Key Takeaways
- •Rep. Griffith (R, VA-9) led an examination of how healthcare consolidation and "opaque" programs like 340B drive up patient costs while limiting independent provider choices.
- •Barbara Merrill (CEO, American Network of Community Options and Resources) testified that home-based care costs $70,000 annually compared to $395,000 for institutionalization, warning that Medicaid cuts threaten these savings.
- •Rep. Guthrie (R, KY-2) pressed Richard Pollack (President and CEO, American Hospital Association) on "irrational" pricing after his wife received a $28,000 bill for a six-hour hospital stay.
- •Republicans argued that vertical integration and regulatory burdens stifle competition, while Democrats contended that GOP-led Medicaid cuts and expired ACA tax credits are the primary drivers of uncompensated care.
- •The subcommittee signaled future legislative action on Medicare physician payment reform and site-neutral payment policies to stabilize independent practices and reduce federal healthcare spending.
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Hearing Analysis
Overview
The House Energy and Commerce Subcommittee on Health convened on March 18, 2026, for a hearing titled "Lowering Health Care Costs for All Americans: An Examination of the U.S. Provider Landscape." This session served as the third installment in the committee's health affordability series, following previous examinations of insurance executives and the prescription drug supply chain. Subcommittee Chair H. Griffith (R, VA-9) opened the hearing by highlighting the dramatic consolidation of the provider market, where hospitals are increasingly acquiring independent physician practices, leading to fewer choices and higher costs for patients. The primary purpose was to investigate how the current provider landscape—comprising hospitals, independent doctors, and community-based services—contributes to rising healthcare expenses and to identify policy levers to improve transparency and competition.
Key Testimony
The witness testimony reflected the diverse and often conflicting pressures within the healthcare system. Richard Pollack, President and CEO of the American Hospital Association (AHA), testified that hospitals are the backbone of the nation's infrastructure but face unsustainable financial strain. He noted that hospital expenses rose 7.5% in 2025, driven by a 10% increase in medical supply costs and a 13% rise in drug prices, while government reimbursement remains below the cost of care. In contrast, Dr. David H. Aizuss, Chair of the Board of Trustees for the American Medical Association (AMA), and R. Shawn Martin, CEO of the American Academy of Family Physicians (AAFP), focused on the erosion of independent medical practices. Dr. Aizuss emphasized that Medicare physician payments have plummeted by 33% since 2001 when adjusted for inflation, while Mr. Martin observed that 75% of family physicians are now employed by large systems, up from 35% two decades ago. Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health (PBGH), represented large self-insured employers, arguing that hospital pricing is "utterly irrational" and not tied to quality, calling for mandatory price transparency.
Policy Proposals
Specific policy proposals were a central focus of the discussion. Dr. Anthony DiGiorgio, a neurosurgeon at the University of California San Francisco (UCSF) Health, advocated for the repeal of Section 6001 of the Affordable Care Act (ACA), which prohibits the expansion of physician-owned hospitals. He argued these facilities provide a necessary competitive check on corporate consolidation. Members also discussed "site-neutral" payment reform to align Medicare reimbursement for services regardless of the setting. Rep. Earl Carter (R, GA-1) promoted his "340B ACCESS Act," which seeks to establish a clear patient definition and increase transparency in the 340B drug pricing program to ensure discounts reach vulnerable patients rather than being absorbed as hospital profit. Barbara Merrill, CEO of the American Network of Community Options and Resources (ANCOR), advocated for the "HCBS Access Act" to make home and community-based services (HCBS) a mandatory Medicaid benefit, citing data that keeping individuals with disabilities at home costs $70,000 annually compared to $395,000 for institutionalization.
Overview
Partisan dynamics were sharply defined. Republicans, including Full Committee Chair Brett Guthrie (R, KY-2), focused on market-based solutions, transparency, and the failures of the ACA. Rep. Guthrie shared a personal account of his wife receiving a $28,000 bill for a six-hour hospital stay and being pursued by a debt collector, Medicredit, Inc., despite having high-quality insurance. Democrats, led by Ranking Member Diana DeGette (D, CO-1) and Rep. Frank Pallone (D, NJ-6), blamed the "Big Bad Bill" (H.R. 1) for cutting over $1 trillion from Medicaid. They argued these cuts, along with the expiration of ACA premium tax credits, would leave 15 million people uninsured, increasing uncompensated care costs and forcing rural hospital closures. Rep. Raul Ruiz (D, CA-25), an emergency physician, characterized the Republican cuts as a "gunshot wound" to the healthcare system that would inevitably drive up premiums for all Americans.
