more and urged an immediate extension of ACA tax credits for at least one to three years to prevent sharp increases while broader reforms are debated. He argued that the United States should learn from countries that provide universal care at lower cost and ultimately move toward Medicare for All to guarantee health care as a right.

WITNESS OPENING STATEMENTS

• Mr. White said health care costs were becoming unsustainable and that the ACA had doubled premiums and out-of-pocket costs in the individual market, pushed small-business employees into higher-cost exchange plans, and was driving another major premium hike next year. He argued that simply adding subsidies would entrench these problems and instead urged making subsidies portable so people could use them for lower-cost options such as direct primary care, alternative plans, transparent cash prices, or HSAs they control. He also called for stronger options for small businesses, more state flexibility through waivers and high-risk pools, and reforms to curb hospital and provider monopolies.

• Ms. Strouse said small businesses and individuals faced a coverage crisis, with premiums up more than 120 percent since the early 2000s, fewer insurers in the small-group market, and owners unsure how long they could keep offering benefits. She argued that heavy regulation and layers of intermediaries were structurally driving up costs and limiting choice for employers and workers. She urged Congress to expand tools like ICHRAs, association health plans, short-term plans paired with direct primary care, and modernized HSAs, while scaling back or right-sizing ACA mandates so innovative private-market solutions can deliver more affordable coverage.

• Dr. Fegan said the U.S. health system fails to meet people’s needs and that an expanded Medicare for All system would provide universal, high-quality care without profit-driven conflicts. She argued that ACA subsidies and their expansion under the American Rescue Plan had saved lives and warned that losing subsidies or Medicaid coverage would lead to tens of thousands of preventable deaths as patients delay care. Drawing on her clinical experience, she criticized Medicare Advantage and work requirements for wasting money and denying needed care, and said medical savings account proposals would not help low-wage workers who must choose between preventive services and basic necessities.

QUESTION AND ANSWER SUMMARY

• Chair Cassidy (R-LA) asked how high deductibles and out-of-pocket maximums under ACA exchange plans affected access to care, emphasizing that a $6,000 deductible effectively left many people underinsured. Ms. Strouse and Mr. White responded that deductibles and out-of-pocket limits often exceeded $8,000–$10,000 and functioned as a major barrier to primary and routine care, especially since most families had only about $1,000 in savings.

  Chair Cassidy then asked for an explanation of how fully funding ACA cost-sharing reduction payments, as originally envisioned, would lower premiums and reduce the deficit, and Mr. White explained that proper appropriations would end “silver loading,” lower premiums for unsubsidized enrollees, and save about $33 billion while reducing premiums roughly 11 percent.

• Ranking Member Sanders (I-VT) asked whether the United States should join other major countries in guaranteeing health care as a human right, with Mr. White and Ms. Strouse opposing and Dr. Fegan supporting that approach and noting other nations’ broader coverage at lower cost.

  Ranking Member Sanders cited CBO estimates that Medicare for All could save $650 billion per year while covering everyone and asked how the current fragmented, high-deductible system affects patients. Dr. Fegan said that complexity and cost prevent people from using care and contribute to tens of thousands of preventable deaths.

  Ranking Member Sanders then criticized Republican Medicaid cuts designed to fund tax breaks and asked about their impact, and Dr. Fegan testified that dropping millions from Medicaid would worsen chronic disease, push care into emergency departments, raise long-run costs, and increase disability and mortality, while other countries like Canada provide major hospital care with no bills at about half U.S. spending.
  

• Sen. Collins (R-ME) responded that Republicans also cared deeply about affordability and highlighted that a Republican chair was driving the committee’s work, while Biden-era enhancements passed with no GOP support and were meant to be temporary.

  Sen. Collins pressed on whether high-income households should receive enhanced premium tax credits, and Mr. White and Ms. Strouse agreed there should be an income (and effectively asset) cap so lower-income workers are not subsidizing families earning $200,000–$300,000 or more with substantial wealth.

• Sen. Murray (D-WA) argued that Republicans had “run out the clock” and that with open enrollment already underway, the only realistic way to avoid huge premium hikes was a clean extension of enhanced ACA tax credits and potentially a longer enrollment window.

  Sen. Murray recalled a previous bipartisan deal under Chairman Alexander that collapsed after Republican leaders injected abortion restrictions and said she remained skeptical of GOP intentions but was willing to negotiate longer-term reforms after stabilizing premiums. In response, Dr. Fegan said the Republican reconciliation cuts did not make care more affordable and explained that shifting people toward higher deductibles or medical savings accounts still forced them into expensive individual coverage with greater out-of-pocket exposure and fewer choices, especially for small-business owners and self-employed people on the ACA marketplace.

