⚡️ NIMITZ HEALTH NEWS FLASH ⚡️ 

“Full Committee Hearing with Health System CEOs”

House Ways & Means Committee

April 28th, 2026 (recording linked here)

WITNESSES

• Mr. Sam N. Hazen: Chief Executive Officer, HCA Healthcare

• Mr. Wright Lassiter III: President and Chief Executive Officer, CommonSpirit Health

• Dr. Brian G. Donley: President and Chief Executive Officer, New York-Presbyterian

• Dr. Michael Waldrum: Chief Executive Officer, ECU Health

• Mr. Brad Woodhouse: President, Protect Our Care

QUICK SUMMARY

• Hospital pricing, consolidation, and site-of-service billing practices were repeatedly cited as major contributors to rising healthcare costs.

• Insurance coverage dynamics, including Medicaid funding and ACA subsidy changes, were debated as key factors affecting affordability and access.

• Administrative burden, regulatory complexity, and payer practices—especially prior authorization and delayed payments—were identified as significant cost drivers.

• Workforce shortages, particularly in rural areas and behavioral health, were highlighted as critical challenges impacting access and system sustainability.

• Broader structural issues such as cost shifting between payers, transparency gaps, and the balance between competition and system obligations were central themes throughout the hearing.

🐘 Republicans

• Argued that hospital pricing, consolidation, and lack of competition were major drivers of rising healthcare costs, emphasizing site-neutral payments and transparency reforms.

• Focused on reducing regulatory burden, administrative complexity, and government distortions in the market to lower costs.

• Pushed back on claims that recent legislation drove affordability issues, instead blaming systemic inefficiencies and long-standing policy structures.

🫏 Democrats

• Argued that coverage losses, Medicaid cuts, and expiration of ACA subsidies were key drivers of worsening affordability and access.

• Emphasized the importance of maintaining and expanding insurance coverage to reduce uncompensated care and system-wide costs.

• Highlighted workforce shortages, patient access challenges, and the broader impact of healthcare costs on families and communities.

MEMBER OPENING STATEMENTS

• Chair Smith (R-MO) argued that hospitals and broader healthcare system actors had driven excessively high costs for patients, with hospital consolidation and corporate behavior playing a central role. He stated that hospital prices had risen dramatically over the past two decades and were not justified by better patient outcomes, citing examples of extreme billing practices. He contended that mergers, lack of competition, and manipulation of government programs had increased costs while benefiting large health systems financially. He emphasized that the committee sought accountability and answers from hospital executives as part of its effort to reduce healthcare costs.

• Ranking Member Neal (D-MA) argued that the hearing was partly an attempt by the majority to deflect attention from a tax bill that he said had harmed healthcare affordability and access. He maintained that healthcare costs were influenced by factors such as technological innovation and policy decisions, and he defended Democratic efforts to expand coverage and reduce out-of-pocket costs. He highlighted progress in insurance coverage rates and emphasized bipartisan achievements in healthcare expansion. He asserted that recent Republican policies, particularly tax changes, had increased financial strain on families and threatened healthcare systems, calling for policy reversals and more comprehensive solutions.

WITNESS OPENING STATEMENTS

• Mr. Hazen argued that while U.S. healthcare was highly advanced, it remained too expensive for many Americans and required systemic solutions. He emphasized the importance of stable insurance coverage, improved efficiency and quality in care delivery, and better cost transparency across the system. He contended that increased competition and reduced administrative complexity, including reforming certificate-of-need laws and addressing payer-related barriers, would help lower costs and improve access. He highlighted HCA’s role in providing large-scale care, including significant uncompensated services, and called for coordinated efforts across the healthcare system to address affordability.

• Mr. Lassiter argued that integrated health systems improved affordability by increasing efficiency, quality, and access, particularly in rural and underserved areas. He highlighted cost pressures from labor, supplies, payer practices, and regulatory burdens, noting that government reimbursement often fell short of actual costs. He emphasized that administrative complexity and delayed or denied payments from insurers significantly strained hospital resources. He called for collaboration among providers, payers, and government to ensure adequate reimbursement, reduce regulatory burdens, and improve accountability in the healthcare system.

