Lowering Health Care Costs: Policies to Increase Transparency

Subcommittee will come to order.

Yeah.

The chair recognizes himself

So this is our

for five minutes for an opening statement, and we'll let the witnesses come in. I had to run from another committee, so.

One second.

Yeah. All right. Today's hearing will examine ways we can work to improve health care price transparency. Health care affordability has long been a priority for this committee and congressional Republicans. Building on the foundation established by President's Trump's President Trump's transparency initiatives, we have focused on policies that increase competition, expand consumer choice, reduce regulatory burdens, and strengthen transparency throughout the health care system. While there is no single solution to addressing rising health care costs, empowering Americans with better information and transparency data remains a critical step toward a more efficient accountable and affordable health care landscape. For too long, patients, families, and employers have faced a health system where the cost of care is often unclear, sometimes even unclear after the care is delivered. As we have seen throughout our affordability series, health care pricing, medical bills, and coverage information can be complex and opaque. But it does not have to be that way. Greater transparency is essential to creating a more consumer-driven marketplace where patients have the tools needed to make more informed care decisions. When patients have a better understanding of the costs associated with medical treatments, procedures, and services, they are better positioned to compare options, seek high-value care, and avoid unexpected medical bills. Increased transparency is also critical to bringing health care disruptors into the marketplace, and promoting competition amongst insurers and providers, where we continue to see consolidation that contributes to higher health care costs. It is important that we strive to foster a health system that not only delivers high-quality care at a more affordable cost, but also increases accountability across the sector. This administration, both in President Trump's first term and this current term, has prioritized bringing more transparency to health care. Some of the proposals today build off the transparency work that President Trump has implemented through regulatory pathways, meaning a different administration can come in and change or reverse course on those pathways. That's why codification codification is so important, as it aims to allow for a more standardized format in implementation of rules for hospitals and insurers to follow. During this hearing we'll explore a range of legislative proposals aimed at strengthening transparency requirements and providing patients with upfront clear information about health care prices. One of the bills we will consider is an updated version of the lower-cost, which was former which was led by former Chairwoman Cathy Morris-Rogers and passed the House on the floor back in twenty twenty-three. The bill aims to increase price transparency throughout the health care system, including hospitals, ambulatory surgical centers, and clinical labs and imaging testing. Additionally, some of the proposals today look at ways we can empower the centers for Medicare and Medicaid services or CMS with the tools they they need to improve price transparency data and accountability. Further, we look at ways participants can be more fully informed, as one of the discussion drafts requires a Medicare Advantage and commercial health plans to publicly post their prior authorization data, so individuals can view the plan's approval and denial rates for health claims. Another bill we will discuss is H. R. five five eight two, the Patients Deserve Price Tags Act, championed by championed by Representative John James from Michigan. This bill takes a slightly different approach compared to the lower cost more transparency act, but shares the same goal of bringing more transparency into the marketplace. I am proud of this subcommittee's commitment toward working to lower health care costs for all Americans. And I am eager to examine these proposals so we can continue to look for ways to make health care more affordable and more transparent. I thank the witnesses for being today here today. And I look forward to the discussion our committee will have. With that, I now yield back and I now recognize the ranking member, Representative DeGette, for her five minutes for an opening statement. Ms. DeGette?

Thank you, Mr. Chairman. Mr. Chairman, we both agree that health care is too expensive and too complex. Looking after your health, finding a doctor who takes your insurance, scheduling, figuring out exactly what it's going to cost you, and figuring out how to pay for it is difficult at best, if not impossible. Now, I've long supported price and policy transparency throughout the health system, and I look forward to bringing more of it. We need transparency to inform policy next steps and to help researchers to understand exactly how prices got so out of control and how we're gonna work together to bring them down. Sunlight, as they say, is the best disinfectant, and on that we all agree. So, I'd like to have a little sunlight on H R one, which was passed last summer, which I always call the big bad bill. Last year, when we were considering the bill, my democratic colleagues and I warned that it would result in sick people losing their health care and more uninsured Americans. In particular, we warned that the new paperwork requirements would simply add red tape for people who need health care. The majority said that that was an exaggeration. They accused of uh us of engaging in scare tactics, and they even called us liars. I'd um, for example, um, on June twenty second in twenty twenty five, a piece from the New York Post which uh Chairman Guthrie wrote said and and by the way, Mister Chairman, I I believe that you thought this quote, you're exempt if you're medically frail, which includes anyone who's blind, disabled, battling a chronic substance d use disorder or living with a serious and complex medical condition like cancer. OK, so this is what the chairman said to the New York Post after the bill passed, but then when you look at the rule, implementing the chairman and donald trump's bill it specifically states in section four thirty five point five five four c five i that quote we considered including specific conditions within our definition of serious or complex medical condition including human immunosuppressive virus and acquired immunosuppressive virus hiv aids end stage renal disease cancer and sickle cell disease, but we do not believe it is reasonable to categorically consider conditions as serious or complex without factoring in criteria such as the severity of the condition. In other words, if you just have cancer, you still are subject to this. Um, and I'd like to ask unanimous consent to enter this newspaper article into the record, Mister Chairman.

And and the date is June twenty second.

June twenty second, twenty twenty five.

Without objection, so ordered.

Thanks. Now, so this is just all to the point. We saw this coming. We warned of it. We implored the majority not to go forward with this disastrous policy. And the results are clear. The implementation of the big bad bill contradicts how this majority attempted to sell it to the American people and sick people, the ones I just mentioned, are going to be and more are gonna be kicked off of care as a result. So, just remember though, these paperwork requirements were never intended to make people s healthier. What happened was these these cuts to Medicaid were made to give tax handouts to the wealthiest Americans and corporations. So they had to find the offset by cutting Medicaid, which cares for health care for poor and working Americans. And this really ignores the reality that health care should not be a reward for working, but a prerequisite to being stable and productive and healthy so you can work. Now, so this year, since the majority passed through the big bad bill and didn't work with us to expand the enhanced ACA subsidies, more Americans are losing insurance and they're seeing their costs go up. Eighty percent of returning Marketplace enrollees say they're seeing higher costs this year. Fifty-one percent say these costs are quote " a lot higher". And critically, as of March, thirty-seven percent of Marketplace enrollees were cutting back on necessities like food to afford health insurance. And I talked to some of the insurance companies. They said that enrollment is way, way off this year. And so, uh, Mr. Chairman, I agree with you. We need to pass legislation relating to transparency, but we need to sit down and work in a bipartisan way about how we can get affordable health care for all Americans, not just a few. I yield back.

