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.
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.
“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