⚡️ NIMITZ HEALTH NEWS FLASH ⚡️ 

“Lowering Health Care Costs for All Americans: An Examination of Health Insurance Affordability”

House Energy and Commerce Subcommittee on Health

January 22nd, 2026 (recording linked here)

WITNESS

• Mr. Stephen Hemsley: CEO, UnitedHealth Group

• Mr. David Joyner: Chairman and CEO, CVS Health

• Ms. Gail Boudreaux: President and CEO, Elevance Health

• Mr. David Cordani: President, CEO, and Chairman of the Board, The Cigna Group

• Mr. Paul Markovich: President and CEO, Ascendiun

• Ms. Ellen Allen: Executive Director, West Virginians for Affordable Health Care

HEARING HIGHLIGHTS

MEMBER OPENING STATEMENTS

• Chair Griffith (R-VA) opened the hearing by emphasizing the importance of maintaining decorum and welcoming public engagement. He stated that the hearing focused on rising health care costs and patient access challenges across the health insurance marketplace, with particular attention to the role of insurers. He argued that market consolidation, lack of transparency, and complex insurance practices had left patients paying more for less. He criticized the Affordable Care Act for increasing costs, limiting competition, and reducing plan choices, and he called for more competition, transparency, and patient-centered reforms.

• Ranking Member DeGette (D-CO) stated that health care in the United States was excessively expensive and that American health outcomes lagged behind other developed nations. She argued that recent premium spikes were caused by Congress’s failure to extend enhanced Affordable Care Act premium tax credits, despite historically low uninsured rates. She criticized Republicans for prioritizing tax cuts for the wealthy over health care affordability and blamed them for the current affordability crisis. She urged immediate action to extend the tax credits and emphasized the need for accessible, affordable care for all Americans.

• Full Committee Chair Guthrie (R-KY) explained that the hearing was the first in a series examining health care affordability, beginning with testimony from major insurance executives. He cited rising national health care spending and sharp premium increases across both employer-sponsored and ACA markets. He emphasized that affordability challenges were widespread and longstanding, not limited to a single market or political party. He stated that insurers played a central role in the health care financing system and called on them to explain rising costs and propose solutions.

• Full Committee Ranking Member Pallone (D-NJ) argued that Republicans were unfairly blaming insurance executives to distract from their failure to extend enhanced ACA premium tax credits. He asserted that Republican actions had driven up costs, reduced coverage, and undermined access to care. He criticized proposals favoring high-deductible or limited-coverage plans, arguing they disproportionately benefited wealthier individuals. He concluded that expanding subsidies, not offering “junk insurance,” was necessary to make health care affordable.

WITNESS OPENING STATEMENTS

• Mr. Stephen Hemsley stated that UnitedHealth Group was dissatisfied with the current health care system and committed to improving affordability, access, and outcomes. He argued that insurance premiums reflected rising underlying medical and drug costs rather than insurer behavior. He highlighted efforts to negotiate savings, promote preventive care, and expand transparent, consumer-friendly health plans. He emphasized the company’s low margins, investments in value-based care, and commitment to participating in bipartisan affordability solutions.

• Mr. David Joyner stated that rising health care costs were driven by increased demand, provider costs, and high hospital and drug prices. He emphasized CVS Health’s efforts to simplify care, reduce administrative burdens, and expand access to preventive and low-cost services. He highlighted reductions in prior authorization requirements, faster approval times, and expanded use of biosimilars to lower drug costs. He called for policy reforms that increased transparency, preserved competition, and improved interoperability across the health system.

• Ms. Gail Boudreaux stated that rising premiums and out-of-pocket costs were straining families and causing people to delay care. She emphasized that medical and prescription drug costs, particularly hospital price growth, were the primary drivers of higher premiums. She described Elevance Health’s efforts to reduce prior authorizations, streamline administrative processes, and coordinate medical and pharmacy benefits to lower costs. She called for common-sense reforms addressing price growth, fraud, and lack of transparency to improve affordability.

• Mr. David Cordani stated that health care affordability was a major challenge for families and employers and required systemwide collaboration. He identified prevention, value-based incentives, and competition as key areas for improvement. He cited dramatic increases in hospital and pharmaceutical prices as major contributors to rising costs. He emphasized Cigna’s efforts to expand preventive care, lower out-of-pocket costs for critical medications, and improve transparency and coordination of care.