And lady yields back. Now recognize the Chairman of the full committee, Chairman Guthrie, for his five minutes for an opening statement.

Thank you, Chairman Grover. Thank you for holding this hearing today and thank you for all of our witnesses being here. And today we're we're the hearing will examine several health care transparency policies and build on this committee's many years of bipartisan work to bring to get grater transparency to the sector. And we're continuing the committee's work this year to tackle health care affordability for the American people. Again, committee's work this year to tackle it. We'll also consider legislation to build on the Trump administration's historic price transparency regulations, by codifying a framework for hospital and insure insure price transparency. These policies will help provide actionable pricing information to patients and employers, empowering them with the tools they need to get high quality care at the best price. This will ultimately bolster competition and improve American healthcare and affordability for American people. Further, today's hearing will include new pol- newer policies taken action on President Trump's great healthcare plan. We'll consider how to address concerns we've heard from patients and from providers about the burdens created by prior authorization and for improving transparency of ins- transparency of insurers' overhead costs. By providing this information to the American people in a consumer-friendly way, these policies can help consumers better shop for the healthcare plans and will increase competition in the marketplace. We'll also consider a discussion draft that brings pricing information directly to patients when they are seeking care by requiring hospitals to publicly post on their walls a discounted cash price of shoppable services, enabling consumers to make informed choices about where to lower where to find lower cost care. As I noted, this committee has a long track record of working in a bipartisan way to bring greater transparency to the health care system, shining a light on the cost of health care while equipping American patients and employers with the tools they need to lower health care costs It i- it was in this committee over three years ago when Congress had our first hearing wor- working on price transparency legislation. Today's hearing will continue our leadership on this critical work to empower patients by improving healthcare transparency. I thank the witnesses for being here and I yield back.

Gentleman yields back now. Recognize the ranking member of the full committee, Mister Pallone, for his five minutes for an opening statement.

Thank you, Mister Chairman. passage of the republicans big ugly bill healthcare prices are skyrocketing hospitals and clinics are closing and healthcare workers are being laid off over twenty million americans saw their healthcare premiums skyrocket at the beginning of this year because of republicans failure to extend the premium tax credits and republicans big ugly bill cut americans healthcare by more than a trillion dollars and families across the country are facing the brunt of this healthcare crisis now doubling down on this chaos just last week the trump administration issued a rule that will intentionally result in more people losing access to health care when they need it most. And to make, make no mistake, this is by design and what were congressional republicans voted for, people with devastating illnesses, including those with cancer, parkinses and hiv, will be forced to prove over and over again that they're in fact too sick to work in order to maintain their health care. And undoubtedly for many this will be a burdensome and complex reporting scheme that is impossible to navigate when they need the care most, and for states, a costly and inefficient mandate that will only result in fewer people having access to care. In fact, according to the American Cancer Society, these new restrictions are, and I quote, " unreasonably harsh and will be life-threatening for cancer patients". And it could even get worse, as Republicans are considering another budget reconciliation bill that would strip healthcare away from even more Americans, and their big ugly bill. Fortunately, today we are considering bills that will actually improve Americans' healthcare, for bringing more transparency to the healthcare system. And I wanna thank the chair for recognizing the importance of this transparency effort. I heard chairman Guthrie talk about the link between transparency and competition, and I agree, they are linked, but it may be necessary also to create more competition even with increased transparency. Because if you know, as we know, the monopolization with regard to hospitals and so many healthcare interests exists and is getting worse as well. So let's not forget that in order to create in order to use transparency more effectively as many of these bills will. Uh, we have to also look at the competitive environment to make sure it truly is competitive. We'll also discuss a bill that would codify existing requirements for both hospitals and insurers to make healthcare pricing more transparent by requiring price information to be displayed publicly and in a standardized format. And lack of transparency into healthcare prices makes it difficult for consumers to make informed decisions and it also makes it challenging for employers to negotiate more competitive prices. This bill represents work that this committee has been undertaken for several congresses and that I worked on with the previous chair of this committee, chair Rogers, and I look forward to our discussion on this bill today. We'll also discuss a bill that will bring more transparency to hospital ownership by requiring hospitals and physician practices to disclose ownership data, including for entities owned by private equity firms and venture capital firms. And I'm very concerned the private firms investing in healthcare are driving up healthcare costs for consumers, while also reducing the quality of care for patients. Recent studies have shown consumers receiving care at hospitals acquired by private equity, saw an increase in their out-of-pocket costs. Billions of dollars are being invested into the healthcare system by private equity firms, many with unclear ownership structures, and our healthcare infrastructure is becoming increasingly unstable because of it. According to the private equity stockholder, at least twenty percent of health care companies that filed for bankruptcy in twenty twenty three were owned by private equity firms. Policy makers and regulators need better visibility into these ownership structures, and this legislation gives us that visibility. We'll also discuss bills to increase transparency in the Medicare Advantage program to improve care. More seniors with Medicare are now enrolled in MA plans than traditional Medicare, but there's limited data to conduct oversight and ensure that the program is providing good value. And I'm also concerned by reports of some MA plans' misuse of prior authorization requirements and the harmful impact these practices have on seniors accessing timely care. And we'll also consider a bill that would increase transparency and accountability of broken compensation in the MA market. While agents and brokers can play an important role in helping seniors enroll in Medicare, they deserve access to unbiased and accurate information about coverage options that best serve their individual needs. And it's critical that we increase transparency and accountability of broker compensation in order to protect Medicare beneficiaries. So I look forward to the discussion today. We can't have a comprehensive conversation about addressing healthcare affordability without acknowledging the ongoing harm of the Republicans' big ugly bill and I I also hope that their efforts to try to improve or expand I guess I should say the big ugly bill hopefully they come to naught uh for the sake of our