• Dr. Donley argued that rising healthcare costs were a serious concern and that hospitals shared responsibility alongside other system stakeholders. He emphasized strategies such as improving care quality, shifting services to lower-cost settings, leveraging technology for efficiency, and investing in community health to reduce long-term costs. He noted significant financial pressures from labor, supply, and pharmaceutical costs, as well as insufficient government reimbursement and administrative burdens from insurers. He called for collaborative solutions across the healthcare system to make care more affordable and accessible.

• Dr. Waldrum argued that rural healthcare systems faced unique structural challenges that required tailored policy solutions rather than one-size-fits-all approaches. He emphasized that rural populations were sicker, older, and more geographically dispersed, making access to care more difficult and costly. He explained that consolidation in rural areas was often necessary for survival, not profit, and warned that resource concentration in urban markets worsened disparities. He urged policymakers to design solutions that addressed the specific needs of rural communities to preserve access and affordability.

• Mr. Woodhouse argued that recent federal legislation had significantly worsened healthcare affordability by cutting funding for Medicaid and the Affordable Care Act to finance tax breaks for wealthy individuals and corporations. He stated that these cuts had already led to loss of coverage for millions, rising costs, and widespread hospital and clinic closures. He emphasized the broader economic and community impacts, including reduced access to care, job losses, and increased strain on remaining healthcare facilities. He called for reversing these policies and prioritizing measures that expand access and lower costs for working families.

QUESTION AND ANSWER SUMMARY

• Health Subcommittee Chair Buchanan (R-FL) emphasized prevention and nutrition as key drivers of healthcare affordability, arguing that obesity and chronic disease were major contributors to rising costs. He asked about supporting “food as medicine” initiatives and healthier hospital food policies, and the witnesses generally agreed that preventive health efforts, community engagement, and improved nutrition could reduce long-term costs and improve outcomes.

• Ranking Member Neal (D-MA) focused on the impact of recent tax legislation on healthcare access and affordability, arguing that cuts to Medicaid and ACA support would harm patients and providers. He highlighted workforce shortages, the cost of medical technology, and the importance of academic medical centers, while asking Mr. Woodhouse about rising premiums and individuals losing coverage.

• Chair Smith (R-MO) pressed witnesses on hospital pricing, consolidation, and reimbursement disparities, arguing that hospitals were a major driver of rising healthcare costs. He questioned executives about insurer relationships, site-neutral payments, and rural hospital classifications, specifically challenging Dr. Donley on New York-Presbyterian’s “rural referral center” designation.

  Witnesses defended their roles within current regulations while acknowledging system complexity, and Smith emphasized the need for systemic reform across all stakeholders.

• Rep. Doggett (D-TX) argued that lack of stable insurance coverage, high pharmaceutical costs, and Medicare Advantage payment practices were key drivers of rising healthcare costs. He criticized Republican policies for reducing coverage and increasing uncompensated care burdens, and highlighted legislation to ensure prompt payment from Medicare Advantage plans. Mr. Lassiter confirmed significant unpaid claims and administrative burdens associated with Medicare Advantage, supporting the need for reform.

• Rep. Smith (R-NE) challenged claims that recent legislation caused healthcare facility closures and questioned the drivers of rising hospital prices. Mr. Lassiter confirmed that the specific closing was due to low patient volume.

  Rep. Smith then focused on the relationship between hospital pricing and insurance premiums, pressing Mr. Hazen on HCA’s pricing relative to Medicare rates and raising concerns about market concentration. Increased demand, patient complexity, and cost pressures were identified as key factors.

• Rep. Thompson (D-CA) argued that Republican healthcare cuts, particularly to Medicaid, would reduce access and force hospitals to cut services or close, especially in rural areas. He used witness testimony to support claims that coverage loss would increase costs and worsen outcomes, and confirmed with witnesses that hospital closures would impact all patients regardless of insurance status.