• Sen. Murkowski (R-AK) described a constituent whose unsubsidized premiums for a weak plan were projected to reach $3,000 per month and said she supported a short-term extension with reasonable caps while the committee pursued deeper cost reforms.

  Sen. Murkowski asked which programs best reduce costs when considering prevention as a long-term strategy. Mr. White suggested allowing premium discounts tied to wellness programs in the individual market, Ms. Strouse urged expanding HSA-eligible preventive and holistic services and elevating direct primary care, and Dr. Fegan emphasized investment in primary care and proven screenings such as Pap smears and colonoscopies.

• Sen. Baldwin (D-WI) noted that only a little over 6 percent of Americans are in the individual market but warned that letting ACA tax credits expire would push many of them into uninsurance or “junk” plans and would not fix larger problems like consolidation, middlemen, and private equity.

  Sen. Baldwin argued that ACA plans, despite high deductibles, guarantee no-cost preventive care and protect families from medical bankruptcy, and she said the priority should be extending enhanced tax credits to buy time for broader transparency and anti-consolidation reforms. Dr. Fegan said that with only days left in open enrollment, families were already deciding whether to drop coverage because of cost, and she stressed that losing subsidies would force many working-class people to go uninsured and face unpredictable but potentially catastrophic health events without protection.

• Sen. Husted (R-OH) said many working Americans feel “screwed” because they earn too much for free coverage but face unaffordable premiums and deductibles, and he argued constituents simply want government to fix the problem regardless of party blame.

  Sen. Husted outlined a “fraud, freeze, and fix” approach—requiring minimal payments to validate real enrollees, temporarily freezing subsidies to provide short-term relief, and advancing bipartisan competition-focused reforms. He also cited a constituent whose lone plan consumed nearly a third of his $83,000 income, with Mr. White broadly supportive of more competition and guardrails.

• Sen. Kaine (D-VA) reported a near tripling of constituent health-care correspondence and gave examples of Virginians whose premiums would double or triple without enhanced ACA subsidies.

  Sen. Kainecriticized giving $1 trillion in tax cuts to the top 1 percent instead of using about $350 billion to extend the subsidies and called for at least a two-year extension while pursuing bigger reforms, promoting his Medicare X public-option bill and urging immediate passage of bipartisan PBM reform, which Mr. White and Dr. Fegan both supported in principle.

• Sen. Marshall (R-KS) said there was broad agreement that costs are unsustainable and argued the ACA routes roughly $150 billion annually to insurers, money that should partly be redirected into HSAs to turn patients into price-sensitive consumers.

  Sen. Marshall championed his “Patients Deserve Price Tags Act,” claiming strong economic support and potential savings up to $1 trillion through robust price transparency, and Mr. White and Ms. Strouse agreed that exposing dramatic price variation (for MRIs, hip replacements, etc.) and pairing transparency with expanded HSAs and direct primary care would improve shopping and control costs.

• Sen. Hassan (D-NH) acknowledged bipartisan progress on ideas like transparency and PBM reform but said the immediate priority, with enrollment deadlines looming, must be a short-term extension of enhanced ACA subsidies plus any small bipartisan tweaks that can pass quickly.

  Sen. Hassan warned against “amnesia” about pre-ACA conditions—when people with preexisting conditions or in low-hour jobs often had no coverage. Dr. Fegan urged extending subsidies to prevent people from going uninsured and warned that lifetime limits would again expose cancer survivors and high-cost patients to catastrophic gaps in coverage.

• Sen. Hawley (R-MO) cited a 2,109 percent increase in health spending since 1960, noted that Americans now spend more on health care than on groceries or housing, and highlighted widespread medical debt and borrowing.

  Sen. Hawley warned of a looming crisis for tens of millions if subsidies are not addressed in coming weeks and urged leadership to reach a fast solution, while also proposing to make health care tax-free by allowing above-the-line deductions for premiums and out-of-pocket costs for working families. Dr. Fegan, Ms. Strouse, and Mr. White all said the concept could help, particularly self-employed people currently disadvantaged by itemization rules.

• Sen. Hickenlooper (D-CO) questioned rolling back essential health benefits or reinstating lifetime limits, warning it could worsen a medical-debt crisis already affecting over 20 million Americans, and asked about the impact. Ms. Strouse argued ACA regulations themselves accelerated costs and benefited middlemen, citing lower costs under her own “grandmothered” plan.