Chairman yields back. We now conclude with member opening statements. The chair would like to remind members that pursuant to committee rules, all members' opening statements will be made a part of the record. We want to thank our witnesses for taking their time to testify before our subcommittee today. Although it is not the practice of this subcommittee to swear in witnesses, I would remind our witnesses that knowingly and willfully making material false statements to the legislative branch is against the law, under title eighteen, section one zero zero one of the United States Code. You will have the opportunity to give an opening statement, followed by questions from members. Our witnesses today are Miss Carol Skiens, who is the Chief uh of Staff at Turquoise Health. We we also have Mister Sean Greminger, who is President and Chief Executive Officer for National Alliance of Healthcare Purchaser Coalitions. Mister Benedict Epil Epilito. is Senior Fellow at the American Enterprise Institute. Doctor Christopher Whaley is the Associate Director of the Center for Advanced Health Policy through Research and Associate Professor of Health Services, Policy and Practice at Brown University School of Public Health, and uh, Miss Sophia Tripoli, who is the Senior Director of Health Policy at Families USA. Per committee custom, each witness will have the opportunity for a five-minute opening statement. followed by a round of questions from the members. The light on the timer in front of you will turn from green to yellow when you have one minute left. I now recognize Ms. Karol Skins for her five minutes to give an opening statement. Welcome.

Chairman Griffith and Guthrie, and distinguished members of the subcommittee, thank you for the opportunity to be a witness today. My name is Karol Skins and I'm Chief of Staff at Turquoise, a healthcare pricing and transparency platform that partners with more than three hundred hospitals, payers, employers, life sciences organizations, and researchers to make price transparency data useful, reliable, and actionable. I wanna start with a simple observation. The transparency framework this subcommittee helped build is making an impact. When hospitals were first required to post machine readable files in twenty twenty one, initial observations were that the data would be too complex or incomplete to use. When payers followed in twenty twenty-two, the files were so large that many doubted whether anyone could even parse them. We've come a long way since then, between iterative final rules and improved file quality, and at Turquoise, we see industry stakeholders, regulators, and consumers deriving value from price transparency data every day. The transparency rules are creating competitive pressure, and we see it in the market. Payers and providers are negotiating rates with more clarity and efficiency. Self-insured employers have better ownership of their fiduciary responsibilities by using price transparency data to find save savings opportunities and shop smarter within their existing networks. But MRF data alone does not answer the question patients and employers actually ask, " How much is this gonna cost me?" Answering that question requires solving four problems. First, bundling individual billing codes into complete open license procedure packages. Second, integrating benefits data so cost calculators reflect what a specific patient actually owes. Third, improving data quality because today there are none yet solvable gaps in the MRF data. And lastly, targeting administrative waste in the healthcare transaction in areas besides pricing data. These include prior authorization, simplified modular contracts, and streamlined claims processing. Turquoise has built more than four hundred open-licensed standard service packages specifically to bridge that gap. And in February, we partnered with New York City to launch the first consumer price comparison tool in the country, powered by MRF data. It reached eighty-three thousand users in days. A colonoscopy in New York City ranges from five hundred dollars to nine thousand, depending on a number of factors, including which patient uh, which door a patient chooses to walk through. And for the first time, patients can see the range before they walk through any specific door. Scaling that nationally requires Congress to act. We urge this subcommittee to pass legislation that aligns with current final rules. Bills such as the Lower Costs More Transparency Act and the Patients Deserve Price Tag Act Price Tags Act have the opportunity to codify the existing MRF requirements and statute extend them to non-hospital providers, mandate drug price reporting, self-pay, and stop-loss rate disclosure, and establish uniform schema standards. Any such legislation should ensure that when prices cannot be expressed as fixed dollar values The underlying formulas, algorithms, and contractual methodologies used to determine payment amounts are disclosed as well. And beyond price, we ask Congress to also support process transparency. Open standards can reduce prior authorization burden, cut claims denials, and eliminate the administrative waste that consumes nearly twenty-five cents of every healthcare dollar. Any system supporting process transparency should be consumer-friendly and open license. The patient demand is ever-present. An open AI reports two million health insurance pricing and benefits questions to chat GPT every week, most of which occur outside of working hours, and they allow patients to use plain language to ask common questions. We've entered a new before and after era of consumer activation and engagement with price transparency. Before, when the original final rules and laws were passed, our best bet was patient estimate tools and patient education. Now, AI has given us both an accelerant and a new era, because it lowers the barrier to entry for consumers in an incredibly meaningful way. The data is ready, and innovators like the team here at Turquoise are ready. So now more than ever, we're at a critical moment where AI-enabled technology can give patients and employers the chance to utilize new tools for understanding the cost of care. Our hope is that today we can discuss the legislative framework necessary to keep that momentum going. Thank you again for the opportunity to speak with you. I welcome your questions.

Thank you very much. And now recognize uh Mr. Sean Grimminger for his five minutes for an opening statement.