Key Testimony
The hearing identified several organizations in specific contexts: - American Medical Association (AMA): Represented by Dr. Aizuss; advocated for Medicare payment reform and reducing prior authorization burdens. - American Network of Community Options and Resources (ANCOR): Represented by Ms. Merrill; warned that Medicaid cuts threaten disability services. - Centers for Medicare & Medicaid Services (CMS): Referenced regarding its role in setting physician fee schedules and site-neutral payment policies. - Purchaser Business Group on Health (PBGH): Represented by Ms. Mitchell; called for price transparency to assist large employers. - Medicredit, Inc. (Medicredit): Criticized by Rep. Guthrie for aggressive debt collection practices. - University of California, San Francisco (UCSF): Witness affiliation for Dr. DiGiorgio; mentioned regarding academic medicine. - American Academy of Family Physicians (AAFP): Represented by Mr. Martin; pushed for doubling national investment in primary care. - Congressional Budget Office (CBO): Cited for findings on 340B program costs and insurance coverage projections. - Developmental Disabilities Resource Center (DDRC): Mentioned by Ms. Merrill as a provider of essential HCBS in Colorado. - American Hospital Association (AHA): Represented by Mr. Pollack; defended hospital costs as necessary for emergency infrastructure. - Denver Health: Cited by Rep. DeGette as a safety-net hospital at risk due to Medicaid funding changes. - Islamic Republic of Iran (Iran): Mentioned by Rep. Pallone to contrast healthcare spending with foreign conflict costs. - Colorado Hospital Association (CHA): Referenced by Rep. DeGette regarding potential rural hospital closures. - Avalere Health (Avalere): Cited by Rep. Neal Dunn (R, FL-2) for research on drug negotiation impacts. - BayCare Health System (BayCare): Praised by Rep. Gus Bilirakis (R, FL-12) for its behavioral health urgent care model. - Medicare Payment Advisory Commission (MedPAC): Referenced by Dr. DiGiorgio regarding reimbursement differentials.
The hearing concluded with Chairman Griffith and Chairman Guthrie expressing a commitment to advance bipartisan legislation on price transparency and physician payment stability. While no specific deadlines were set, the subcommittee indicated that the testimony would inform upcoming legislative markups aimed at curbing consolidation and lowering out-of-pocket costs for patients.
Transcript
Subcommittee will come to order. The chair recognizes himself for a five-minute opening statement. Today we will discuss health care costs and patient access challenges by examining the health care provider landscape. This is the third hearing in the committee's health affordability series, following hearings with health insurance executives back in January and stakeholders from the prescription drug supply chain last month. The United States provider landscape includes a wide range of entities and organizations that deliver services to patients. Hospitals and large health care systems, hospitals and large health care systems provide acute and specialized care. However, we have also seen these entities expand into outpatient service delivery. Independent physician practices and group practices deliver much of the primary and outpatient services that patients rely on every day. Although they are not before us in this hearing, I also want to recognize the critical role that federally qualified health centers, rural health clinics, and community hospitals play in our health system, especially in our, in our most rural and underserved areas. It is no secret that across the country, patients are faced with fewer choices about where they can receive care as the provider market has consolidated dramatically. Hospitals are acquiring physician practices, systems are merging, and too often patients have little options among providers. In many cases, the states that see the most consolidation have the largest rural population, exacerbating access challenges, leaving communities strained and contributing to overall unaffordability. On top of vertical integration limiting the viability of independent practices, the so-called Affordable Care Act has enabled the landscape to become even more narrow. In fact, because of the Affordable Care Act, any existing physician-owned hospital built before 2010 is prohibited from growing beyond the size it was when the bill became law, forcing me to ask myself, how does that make sense? I don't think it does. As a result, many patients face limited provider options in their communities and may encounter higher prices with little insight into the cost of health services. At the same time, transparency in the health care provider system remains insufficient. Prices can vary widely for the same service depending on where care is delivered, and billing statements may include facility fees, multiple providers, negotiated rates, etc., that are difficult for patients and Congress to understand. Additionally, programs such as the 340B drug pricing program have become opaque, and a few hospitals have gone against the true intent of that good program. The 340B program was created with the intention of helping safety net providers care for low-income and vulnerable patients. However, as hospitals and large entities participate and expand affiliated contract pharmacies, visibility has become limited into how the program's generated discounts are used and whether those savings are reaching the patients that they were meant to reach. In many cases, the result of this system is that Americans are left navigating complex and often expensive medical bills, whether from a hospital or routine appointment, bills that they did not anticipate, cannot easily afford, and sometimes only learn about weeks or months after receiving care. When provider markets lack competition and transparency, prices can rise without patients having the information needed to make cost-conscious decisions. Today we will hear from different organizations that represent health care providers across a variety of settings so that we can look for ways to try and make delivering and receiving care more affordable. We have the American Hospital Association in front of us, who represents many types of hospitals and health care networks. We also will hear from the American Medical Society, who represents many physicians across the country. The American Academy of Family Physicians is here to give their perspective. We also have the Purchaser Business Group on Health before us to provide insights into the relationship between private employers and public purchasers. We also have a neurosurgeon from the University of California San Francisco to give the perspective of specialty doctors and the care that they provide to patients. Lastly, we have Barbara Merrill from the American Network of Community Options and Resources. These witnesses have unique insights into the factors that are currently leading to the high costs patients are facing when receiving care, and I am looking very much in favor of hearing all of this discussion. And with that, Madam Chair, excuse me, Madam Ranking Member, I yield back and maybe, maybe not. We'll see. Time will tell. I think we're going to be just fine. But that said, to my good friend, the ranking member, Ms. DeGette, I now yield her five minutes.
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