• Rep. Kelly (R-PA) framed healthcare affordability as a fundamental economic and operational challenge, emphasizing cost structures and market realities, particularly in rural areas. He asked for practical solutions, and Mr. Hazen and Mr. Lassiter highlighted the importance of insurance coverage, reducing regulatory burden, increasing competition, and simplifying administrative processes.

• Rep. Larson (D-CT) focused on healthcare as a fundamental right and explored support for universal coverage concepts such as “Medicare for All.” He asked witnesses about their support for universal coverage and raised concerns about competition, including a DOJ antitrust case involving New York-Presbyterian. Dr. Donley responded cautiously due to ongoing litigation.

• Rep. Schweikert (R-AZ) emphasized long-term structural drivers of healthcare costs, including demographics, chronic disease, and obesity. He argued that policymakers overly focused on financial mechanisms rather than underlying health trends, and witnesses agreed that patient populations were becoming sicker and more complex over time, increasing costs.

• Rep. Sánchez (D-CA) raised concerns about immigration enforcement in healthcare settings and its impact on patient access and trust. She questioned policies regarding law enforcement presence in hospitals, emphasizing that such actions could deter patients from seeking care. Mr. Lassiter affirmed the importance of delivering care without disruption while maintaining compliance with legal requirements.

• Rep. LaHood (R-IL) emphasized shared responsibility across insurers, hospitals, drug manufacturers, and PBMs for rising healthcare costs, with a particular focus on consolidation and rural access challenges. He asked about the 340B drug pricing program, and Dr. Donley and Dr. Waldrum explained that it supported care for vulnerable populations and helped offset Medicaid shortfalls, while cautioning that additional administrative burdens could reduce its effectiveness.

• Rep. DelBene (D-WA) focused on prior authorization practices, arguing they delayed care and increased administrative burden. She asked about these impacts and raised concerns about the “Wiser” model, which uses AI to deny Medicare claims, highlighting potential misaligned incentives. Mr. Lassiter acknowledged widespread delays, high administrative costs, and concerns about financial incentives tied to claim denials.

• Rep. Estes (R-KS) highlighted hospital investments in workforce development but raised concerns about consolidation and site-of-service payment disparities. He questioned whether higher hospital outpatient costs were justified, and Dr. Waldrum responded that in rural areas, consolidation was often necessary to maintain access and financial viability rather than to increase profits.

• Rep. Arrington (R-TX) argued that the healthcare system was fiscally unsustainable and pressed for site-neutral payment reforms to reduce costs. He emphasized bipartisan support for such reforms and potential savings, while Mr. Hazen acknowledged some merit but noted that hospitals required higher reimbursement in certain cases due to cost structures and patient complexity.

• Rep. Sewell (D-AL) highlighted the financial strain on rural and underserved hospitals, particularly in states with low reimbursement rates like Alabama. She asked about the impact of Medicaid cuts, and Dr. Waldrum warned they would lead to reduced services and access, with the Rural Health Transformation Fund insufficient to offset losses.

• Rep. Smucker (R-PA) challenged claims about healthcare coverage losses and criticized nonprofit hospital practices, questioning executive compensation and financial activities. He asked about differences between nonprofit and for-profit systems, and Mr. Hazen responded that operational differences were minimal.

  Rep. Smucker also questioned whether nonprofit status was justified given financial practices, while Mr. Lassiter emphasized community benefit spending.

• Rep. Murphy (R-NC) argued that the healthcare system was overly complex and criticized insurers, regulations, and rising costs across the system. He questioned the role of for-profit hospitals, pressing Mr. Hazen on profit levels, and expressed concern that profit motives could conflict with patient affordability, while acknowledging broader systemic cost pressures.

• Rep. Chu (D-CA) focused on public health and policy impacts, particularly vaccine misinformation and its role in increasing healthcare costs.