Thank you, Mr. Chairman, ranking member DeGette, and members of the subcommittee. Thank you for the opportunity to speak on behalf of America's employers and healthcare purchasers. I'm Sean Grimminger, President and CEO of the National Alliance of Healthcare Purchaser Coalitions. We're a national trade association representing nearly f- uh, more than four hundred regional employer purchaser coalitions around the country. Our member coalitions represent employers of every size. from Fortune five hundred companies to small businesses to public entities, providing health care coverage to roughly ninety million Americans. These are the employers who write the checks. And I'm here to tell you what they're getting in return is not acceptable. The problem is simple, even if the solution is hard. Health care costs continue to outpace wages and inflation. A family health plan now approaches thirty thousand dollars per year, and health care inflation is rising at the fastest pace in at least fifteen years. Every dollar consumed by rising health care costs is a dollar not going to wages, retirement, or business growth. What makes this especially maddening is that higher prices don't mean better care. In my written comments, I highlight the lack of connection between cost and quality by hospitals in Virginia and Colorado. In the Commonwealth, my home state, the highest-priced hospital with more than two hundred beds has negotiated rates at three hundred and twenty-seven percent of Medicare. It has a two-star Quality rating by CMS. Just fifty miles away, the lowest priced hospital in the state with more than two hundred beds, has rates less than two hundred percent of Medicare and boasts a five-star quality rating. Employers are often paying more and getting less. And as we know, and it's been discussed already, the system is deliberately opaque. Five years after the federal price transparency rules took effect, less than half of hospitals are fully compliant, though the stats depend on who you ask. When the data does exist, it's often too inconsistent and poorly standardized. and that it uh takes an army of data engineers just to make it usable. Though I agree with Mrs. Ski- Ms. Skeens uh that the transparency rules have remade provided meaningful improvements over uh the previous regime. But here's what I find most troubling. Many employers can't even access their own claims data. In our twenty twenty five survey of more than three hundred purchasers, forty-two percent said their vendors refused to provide complete data access. More than half of smaller employers said they simply can't get it. Employers are all paying the claims. They're bearing the financial risk, and someone else is deciding whether or not they get to see their bill. When employers do have access to their claims, the results speak for themselves. They're far more likely to implement direct contracting, centers of excellence, side of care programs that reduce costs and improve outcomes. Data access isn't just a compliance issue. It drives real, measurable savings. So what do we need from Congress? Among the bills the committee has before uh before it, I wanna focus on the Patients Deserve Price Tags Act, particularly section seven, which establishes once and for all that plan sponsors have a right to their own claims and encounter data. This should not be controversial. Employers fund these plans. They have fiduciary obligations to their workers. They need this information to do their jobs. The legislation also codifies and strengthens the hospital and pr- uh price transparency rules, uh, requires dis- uh, disclosures of how prices are actually calculated and creates meaningful enforcement mechanisms. It's the most comprehensive transparency bill before this body. I should note that we also prov- uh, support provisions from the Check Act, the Lower Costs More Transparency Act, and others, but none go far enough without the employer access data provisions in section seven. I also wanna be clear about something. Transparency alone will not solve this problem. In markets dominated by one, two, or three health systems, employers may gain visibility into prices, but still have no leverage to negotiate. Transparency is necessary, but it is not sufficient. This committee should also pursue site-neutral payment policies, restrictions on facility fees, and prohibitions on anti-competitive contracting practices that lock employers into overpriced networks. And in the most consolidated markets, policymakers should seriously consider reference-based pricing benchmarks tied to Medicare. States as diverse as Indiana, Vermont, Montana, and Washington have already gone in this direction. These are not radical policies. their rational responses to failed markets. Finally, I wanna leave you with this. A poll conducted just last month uh by the United States of Care found that more than seven in ten Americans believe health care costs are unaffordable and nearly half have faced financial pressure from medical bills in the past two years. Sixty-nine percent of uh people believe Congress should act including majorities of both Democrats and Republicans. The public's frustration matches what employers feel every day. The diagnosis is not in dispute. What we need now is the will to act. If we do not give employers the tools to bring costs under control, the commercial market will buckle. And what replaces it will almost certainly be worse for American workers and their families. The moment for action is now. Thank you very much.

Chairman yields back. Now recognize Doctor Benedict uh, Ippolito, for his five minute opening statement.

Thanks very much, Chairman Griffith, and uh, Ranking Member DeGette. members of the committee. Uh, my name is Benedict Ippolito. I'm an economist at the American Enterprise Institute. I'm also an incoming commissioner at MedPak, and I believe that obliges me to say that these are my views and of course not theirs. Um, many, not all, but many of the challenges that health care markets face stem from a direct or directly or indirectly from a lack of transparency. Either you have market actors who have to make decisions without all the relevant information in front of them, or you have policymakers like yourselves who are tasked with with regulating or overseeing markets yet you don't have all the relevant to do so. And so, today I I think you're you're considering several bills that illustrate the broad potential value of transparency. There's many of them, so I'm just gonna uh uh focus on a couple that I think are are notable. Um, I'll start by saying first, one of the most important ways that individuals influence health care markets is by the way they choose their insurance plan. When they do that, they make these trade-offs between premiums and various measures of generosity on plans, how broad is the network, how low is the cost sharing, which hospitals are in and which hospitals are out. All right? When when we are in a well-functioning market, those decisions reflect their preferences and they direct insurers how to design their markets and they influence hospitals and and other other market actors. If they are making those decisions without relevant information, there's no reason to think that the outcomes we observe actually reflect their preferences. So I really like the provision to start publishing uh great information prior authorization rates denial rates things of that nature that is clearly something that consumers value we see it in surveys I am sure you hear about it in your offices um it's also something that's opaque and it varies a lot across insurers and so what you have are people or their employers picking between plans where there's big variation in this measure and yet they can readily observe it so that strikes me as a very good idea um second I appreciate the proposal the increased reporting of ownership and merger information this has been a a sort of consistent frustration. Um, as healthcare markets have evolved, we have seen a greater share of consolidation come in the form of serial acquisitions that are too small to require reporting to antitrust agencies or other regulators that means that we've got a lot of sort of stealth consolidation that occurs particularly in markets like the physician market. Um, this is a tactic that you often see private equity firms employ. Um, it's very difficult to tell policymakers what you should do about this, if we don't really have a good handle on what that consolidation looks like um and what the effects of it are. And so efforts to increase reporting of ownership, transactions, and update that every year seem like a very good idea to me. Um I'll conclude with one I guess m- maybe a little bit more nuanced point. Um the committee is considering increasing transparency into broker fees in the MA program and and considering restrictions on how large those fees can be. I just wanna flag that that does come with some complications. trying to regulate financial transactions between private entities can be fraught. The bill includes a laundry list of fees that are included and tried to be captured in this in this uh limit. Uh, you know, it's it's transactions, payments, gifts, reimburses for costs, all sorts of things. That illustrates how hard it is to sort of encompass all potential transactions. I just highlight that it's possible that includes everything, it's equally possible that we're gonna find creative workarounds and that limit I also wanna say that I think that provision I don't wanna tell anyone what what they think, but it strikes me that that really reflects a question about Medicare advantage and how those payments work in the program. Um, if you think those payments are too high or you think those payments are otherwise inappropriate in some form, that seems to me to be the underlying issue. That's what's giving these plans a big incentive to pay large fees, to brokers, to encourage enrollment in those programs. plans and so it strikes me that the more direct thing to do is address the Medicare Advantage program directly that will come with important trade-offs you will hear about those trade-offs from your constituents but it strikes me that that's worth uh confronting directly rather than trying to do it through sort of broker fee restrictions and things like that. Um that said I think this strikes me as a constructive effort to improve transparency in the healthcare market. It reflects the broad value that transparency can have for consumers and for policy makers and so I thank you for having me and I look forward to questions.