• Mr. Paul Markovich stated that the U.S. health care system was unaffordable, inefficient, and failing too many Americans. He argued that profit-driven behavior and systemic complacency had created a complex and mistrusted system. He called for bold reforms, including outcome-based payment models, elimination of drug pricing kickbacks, universal digital health records, and budgeting the health system. He acknowledged Ascendiun’s role in the problem while committing to aggressive reforms and government leadership.

• Ms. Ellen Allen testified that the expiration of enhanced ACA premium tax credits had made health insurance unaffordable for her and millions of others. She described her personal experience with a dramatic premium increase that forced her to downgrade coverage and face significant out-of-pocket costs. She emphasized that the credits had significantly reduced uninsured rates, particularly in West Virginia. She urged Congress to restore and make permanent the credits, arguing that health care affordability was a policy choice and a moral responsibility.

QUESTION AND ANSWER SUMMARY

• Chair Griffith (R-VA) began by testing the panel’s view that competition lowered costs and asked whether repealing the ban on physician-owned hospitals would increase provider-market competition; no witnesses disagreed. He then asked whether more insurance-market competition was needed, given insurer ownership of pharmacies and PBMs; Mr. Hemsley said the market was already competitive but welcomed competition.

  Rep. Griffith pressed on rural reimbursement and single-provider markets; Mr. Cordani said hospital rates were negotiated case-by-case and that consolidation or lack of choice drove faster price inflation. Rep. Griffith then asked about Optum’s purchase of Holston Medical Group; Mr. Hemsley framed it as supporting value-based care.

  Rep. Griffith closed by pushing on whether looser ACA enrollment validation increased waste; Mr. Hemsley called for stronger oversight rather than a clear yes/no.

• Ranking Member DeGette (D-CO) asked what insurers could do before the ACA, such as excluding preexisting conditions, imposing waiting periods, setting lifetime limits, and charging for preventive care, and pressed for confirmation that those practices were no longer allowed under ACA rules.

  Rep. Degette then asked Mr. Markovich to confirm subsidies were pegged to low-cost plans, creating price competition, and asked about 2024 results; Mr. Joyner confirmed enhanced subsidies were in place and his segment posted a $984M operating loss.

  Rep. DeGette asked who suffered more when insurance was unaffordable; Ms. Allen said going without coverage could be catastrophic for individuals and lead to delayed care.

• Rep. Guthrie (R-KY) questioned why ACA marketplace premiums for 2026 rose 30–50% when estimates tied to the expiration of enhanced tax credits projected smaller increases. He asked whether premiums would have increased even if the credits were extended; Ms. Boudreaux said yes, because premiums reflected underlying medical costs.

  Rep. Guthrie focused on the ACA medical loss ratio, arguing it incentivized higher premiums by allowing insurers to retain more dollars as premiums rose. He then pressed on whether those incentives encouraged vertical integration; Mr. Hemsley said integration improved coordination, data use, and value rather than suppressing competition.

• Rep. Pallone (D-NJ) questioned whether replacing ACA premium tax credits with health savings accounts would meaningfully help patients. He asked whether a few thousand dollars in an HSA would offset premium and out-of-pocket costs and Ms. Allen said it would be insignificant and insulting compared to $2,000 monthly premiums.

  Rep. Pallone asked what plans were hearing from ACA enrollees and Mr. Markovich described middle-income, older individuals facing premium increases that forced plan downgrades or going uninsured. Rep. Pallone argued HSAs primarily benefited the wealthy and said extending premium tax credits was the only immediate affordability solution.

• Rep. Harshbarger (R-TN) focused on consolidation and vertical integration, arguing that insurer control over coverage, pricing, PBMs, pharmacies, providers, and data undermined competition and harmed rural patients. She asked Mr. Hemsley and Mr. Joyner what specific guardrails prevented steering to affiliated pharmacies, clinics, or PBMs; both cited general regulatory frameworks and integration benefits but did not identify concrete prohibitions.

  Rep. Harshbarger then questioned UnitedHealth’s financial relationship with AARP, asking why the company paid roughly $9 billion and what share of AARP revenue came from UnitedHealth; Mr. Hemsley did not provide direct answers before time expired.

• Rep. Ruiz (D-CA) examined the system-wide effects of a growing uninsured population. He asked how uncompensated care affected hospitals, and Mr. Markovich said hospitals absorbed losses and then sought higher reimbursements from insurers.

  Rep. Ruiz followed up by asking what plans did in response; and Mr. Markovich acknowledged that premiums ultimately rose to cover those pressures.

  Rep. Ruiz asked whether increased uninsured rates worsened health outcomes and raised premiums, and witnesses agreed that delayed care, higher emergency use, and uncompensated care increased costs across the system.