  She also raised concerns about private equity involvement in struggling hospitals, arguing that financial pressures from recent policies could push hospitals toward investor-driven models, with Mr. Woodhouse warning this could worsen access and costs.

• Rep. Fitzpatrick (R-PA) examined pricing practices and workforce shortages, asking about cost structures and the role of graduate medical education. Dr. Donley emphasized the importance of expanding residency slots to address projected physician shortages and maintain access to care.

• Rep. Kustoff (R-TN) focused on price transparency and site-of-service cost differences, questioning whether patients could know facility fees in advance and whether hospital pricing disparities were justified. Dr. Donley acknowledged transparency goals while noting higher hospital costs due to patient complexity, regulatory burden, and broader service obligations.

• Rep. Moore (D-WI) challenged claims that Medicaid cuts were minimal and emphasized their impact on healthcare access. She also discussed the potential benefits of covering obesity treatments like GLP-1 drugs and raised concerns about provider taxes. She questioned the use of AI and telehealth, and Mr. Lassiter confirmed these tools were being used to support care delivery and reduce administrative burden, not replace in-person care.

• Rep. Steube (R-FL) focused on site-of-service pricing and transparency, pressing hospital executives to justify higher facility fees for outpatient services. Witnesses, including Mr. Hazen, Mr. Lassiter, and Dr. Waldrum, acknowledged cost differences tied to hospital obligations such as emergency readiness and uncompensated care, while agreeing there may be opportunities to reduce disparities and improve pricing structures.

• Rep. Tenney (R-NY) argued that state-level policies and the Affordable Care Act were primary drivers of high healthcare costs, particularly in New York. She criticized claims that recent federal legislation caused affordability issues and attributed rising premiums and financial strain on employers to longstanding state taxes, mandates, and policy decisions.

• Rep. Beyer (D-VA) focused on mental health access, workforce shortages, and administrative costs. He asked Dr. Donley about behavioral health initiatives, prompting discussion of care coordination programs that reduced emergency room use, and questioned Dr. Waldrum and Mr. Hazen about workforce pipelines and administrative burden, with witnesses emphasizing training expansion, pipeline efficiency, and reducing regulatory complexity.

• Rep. Van Duyne (R-TX) emphasized competition and regulatory burden, advocating for physician-owned hospitals and questioning administrative costs. She asked Mr. Hazen about competitive dynamics and raised concerns about regulatory requirements, while witnesses pointed to uneven obligations between hospital types and identified overlapping federal reporting requirements and payer complexity as major cost drivers.

• Rep. Feenstra (R-IA) examined cost structures and insurance dynamics, arguing that administrative complexity and insurance involvement inflated costs. He asked about cash-pay discounts and cost shifting, with Mr. Hazen and Dr. Donley confirming significant discounts for uninsured patients and acknowledging that commercial payers often subsidized underpayments from government programs. He also raised concerns about rural maternity care, and Dr. Waldrum emphasized the need for cross-subsidization to maintain services in low-volume rural areas.

• Rep. Evans (D-PA) focused on affordability challenges for individuals, particularly those losing coverage or facing rising premiums. He asked about real-world impacts, and Mr. Woodhouse described financial tradeoffs facing families and increased strain on the healthcare system from uninsured patients, while Dr. Donley highlighted employer-focused benefits and support programs for healthcare workers.

• Rep. Hern (R-OK) emphasized rising hospital costs and questioned witnesses on policy solutions, including opposition to Medicare for All and support for site-neutral payments. Witnesses stated they did not support Medicare for All and indicated they did not acquire physician practices to increase prices, while Dr. Donley discussed current reporting practices for nonprofit community benefit requirements.

• Rep. Miller (R-WV) challenged claims linking hospital service reductions to recent federal legislation and focused on rural healthcare policy and classification issues. She asked about New York-Presbyterian’s rural designation, and Dr. Donley explained it was a regulatory classification tied to referral patterns rather than geography, while emphasizing the system’s role in serving rural patients.