Gentleman yields back. Now recognize Doctor Christopher Whaley for his five minute opening statement.

Thank you. Chairman Guthrie and and Griffin, ranking members, Pilon and DeGette, and members of the subcommittee, thank you for the opportunity to testify today. My name is Christopher Whaley. I'm an health economist and an associate professor at the Brown University School of Public Health. My research focuses on health care costs, price transparency, and the impacts of market consolidation on the employer-sponsored and Medicare markets. Today, I want to make three core points. First, health care prices are high, and I think broken. Second, transparency in both price and organizational structure is a necessary foundation to improve health care affordability. And finally, the bills before you this morning would take steps, I believe, to directly address the gaps that matter the most. The United States leads the world in health care spending. High spending is driven by price, not by sick or patients, or better care. For a family of four with employer-sponsored insurance coverage, premiums are projected to exceed thirty-seven thousand dollars per year. My work shows that private insurance hospital prices average two hundred and fifty-four percent of what Medicare pays nationally, but in some states like West Virginia, Florida, and Georgia, prices exceed three hundred percent of what Medicare pays. Critically, these high prices are not linked to better quality. Several studies show that higher-priced hospitals and providers do not provide better quality of care. Instead, a major driver of high prices is consolidation. Over the last two decades, roughly two thousand hospital mergers have produced massive health system conglomerates, increasing prices with no quality improvement. Beyond hospitals, over half of US physicians are now employed by a hospital or healthcare system, and private equity firms have deployed nearly a trillion dollars in h- healthcare markets over the last decade. These new ownership models remain deeply opaque to patients, employers, and regulators alike. To improve the affordability of the US healthcare system, I think it's critical for Congress and policymakers to improve both price and organizational transparency. And I want to make one thing clear. Transparency by itself is not a cure-all for the US healthcare system. Patient-facing price tools have largely not changed shopping behavior, and healthcare is far too complex for that alone. But I think transparency is foundational for everyone else who needs to act. whether it's employers negotiating on behalf of their workers, researchers studying healthcare market dynamics such as myself, states designing price reforms, and federal regulators overseeing the Medicare program. I think transparency is already working. Transparency data has allowed researchers like myself to document several things, including private equity affiliated physician charge prices that are six to ten percent higher than prices that independent doctors charge. In addition, Medicare Advantage plans pay less than half what commercial plans pay, negotiated by the very same insurer. And finally, prices at ambulatory surgical centers are approximately thirty-six percent lower than hospitals in the same county providing what I think is rigorous evidence for site neutral payment reforms. Transparency data has also provided the evidence base for Oregon's hospital payment limits, which saved over a hundred million dollars in two years, with no harm to quality or the workforce. Purchasers like the Thirty-Two B J Health Fund have used their own claims data to generate a hundred million dollars in annual money that went back directly to the workers and in the largest pay increase in their union's history. To further these innovations and to fully understand evolving U. S. health care ecosystem, I think it is critical for Congress to continue their existing efforts. As I discuss in more detail in my written testimony, the bill to the subcommittee is considering how the potential to address some of the most consequential gaps in our current transparency framework. First, the Lower Cost, More Transparency Act and the Patients Deserve Price Take Act would strengthen price disclosure and ensure that employers can actually access their own claims data, data data that third-party administrators currently withhold despite clear fiduciary obligations that employers and purchasers have. I want to emphasize the importance of ensuring that employers have access to their own claims data which is critical for them to fulfill their fiduciary obligations. The Check Act would extend those protections to itemize billing and limit excuses about gay clauses and other provisions for not sharing data. And likewise, the ownership transparency data would create the national database we need to track organizational changes. And finally, the Medicare Advantage bills would bring long overdue accountability to broker compensation and the MA encounter data. Both areas are my colleagues and I have documented serious problems. My colleagues found in a recent su- study that over ten billion dollars in payments to MA brokers uh from MA plans per year raising what I think are concerns that the advice that Medicare Advantage beneficiaries use to select their plans might be conflicted by broker payments. In conclusion, Congress can help transpar- bring transparency into the increasingly complex US healthcare system, uh, which I think will benefit patients, employers, and policymakers. Thank you, and I look forward to questions.

Gentleman Neal's back and I will now recognize um, Miss Sophia Tripoli for her five minutes testimony.