  Sen. Hickenlooper then pressed for price transparency as a key future reform, and Dr. Fegan said transparency is important but health care is not a typical market. She agreed, however, that giving large employers clear price data across hospitals could help them exert pressure and curb “charge what the market will bear” pricing.

• Sen. Moody (R-FL) focused on fraud and weak safeguards around subsidies, particularly in Florida, describing major cases where bad actors enrolled homeless or ineligible people into $0-premium plans to siphon federal funds. She argued that continuing the current system without major program-integrity reforms is irresponsible and contributes to rising premiums for everyone. Mr. White responded that $0 premiums and sending subsidies directly to insurers, combined with expensive standardized plans, encouraged fraud, citing CMS data suggesting 35 percent of exchange enrollees had zero claims and estimating millions of fraudulent enrollments, and he recommended requiring modest monthly payments and enrollment alerts to beneficiaries to deter and detect fraud.

• Sen. Kim (D-NJ) described New Jersey families facing premium hikes of 85–174 percent and asked how people respond when coverage becomes unaffordable. Dr. Fegan said patients routinely skip preventive visits, screenings, and medications, which leads to more advanced cancer, cardiovascular disease, and diabetes complications and lowers workforce productivity.

  Sen. Kim then asked each witness whether these spikes were the fault of families, and all witnesses said the problem lay with the ACA’s structure, congressional policy choices, and underlying medical inflation.

  Sen. Kim pressed for solutions that could be implemented before the new year and was told by Mr. White that fully funding cost-sharing reductions would take longer, while redirecting subsidies into HSAs tied to bronze and catastrophic plans would require statutory changes to let those dollars be used for premiums.

• Sen. Banks (R-IN) focused on hospital consolidation, noting Indiana’s market dominance by a handful of systems, and Mr. White said ACA-era changes to the 340B drug discount program and the medical loss ratio encouraged nonprofit hospital acquiring physician practices and facilitated insurer vertical integration, leaving 97 percent of hospital markets noncompetitive and raising prices by up to 30 percent after mergers. Mr. White recommended stronger FTC authority over nonprofit mergers, aligning hospital and physician payment rates, reconsidering 340B’s incentives, and banning anticompetitive contract clauses through measures like the Healthy Competition Act to reduce premiums.

  Sen. Banks then asked about age rating. Ms. Strouse said moving from a five-to-one to a three-to-one age band under the ACA raised premiums for younger adults, pushed many of them out of the market, and contributed to overall rate inflation.

• Sen. Blunt Rochester (D-DE) criticized a recent administration rule that would allow higher deductibles and cost sharing for 160 million privately insured Americans, calling it a “pay more for less” change. Dr. Fegan responded that even small copays cause patients with chronic disease to skip visits and tests because they must choose between medical costs and essentials like rent or food.

  Sen. Blunt Rochester previewed her Restoring Patient Protection and Affordability Act, which would extend ACA tax credits for three years, streamline enrollment, require clearer eligibility information, and lower out-of-pocket costs, and she stressed that with open enrollment closing in about 12 days, Congress had very little time to act.

• Sen. Alsobrooks (D-MD) pressed on short-term limited-duration insurance, noting that pregnancy is typically not covered and pointing out that a cesarean birth alone can cost about $30,000, which would leave many women bearing enormous out-of-pocket costs, particularly if they enrolled after conception. Sen. Alsobrooks argued that rolling back ACA protections would again make it more expensive and riskier to be a woman or a sick patient. Dr. Fegan added that U.S. maternal mortality has risen to more than 14 deaths per 100,000 live births over the past 20 years, unlike other industrialized countries, which she framed as a stark warning against weakening coverage for pregnant people.

• Sen. Markey (D-MA) criticized Republicans for blaming the ACA while supporting Medicaid cuts and tax breaks for wealthy households, saying 22 million Americans could lose coverage or see massive cost increases if premium tax credits expire in a few weeks.

  Sen. Markey argued that pre-ACA “flexibility” meant routine exclusions of preexisting conditions and caps that left families and small business owners exposed to debt, and cited polling that 87 percent of small business owners want ACA tax credits permanent because 10 million owners and employees rely on them. He said Republican ideas like expanded HSAs and short-term “junk” plans were unrealistic for families who cannot afford a $400 emergency. Dr. Fegan replied that high-deductible products create an illusion of coverage while out-of-pocket costs still cause patients to forgo needed care.