• Rep. Panetta (D-CA) focused on Medicare reimbursement and access issues, particularly delays and administrative burdens in Medicare Advantage. He questioned Mr. Lassiter, who highlighted underpayment from government programs and significant unpaid claims, emphasizing how these challenges affected hospital sustainability and patient access.

• Rep. Carey (R-OH) examined the impact of insurance coverage changes and hospital pricing practices. He asked about the effects of expiring ACA subsidies, and Mr. Hazen noted increased uninsured patients but no direct pricing changes, and discussed charge master pricing, which he described as a legacy regulatory requirement not directly tied to actual reimbursement.

  Rep. Malliotakis (R-NY) focused on nonprofit hospital obligations and policy tradeoffs in affordability reforms. She asked Dr. Donley about community benefit standards and site-neutral payment policy, and he emphasized the importance of Medicaid-related care, patient complexity, and regulatory burdens in evaluating hospital costs and maintaining access to care.

• Rep. Gomez (D-CA) argued that healthcare costs were rising due to systemic cost-shifting among stakeholders and criticized recent Republican legislation for worsening affordability by cutting Medicaid and allowing ACA subsidies to expire. He emphasized the real-world consequences for patients, including delayed care and increased uncompensated emergency treatment, and contended that current policy decisions had exacerbated an already fragile system.

• Rep. Yakym (R-IN) focused on hospital pricing, rural access, and regulatory burden, asking about rural classification policies and administrative costs. Dr. Donley explained that New York-Presbyterian’s designation was tied to its role as a referral center rather than geography, while Mr. Hazen highlighted regulatory complexity and overlapping state and federal requirements as key drivers of administrative costs.

• Rep. Bean (R-FL) sharply criticized rising hospital prices and questioned whether prior policy efforts, including the ACA, had failed to control costs. He pressed on transparency and competition, arguing that increased funding and consolidation had not reduced prices, while Dr. Waldrum emphasized growing patient complexity and the need for broader coverage to reduce cost shifting.

• Rep. Schneider (D-IL) emphasized access to care and system strain, highlighting increased demand, hospital capacity challenges, and the importance of insurance coverage. He confirmed with witnesses that hospitals did not discriminate based on insurance status but that uninsured patients created financial strain, and Mr. Hazen noted rising uninsured rates alongside declines in exchange-based coverage.

• Rep. Moore (R-UT) focused on market competition and contracting practices, questioning whether hospital systems or insurers restricted patient choice. Mr. Hazen and Mr. Lassiter stated they did not engage in such practices, while Rep. Moore also raised concerns about AI investments, and Mr. Lassiter emphasized that these tools were intended to improve care quality and workforce conditions rather than increase revenue.

• Rep. Horsford (D-NV) argued that recent federal legislation had harmed healthcare systems, particularly in rural areas, by reducing funding and increasing financial strain on hospitals. Mr. Lassiter confirmed significant projected reimbursement losses, while Mr. Woodhouse stated that supplemental rural funding would not offset broader Medicaid cuts, and Horsford also raised concerns about workforce stability and hospital layoffs.

• Rep. Moran (R-TX) criticized policy approaches that expanded public coverage and challenged witness credibility during the hearing, while also focusing on site-neutral payment disparities and broader system incentives. He argued that hospitals and other stakeholders were exploiting legal structures to increase costs and called for comprehensive reform to prioritize patients over institutional profit.

• Rep. Suozzi (D-NY) emphasized the complexity of healthcare financing and the role of cost shifting across payers. He confirmed with witnesses that hospitals generally lost money on Medicare, Medicaid, and uninsured patients, and relied on commercial insurance, philanthropy, and other mechanisms to offset losses. He called for bipartisan collaboration and stakeholder engagement to develop comprehensive solutions to reduce costs and improve access.

• Chair Smith concluded the hearing by addressing claims about coverage losses and healthcare cuts, citing Congressional Budget Office estimates to argue that many projected coverage losses were tied to eligibility changes and policy expirations rather than direct coverage removal. He emphasized the need to clarify the data and formally closed the hearing.