Thank you. Chairman Guthrie and Griffith, Ranking Members Pallone and DeGette, and members of the committee, thank you for the opportunity to testify. My name is Sophia Tripoli and I lead health policy at Families USA, the long-time voice for healthcare consumers. I wanna start with a near universal truth. Healthcare affordability is the top issue for voters across the country. And ninety-one percent of Americans, including conservative Republicans and progressive Democrats want Congress to lower their healthcare costs. A big part of why costs are out of control is because the system has been operating in the shadows. And the institution's profiting as a result have fought hard to keep it that way. For decades, hospitals, health plans and drug companies have been allowed to quietly take over entire sectors of the American healthcare system, consolidating markets to drive up prices, aggressively billing patients, denying access to care, and hiding all of it behind layers of complexity designed to keep patients and lawmakers in the dark while maximizing their profits. It may be tempting to chop this up to just a broken system or to scapegoat scapegoat vulnerable populations as the reason why health care costs too much, but that is a false representation of what's actually occurring. The US health care system is working very well, but just not for us. While families struggle to afford the care they need, corporate consolidation in health care is accelerating. Insurers grow larger and more dominant. Hospital systems consolidate in pow- into powerful regional monopolies that charge any price they want. Private equity has moved aggressively into care delivery. And drug companies still block lower-cost generic drugs from entering the market, while drastically increasing drug prices, almost entirely unchecked. Consider the example of Common Spirit Health, the nation's largest non-profit health system which owns a hundred and fifty-eight hospitals and more than two thousand health care centers across twenty-one states. They charge more than three times what Medicare pays for the exact same hospital services, generating seventeen million dollars in net income per hospital per year. Or take the Medicare Advantage program, where thirty-three million of our nation's seniors get their care. Just five health insurance giants now control eighty percent of the market, where insurers ab- abuse the billing system by making enrollees appear sicker than they are to generate higher payments for Medicare. This upcoding cost the Medicare program forty billion dollars each year. Or take that nearly sixty percent of doctors say their patients were delayed need of care because of prior authorization. These are symptoms of a sickness spreading, the corporate capture of our health care system, all facilitated by a complete lack of transparency. Nowhere is this more alarming than in the case of hospitals. Over the last twenty-five years, unchecked hospital consolidation has driven up prices by over two hundred and twenty percent costing hard-working Americans nearly a trillion dollars in lost wages since twenty-twelve private equity has compounded the damage, becoming one of the largest investors in health care delivery over the past decade. P E firms increasingly buy up small health care providers in order to skirt antitrust oversight and enforcement, all while driving up prices and worsening access and outcomes for patients. For too long, health care corporations have been allowed to set prices in secret, hide their ownership structures behind layers of shell entities and operate with almost no accountability. American families are not bargaining chips to be traded in the backroom deals between corporate giants, and their lobbyists. And this Congress has the power and responsibility to end that game. This is why this hearing is so important. Our health care system is in desperate need of transparency of prices, ownership status, care denials, coding abuses, and the bad behavior of brokers and agents. Transparency is essential to any meaningful effort to hold corporate health systems accountable. Just ask Jessica, an Arizona resident who waited months for a cancer screening she can't get a price on. Jessica needed a procedure to investigate her GI bleeding. With her history of cancer, every delay matters. Jessica lives paycheck to paycheck and cannot afford a big medical bill. So she spent weeks calling surgery centers, calling her insurers to find out how much the procedure would cost her, all while her bleeding bleeding worsened. No one she talked to could give her an answer. Jessica told us, " I still don't have a price, so I have to keep waiting." This is a system designed to protect corporate greed at the expense of people like Jessica and families across the country. Congress should advance meaningful proposals such as the Patients Deserve Price Tags Act, mandatory ownership transparency, display displaying care denials, the Check Act, improving MA and counter data and MLR transparency, limiting agent and broker compensation in MA and other reforms. These are practical bipartisan solutions that are long overdue. As I wrap, I wanna make one more point. As critical as transparency is, and we desperately need it, it will not be nearly enough to lower health care costs. It is an essential step, but not sufficient to solve the American affordability crisis. We implore you to ensure greater transparency in the system and to advance bold solutions that will fundamentally lower prices and bring down the cost of care. Thank you, and I look forward to your questions.

Thank you. Now we'll begin questioning it, and I'd ask that members not begin a new question to our witnesses. As our five minutes expire, I would encourage members to submit written questions for the record. And I now recognize myself for five minutes. Um, Miss, Doctor Whaley, uh, your testimony notes that commercial hospital prices now average roughly two hundred and fifty-four percent of Medicare nationally with some states exceeding three hundred percent of Medicare. So, can you explain what's driving up those extreme price differences between markets and whether consolidation is a primary factor?

Sure. So, nationally, hospital prices average two hundred fifty percent of Medicare, and we see wide variation in what hospitals charge uh patients with commercial insurance. And what's really driving those prices is not due to difference in quality, not due to differences in, say, cost shifting, but a key, uh, driver is consolidation, where we've seen tremendous mergers and acquisitions within the hospital district.

Yeah, exactly. And I'd like to enter into the record an article from the Associated Press, dated June ninth, twenty twenty six, highlighting, um, the Trump administration's recent actions to ensure hospitals are complying with hospital price transparency rules and making available information. about the prices they're charging to consumers. So without objection? So ordered. You know, it talks about uh they have worn more than five hundred hospitals, hospitals that are failing to provide the public with basic pricing information. So I'll continue with you, Doctor Whaley, your testimony highlights significant payment differences between hospital, outpatient departments and ambulatory surgical centers for the exact same services. And as somebody who uh supports preserving access to independent community uh based care you know my worry is that current payment incentives are pushing more caring to higher cost hospital owned settings. Uh, do you believe greater transparency around side of service pricing could help slow consolidation and encourage lower cost community-based, uh, care options, sir?

I do. I certainly think that transparency around side of care as well as

Yeah.

site neutral payment policies can help narrow those gaps.

Yes. Great. Doctor Ippolito, uh, in your testimony you discussed the importance of ownership, transparency, and how complex ownership structures can obscure uh, consolidation trends. We don't know who wants who. So, it's difficult for policymakers and regulators to even understand who actually owns health care delivery assets in a local market. So, uh, would better ownership reporting from Congress and antitrust regulators identify anti-competitive behavior earlier, before communities lose independent providers?

Yeah, I think so.

Well, that's good. I got another question for you, sir. Uh, I think most Americans would be shocked to learn how little visibility patients have into claim denial rates and utilization management practices before enrolling in a plan, you mentioned that in your testimony. It's unbelievable when the only way you know it is when you get denied or when you, you're required to get a prior approval. Do you believe consumers would make different plan choices? And even uh, you know, private entities and health sponsors, if denial rates and prior authorization practices uh were presented clearly and uniformly during the enrollment phase.

Yeah, they certainly might. There's a trade-off. It, you trade-off lower premiums for more, you know, oversight of services that you, you, you, you get. Let's let consumers choose what they prefer. I think that's the right way to do it.

Yeah.

Transparency seems perfect for that.

I'm all about that, exactly. Because if you work in the healthcare industry, even as a pharmacist and you're looking at these claims that are denied or these prescriptions, it's unbelievable what the process you have to go through. You have to have a dedicated person to do all these things. But if the plan sponsor knew ahead of time that this was gonna cost their company money, I think they'd make a different choice. Um, and it also put market pressure on insurers. to uh change their behavior, don't you think?

Yeah, the whole point is that the insurers should be offering what customers actually want this is an important amenity that they should be evaluating that, uh, that decision on. Yeah.