• Rep. Bilirakis (R-FL) questioned delays and denials for specialty drugs and rare disease treatments. He asked how insurers could reduce barriers to critical medications and Mr. Hemsley said continuity-of-care protections and faster, real-time prior authorization were needed.

  Rep. Bilirakis asked whether prevention was preferable to post-event hospitalization costs, and Mr. Hemsley agreed insurers preferred preventive treatment.

  Rep. Bilirakis then asked how Cigna handled high-cost gene therapies, and Mr. Cordani said coverage decisions were employer-based and described a per-member risk-pooling model that ensured access while removing employer financial uncertainty.

• Rep. Dingell (D-MI) highlighted the human impact of rising premiums, deductibles, and executive compensation. She asked Ms. Allen to explain being forced into a Bronze plan, and Ms. Allen said high coinsurance and out-of-pocket costs forced her to draw down retirement savings.

  Rep. Dingell then questioned reports showing high denial rates at UnitedHealthcare. Mr. Hemsley disputed the figures, saying fewer than 2% of interactions involved prior authorization and that most care was covered. Rep. Dingell expressed concern that patients spent critical time fighting insurers and said she would submit further questions for the record.

• Rep. Buddy Carter (R-GA) focused on insurer profits, executive compensation, and patient harm. He questioned executive pay at CVS; Mr. Joyner clarified his compensation and said he returned his bonus to an employee relief fund.

  Rep. Carter pressed Mr. Hemsley on whether he had personally faced patients harmed by denials and described a cancer patient allegedly denied necessary medication. Mr. Hemsley said he was unfamiliar with the case but offered to look into it. Rep. Carter closed by asking whether UnitedHealth would support the President’s proposed patient-controlled health plan, and Mr. Hemsley said he was open to bipartisan ideas.

• Rep. Barragán (D-CA) pressed the executives on whether their compensation included stock and argued that equity incentives tied pay to corporate performance. She challenged reported UnitedHealthcare denial rates, citing a KFF figure of 33% and contrasting it with Mr. Hemsley’s “less than 2%” claim. Rep. Barragán cited a case involving a child with a rare condition and bankruptcy-level medical debt, and argued patients rarely appeal denials despite frequent reversals. Mr. Hemsley said he lacked case specifics, called the situation tragic, and said the company should make coverage decisions easier and more intuitive.

• Rep. Joyce (R-PA) emphasized that hospital costs surpassed 30% of national health spending and argued that provider consolidation created regional monopolies that undermined insurers’ ability to contract competitively, and witnesses signaled agreement. He argued the ACA’s medical loss ratio created incentives for vertical integration and potential self-dealing, citing reports that affiliated providers may be paid more under MLR rules. He requested detailed written disclosures on subsidiaries counted under MLR, affiliate versus non-affiliate rates, and community versus insurer-owned pharmacy dispensing costs. The insurers raised their hands, committing to provide the information by the end of February.

• Rep. Schrier (D-WA) focused on Medicare Advantage prior authorization and post-service denials, describing a stroke patient whose hospitalization was deemed “medically unnecessary,” leaving them with a large bill and a year-long fight before payment. She said many denials were overturned on appeal and questioned why denials happened in the first place. Mr. Hemsley said he lacked specifics but agreed patients should receive appropriate care and said the company was reducing prior authorization and speeding processes. Rep. Schrier argued the pattern looked like a business model designed to wear patients down and called for Medicare Advantage reform.

• Rep. Miller-Meeks (R-IA) criticized Medicare Advantage diagnosis “padding,” arguing insurers demanded documentation to pay providers but billed CMS based on home-visit diagnoses like congestive heart failure without comparable accountability. She then shifted to PBMs and PBM-GPOs, questioning how rebates and fees flowed and whether patients received any direct benefit from rebates embedded in higher prices. Mr. Joyner said his PBM passed through 99.9% of rebates to customers. She challenged why Cigna’s GPO was headquartered in Switzerland and taxes on fees, and Mr. Cordani cited global infrastructure. She likened the structure to conflicts physicians would face under Stark rules.

• Rep. Trahan (D-MA) argued insurance market concentration and vertical integration weakened competition, squeezed independent providers, and raised costs, using an “auto market” analogy to highlight steering and self-dealing risks. She focused on UnitedHealth/Optum’s scale and questioned where competitive pressure existed when the insurer also owned large segments of care delivery and data infrastructure. Mr. Hemsley said integration improved consumer value and claimed oversight and benefit sponsors constrained pricing. Rep. Trahan countered that federal scrutiny, including DOJ investigation, undercut assurances and argued the system favored corporate profits over patient affordability.

