At a Glance
- Five major health-insurer CEOs will testify before House Republicans on Thursday.
- Hearings focus on the sudden loss of enhanced Affordable Care Act subsidies that began at the end of last year.
- Lawmakers will probe the ACA itself, claiming it drives higher costs for healthier Americans.
- Why it matters: The hearings could shape the next wave of legislation on health-care affordability.
The next Thursday, a quartet of House committees will turn the spotlight on the CEOs of UnitedHealth Group, CVS Health Group, Cigna Health Group, Elevance Health, and Ascendiun. Republicans are looking to pin the blame for soaring health-care premiums on the industry as they prepare for a new round of budget negotiations.
The Trigger: Expired ACA Subsidies
The hearings come in the wake of a decision that many say was a cost-cutting gamble. At the end of last year, Congress allowed the enhanced tax credits that had kept premiums low for millions of Americans to lapse. The result was a sharp jump in premiums for those who relied on the Affordable Care Act (ACA).
- Enhanced subsidies ended: December 31, 2023
- Premium hikes: Immediate and widespread
- Legislative response: House and Senate still split on how to restore or replace the credits
Because the Senate is out for the week and the House is headed into recess next week, experts say the odds of a bill moving forward are slim.
Who’s Testifying?
| CEO | Company |
|---|---|
| Stephen Hemsley | UnitedHealth Group |
| David Joyner | CVS Health |
| [Name not provided] | Cigna Health Group |
| [Name not provided] | Elevance Health |
| [Name not provided] | Ascendiun |
The CEOs will be asked to explain why premiums have risen and what the industry can do to keep costs down. They will also be held accountable for the broader health-care system’s role in driving prices.
What the House Wants to Know
The hearings are part of a broader effort to understand the “root causes” of higher health-care costs, according to committee chairs Brett Guthrie, R-Ky., and Jason Smith, R-Mo. The focus will include:
- The ACA’s mandate that insurers cover individuals regardless of pre-existing conditions.
- The prohibition on underwriting at the individual level.
- How these rules have increased access for the unhealthiest Americans but also lifted costs for healthier ones.
“The ACA mandated coverage for individuals regardless of underlying health conditions and largely prohibited plans from underwriting plans at the individual level,” a hearing document notes. “Effectively increasing health-care access and affordability for the unhealthiest Americans but also driving up health-care costs for healthier Americans.”
Insurers’ Defense
Insurers argue that premium increases mirror rising costs across the health-care system, especially in hospitals and prescription drugs. Stephen Hemsley, CEO of UnitedHealth Group, will likely say:
> “It is a symptom, not a cause. Premium rates are based on two key factors: how much care is used and how much is charged for that care. When the price of care goes up and care activity increases, the cost of health coverage necessarily follows.”
Similarly, David Joyner, CEO of CVS Health, will point out that:
> “What’s driving these costs is understood: Greater demand for care, growing medical provider costs, and persistently high prices for hospital care and prescription drugs.”
Critics of the ACA
Gideon Lukens, a senior fellow at the Center on Budget and Policy Priorities, will argue that the ACA has stabilized the insurance market. He said:
> “Before the ACA, insurers on the individual and small-group markets could deny coverage to people with pre-existing conditions like cancer or diabetes, or could charge them much more. Insurance premiums in these markets often fluctuated widely year to year, and options were limited.”
Lukens also warned that the “elephant in the room” is the expired enhanced tax credit. He urged lawmakers to focus on the affordability crisis and to extend the subsidies as soon as possible.
The Bigger Picture
The hearings are not about President Trump’s health-care plan, which was unveiled last week and proposes redirecting ACA subsidy funds into health savings accounts. The plan lacks detail and will likely be a side note.
Instead, the focus is on whether the industry can shoulder more responsibility for rising costs or whether the problem lies deeper in the health-care system. The outcome could influence the next wave of legislation on health-care affordability.
Key Takeaways
- Congressional scrutiny: Five top insurer CEOs will testify before House committees.
- Root cause debate: Lawmakers will examine the ACA’s role in driving costs.
- Insurers’ stance: Premium hikes reflect broader health-care cost increases.
- Policy uncertainty: No immediate plan to restore enhanced subsidies; the next bill is unlikely to pass soon.
- Potential impact: The hearings could shape future health-care reform and the political debate over subsidies.
The hearings are a pivotal moment in the ongoing battle over health-care affordability. The outcomes will reverberate through policy discussions, insurance markets, and the wallets of millions of Americans.