Yeah. You know, uh I think Americans increasingly feel like health care pricing operates in a black box, where nobody knows the price, nobody understands the billing, and patients, they don't have any leverage. Miss Tripoli, you said it. You've got patients who don't they can't get surgery because they don't know how much it's gonna cost. If Congress could enact just one transparency reform this year that would most directly lower health care costs for patients and employers, what would it be quickly? Miss Gint?

Increased price and process transparency across the board.

Mr. Grimminger?

The section seven of the Patients Deserve Price Tax Act.

Doctor Ippolito?

Uh, data on ownership structures.

That's right.

I I think the patience is our price exact.

It's triply.

Agree, patience is our price exact.

OK. Well, with that, I yield back. And now I'll recognize uh the ranking member representative to get for her five minutes.

Thank you, Madam Chair. Uh, well, um, I think um it's it's great to hear all of our witnesses here today saying that addressing transparency and consolidation um are really important towards beginning to under understand the high prices of health care. And I was just recently at a conference with Doctor Ippolito where he explained in greater depth about um his his views on this and and and there it was a bipartisan attendance at this conference and there was a lot of bipartisan agreement. So that was great, but what I wanna talk about is how transparency and also addressing consolidation could be first steps but they're not the solution to the problem of high healthcare costs. So, Doctor Whaley, I I wanna start with you, with additional transparency, I'm gonna give you an example. Do you think people would shop for MRIs in the same way they shop for cars? There's transparency, the MRI over here costs this and costs that over there.

Uh, as currently constructed, patients probably have a hard time shopping for MRIs the same way they do as a car.

Do you think they would um if we had more

It it would help somewhat, but it wouldn't move us all the way there.

And why not?

What one of the things that my research has shown is that when patients get even something we think is simple like an MRI, it's not just their choice, it's the choice of the physician referring them, and if your say physician works for a hospital system or a private equity company, then they have incentives to refer you to a higher price provider despite what the patient might want.

Right, so so just because we have transparency doesn't necessarily mean the patient is gonna get the cheapest MRI or, by the way, that this cost savings will inure to the patient.

Exactly.

Um, so so who would really use the information that we would get from new transparency requirements?

I I think it's important for employers like such as the ones that Mister Grumminger represents when they're designing networks, even upstream of the patients to ensure that they have access to efficient providers who have lower costs or negotiate better prices, I think it's also very important for regulators, research associates and myself, to use this type of data to understand the impacts of consolidation and design policies.

So it's it's it's really a good data point for everybody, but it doesn't necessarily mean it's gonna solve the pricing issue.

I I think if it's used in ways to inform benefit design and to design networks and audit the plans that uh, or the prices that insurers negotiate behalf of employers,

Right.

it could certainly help.

Yeah, okay. Um, So, Miss Tripoli, do you think that transparency in and of itself would bring prices down for the c- health care consumers?

I think, uh, I agree with, uh, Doctor Willey that, uh, price transparency is absolutely essential in terms of unveiling how high in variable prices are, so that we can target where there's low value care and high value care occurring in the health care system. Um, there might be some cases where consumers can shop in certain circumstances and actually find a lower cost service, but for the reasons that Doctor Wheely outlined, I agree, it is most useful for employers to negotiate a better deal for workers, um and for themselves as well as for researchers to help continue to study the markets.

So what would the next steps be if Congress were to enact transparency legislation?

I mean I think once once we hey first of all please enact the the transparency legis legislation it's desperately needed, um and as a as a number of bills are uh in discussion for today are also needed, and then we'd have to have a f- really serious conversation of how do we directly intervene,

Right. So so so just the what I'm trying to get at is just the transparency. It helps open it up and see better what's happening,

Correct.

but it doesn't necessarily in and of itself bring down prices.

Correct.

OK. Um, so, so, I look forward, uh, Madam Chair, to working with you and all of our colleagues, because I do think this first step is something that we can do. Um, but we need to be clear we need to go further, and I yield back.

Thank you. Uh, I recommend Yields back, and I now recognize the Chairman of the full committee, Representative Guthrie, for his five minutes.

Thank you. Uh, this is Mister Grimminger. Um, the price transparency rules that we have now been in effect for several years now and we've seen updates made over time to improve the usability of this data for consumers and employers. Can you give us an example of how employers in your organization have leveraged these tools to lower costs to our employees and how would codifying price transparency frameworks strengthen these requirements?

Thank you for the question, Mr. Chairman. Um, so we have um I'd point to it just a couple of quick things. First, uh, the Purchaser Business Group on Health, uh, uh, one of our members did a data demonstration project. where they married uh claims data that employers have access to with the price transparency data as provided through Turquoise, um and found that they were able to significantly better understand what they were paying understand what plan designs would make a difference in terms of their ability to lower costs what we've seen in the uh in the research that we've done in terms of researching with our employers employers that have better access to data both through the public uh publicly available price transparency data transparency and coverage rule et cetera um, and their own claims data, is they're more likely to engage in more innovative plan designs, including tiered networks, where you would say we're gonna try to drive people to lower cost, higher quality settings, uh, narrow networks where we're gonna say we're gonna exclude high cost or overpriced uh places, uh, working with centers of excellence. Codifying these rules I think will mean that providers will be more likely, first of all, to comply, we've seen not not full compliance,

Mm.

but also more likely to lean in on this as a real reality of the future.

Thanks. You know, and the things that we do here, and you know, Congress is trying to be, we wanna be, make it for the consumer, for the patient, to be friendly for them. And so there was a per particular provision where uh rebates go to the customer. That's why you say rebates go to the customer, cuz we want the benefit to go to the consumer. Well, there was a insurance comp insurance business that we had before us a few months back that created a ch group purchasing organization that was the customer. And so if you're gonna buy their insurance you have to join their group. Guess where the rebate went? To the group purchasing organization. And so what it seems to me is every time we try to really tackle it so the American people benefit it just seems to pop up somewhere else and the coverage is somewhere else and so that's what we're trying to get is make it transparent, so people can make informed decisions and uh like what my my friend from Colorado talked about with uh somebody out shopping for MRIs, you know most people get their health insurance through their employer.