• Rep. Obernolte (R-CA) questioned a reported Blue Shield of California contribution tied to California’s Proposition 50, arguing political spending by insurers eroded public trust. Mr. Markovich said Blue Shield did not support or oppose the proposition, describing the contribution as made to a general account later directed to Prop 50 without the plan’s control.

  Rep. Obernolte then raised rural access concerns, saying Medicare Advantage network decisions pushed patients away from critical access hospitals, risking closures and long travel times. Mr. Hemsley said Medicare Advantage funding pressures constrained what could be served, pledged to look into the situation, and described pilots to expedite and improve rural payments.

• Rep. Ocasio-Cortez (D-NY) walked through CVS Health’s ownership of Aetna, Oak Street Health clinics, CVS pharmacies, and Caremark PBM, arguing it created a “captive” vertically integrated pathway that concentrated market power over pricing and access. She said CVS described “fully engaged members” as unlocking value for the company and argued patients bore the downside. She cited FTC findings about large markups and claimed conglomerates charged more at affiliated pharmacies, framing vertical integration as monopoly-like self-dealing. Mr. Joyner disputed that it was market concentration and said the model worked well for consumers. Rep. Ocasio-Cortez suggested structural separation akin to Glass-Steagall as a potential remedy to restore competition.

• Rep. Bentz (R-OR) focused on insurers’ “float,” arguing insurers earned interest on premium dollars while delaying payment of claims. He pressed on whether HSAs would let patients capture that interest instead, and Mr. Hemsley replied that HSAs earned interest for account holders.

  Rep. Bentz then asked all insurers to provide, in writing, the interest earned during delays on claims ultimately approved.

• Rep. Auchincloss (D-MA) argued insurers were shifting PBM profits into overseas GPOs in anticipation of PBM reform. He questioned UnitedHealth’s GPO “MSR,” citing reporting that it lacked basic public contact info and generated unusually high revenue per employee. Mr. Hemsley said he did not have specifics and estimated “several thousand” employees, and suggested MSR served additional health plans.

  Rep. Auchincloss warned follow-up would examine whether GPOs merely circumvented reforms. He then asked Mr. Hemsley to describe Brian Thompson; Mr. Hemsley called him a “force for good,” condemned violence, and spoke highly of Thompson’s family.

• Rep. Balderson (R-OH) questioned alleged fraud, waste, and abuse tied to enhanced COVID-era premium tax credits, citing growth in ACA enrollments with no medical claims. Ms. Boudreaux said Elevance shared concerns and supported guardrails, but disputed the size of the problem as portrayed, describing suspect enrollment closer to about 15%. She said stronger protections included verifying subsidy eligibility (including stronger identity/eligibility checks), tightening special enrollment periods, and promoting continuous enrollment to stabilize risk pools. Rep. Balderson asked if she supported legislation to strengthen patient validation, she said she was unsure of the specific proposal.

• Rep. Troy Carter (D-LA) challenged step therapy, arguing it overrode physicians and delayed appropriate care. Mr. Hemsley said step therapy could be appropriate at times, but not in the situation described, where it conflicted with a clinician’s judgment. Mr. Joyner said step therapy could create savings, but agreed that if a patient had tried and failed a therapy, the insurer should engage with the provider to move to the appropriate treatment. Rep. Carter asked for a commitment that insurers would work to prevent patients from being trapped in forced step therapy, and the panel signaled agreement.

• Rep. Rulli (R-OH) asked whether competition and “free market” approaches improved affordability, focusing on allowing patients to shop insurance across state lines. Mr. Hemsley said he was open to bipartisan ideas to increase access and reduce costs, including interstate competition. Mr. Markovich said competition was generally beneficial, but warned that state-by-state regulation differences could make comparisons misleading and coverage non-comparable. He offered to work with Mr. Rulli to avoid unintended consequences while improving choice.

• Rep. Fletcher (D-TX) argued insurance affordability was affected system-wide by cuts to Medicaid and expiring ACA premium tax credits that removed people from the risk pool. She then asked, yes-or-no, whether HSAs could be used to pay premiums under current law. Mr. Joyner and Mr. Markovich said no; Mr. Cordani said structurally no, though HSAs could complement high-deductible coverage in the employer market; Ms. Boudreaux said HSAs would need expansion to function that way; Mr. Hemsley did not give a clean yes/no, instead gesturing toward possible bipartisan changes.

  Rep. Fletcher said she would submit additional questions for the record.

• Rep. Langworthy (R-NY) asked each insurer what they were doing specifically to lower premiums, emphasizing rural access and overall cost growth. Mr. Hemsley cited cost management through care coordination, data/insights, and shifting from volume-based to value-based care. Mr. Joyner pointed to population health and aging, focusing on prevention, keeping people out of hospitals, and guiding patients to lower-cost therapies alongside outcomes-based provider arrangements and technology. Ms. Boudreaux said Elevance aimed to reduce costs and simplify the system by streamlining prior authorization, investing in fraud/waste/abuse efforts, and paying for value and outcomes.

• Rep. Veasey (D-TX) centered on vaccines and public health, describing a major measles outbreak and criticizing federal vaccine policy changes under Secretary Kennedy. He asked each CEO to commit to covering ACIP-scheduled vaccines as they existed before those changes for plan year 2026. Mr. Joyner said there would be no change and CVS would continue coverage; Ms. Boudreaux said Elevance covered vaccines as required by law and also relied on ACIP and clinical societies; Mr. Cordani said comprehensive coverage remained intact with $0 cost in much of the employer market; Mr. Markovich said Blue Shield would continue coverage based on medical consensus; Mr. Hemsley indicated comprehensive coverage aligned with established authorities, and Rep. Veasey treated that as a yes.

• Rep. Cammack (R-FL) argued that employer-sponsored insurance families felt coverage “didn’t cover anything” and that executive incentives prioritized financial performance over patient outcomes. She asked executives to raise their hands if compensation was tied primarily to financial metrics, then asked who had compensation tied to patient outcomes, and whether executives faced penalties when harm occurred due to insurer-caused delays or wrongful denials; she saw no hands for meaningful penalties or appeal-related compensation impacts. She requested, in writing, the fine print showing where patient outcomes directly affected executive compensation and referenced pending legislation to allow HSAs to pay premiums.

• Rep. Robin Kelly (D-IL) raised maternal health and asked which companies had standard policies explicitly covering doula services during and after pregnancy, and most raised their hands.

  Rep. Kelly then questioned reports of inappropriate AI-driven prior authorization denials and asked whether United used AI to adjudicate claims or estimates and what auditing governed it. Mr. Hemsley said AI was used only for administrative tasks, not clinical decisions or denials. Rep. Kelly pressed on who determined denials and asked about independent physician review, and Mr. Hemsley referenced clinical policies aligned with medical academies and said physicians oversaw clinical reviews.

• Rep. Crenshaw (R-TX) argued ACA-era premiums rose far faster than inflation and criticized mandates for reducing flexible plan options and competition. He also faulted insurers for participating in consolidation and narrow networks, then asked whether subsidizing low-income patients through HSAs would make more sense than subsidizing insurers. Mr. Markovich and Mr. Hemsley said they were open to consumer-directed mechanisms; Ms. Allen cautioned that the approach could undermine the healthcare system.

  Rep. Crenshaw then pivoted to competition, arguing that consumer control of funds would drive price discipline, but was cut off and asked to submit additional material for the record.

• Rep. Landsman (D-OH) framed healthcare as an example of concentrated wealth and power, citing medical debt burdens and insurer profits. He asked Mr. Hemsley what he would invest in first if profits were redirected back to patients. Mr. Hemsley said he would prioritize the same areas United claimed it was investing in already: accelerating value-based care, improving systems and technology, and reducing administrative complexity to lower underlying costs and improve consumer and provider experience.

  Rep. Landsman said time prevented a hearing from the full panel and urged continued work to realign the system toward patients.

• Rep. Houchin (R-IN) focused on ACA-created incentives, vertical integration, and opaque PBM GPO structures, citing investigative reporting that PBM-owned GPOs generated extremely high revenue per employee. She asked why PBM GPOs were so profitable and suggested they could retain rebates and fees that did not reach employers or patients, especially when headquartered overseas.

  Rep. Houchin then asked about the No Surprises Act arbitration payments, asking whether Elevance tracked compliance and how many awards were unpaid after 30 days. Ms. Boudreaux said Elevance supported the law but argued the arbitration system was being flooded, far exceeding projections, and claimed awards were extremely high.

• Rep. James (R-MI) argued healthcare was unaffordable, citing rising deductibles and premiums since the ACA, and asked witnesses to raise their hands if healthcare was affordable for the average American; none did. He pressed transparency, asking why prices were hidden and whether insurers would commit to publishing clear, comparable rates and coverage information that employers and families could understand. He said insurers claimed they were already doing some transparency work but that it was not producing desired results and demanded stronger accountability through usable disclosure. He promoted his price transparency legislation and urged industry support.