Mm-hmm.

So if you're And so if if every individual went out and shop like that, that would be very, very beneficial, and wanna give them the information to be able to do that. But if employers shop like that, it would really make a big difference on our major, major employers who have lots of cover lives can, and when you talk to them, as well as first hand you'll talk to CEOs of the, you know, fortune fifty companies. A matter of fact, I think even Jamie Dimon, who's a a financial person, where had most sophisticated financial group around him, Tried to get a handle on the information on his, um, their employee's insurance and finally gave up, because they said we couldn't get to this, too opaque and and not clear.

Sure.

And I think it's that way for a reason. Then you have group purchasing organizations show up in Switzerland. That's where the money's going. That's what happened. And and so what do you, what do your employees need? They we we know that there are groups that buy pharmaceuticals at a discounted price and sell full price to employer plans. Uh, and and so what what do your employers need to say, we really s need to sit down and I talked to somebody in the automotive industry my family's automotive business I said, if we had a seven hundred percent mark-up on a product we sold you, what would you do? And they said we'd fire your buyer. Fire you'd fire a buyer and then tell us what what's the deal? What are you doing to get that kind of a mark-up? But there's some medicines that have that kind of a mark-up when you check the discounted price of what they're paying. What do you really need for your employers to be able to sit down with their insurance company and say I'm getting a bad deal.

Yeah, I think it, I mean, two things, particularly in the pharmaceutical side, but really also on the medical benefit. Um, having access to your own claims data so you know exactly what you're paying, not just what you should be paying, but literally what you have paid is extremely helpful cuz then you know whether or not you're getting a bad deal. You otherwise you're just sort of guessing. Um, and then you need competition, right? You need to have multiple choices so that you can change direction. If you have just one or two dominant hospital systems in an area or if you only just a couple of big PBMs that you're having to negotiate with, you may be just trading one bad deal for another bad deal.

Mm-hmm.

What really is gonna make a difference is employers actually having both the transparency and then greater competition to be able to shop.

There appeared to appear to be disruptors coming. I think the tr- the information in the in making it transparent means that they will come into the business place. But we have one uh uh in Ohio said you can go to any doctor that you want to, and here's the number we'll pay, and if you can get it cheaper you get the money. So the the the the patient has some skin in the game on it. On they get to keep money if they get it cheaper than what uh is listed but they can't get on the marketplace because they don't have a network.

Right.

And but the network is every doctor in Ohio, but that's not a sufficient network, and which is frustrating when we do things like that that that prevent people from being disruptors. And that's what we need, disruptor to bring lower price and better quality and better care, so I I'm when I say disruptors what I mean. Uh well you're back.

Gentleman yields back and I now recognize the ranking member of the full committee, Representative Palone.

Thank you Madam Chair. Um, about half of Americans have reported difficulty affording health care and too many families have to delay or forgo necessary care due to rising costs. Meanwhile, health care consolidation and private equity's increased role in our health care system is driving up the prices of health care services for families. So, I'm concerned about the growing influence of private equity and its impact on costs in patient care and health outcomes. I have three questions, so I'm gonna ask each person to maybe spend a minute or so on. in answering the question. Let me start with Doctor Whaley. In your testimony, you discussed how private equity firms have been driving consolidation. Could you briefly, in a minute or so, discuss how private equity arrangements can impact healthcare costs and patient access to care, if you will?

Sure, I I think there are two main ways. So the first is the uh roll-up s strategy, if you will, where your private equity slowly accumulates market power within a given market in a way that Each individual track transaction evades regulatory scrutiny, but cumulatively leaves the private equity company with lots of bargaining power that they can use to negotiate higher prices and we've seen in our own work that that leads to considerably higher prices. The second way is what happens to the firm that they acquire. And in many cases they either saddle the firm with bad debt, uh, eng engage what's often referred to as a sale-leaseback, or charge high and excessive management fees that allow the the private equity company to make money off the firm.

Alright, thank you. Then let me go to uh Miss Tripoli. Can you discuss the impact of private equity acquisitions on our overall health care system?

Absolutely. I mean, I think private equity by definition is incompatible with making sure that patients have health care they need at a price that they can afford. The whole business model is you come in, you buy up the competition, you s- cut off service lines so you get, you remove access to care. Um, you increase prices, you lay off workers, you you make the the business look

No, I appreciate that, and what you say certainly makes sense. There's a lot of evidence that

Mm-hmm. Mm-hmm. Mm-hmm.

private equities investments in healthcare result in price increases for families without and also reduce the quality of care but despite billions of dollars being invested into the healthcare system by these private equity firms the ownership arrangements remain totally opaque to patients and policymakers and regulators that's part of the problem so let me go back to doctor well you can you briefly uh elaborate why transparency in the ownership structure is important what kind of data elements would be helpful for hospitals in providing us a disclose regarding ownership. And this goes back to my thing is, you know, all for transparency, but if there's no competition, what's the point? But if you could answer that with regard to the data or some suggestions.

But most of these transactions are incredibly opaque, which makes it hard for researchers, policymakers, and patients to know who employs a given doctor. And I I think it's critical that we have transparency ar- around these efforts to actually make sure that we're monitoring these markets and ensuring competition and we've seen several examples of this at the state level where they actually require I think meaningful ownership disclosure.

No I I agree and I appreciate it I I just think that transparency is important, without transparent ownership data healthcare consolidation is gonna continue unchecked I mean you know in in my state we have basically two large systems now I mean a few others but there's not really you know the the competition is is not is not really there anymore in my opinion and given the impact of healthcare costs and patient outcomes I mean policy makers and regulators need a need a better visibility into the ownership structure and I support obviously efforts to to strengthen price transparency but we're not gonna be able to achieve it uh without ownership transparency I mean that's that's the key so thank you I appreciate uh the comments from both of you. I yield back. I'm a Mister Chair now.

Thank you, gentlemen yields back, and um appreciate my Vice-Chair taking over while I had to go to another committee where uh my vote was needed. Uh, so I do apologize to the uh witnesses and the members as well. There you go. Um, so now I'll begin my questioning. I yield to myself the five minutes that uh Uh, I am allotted. Um, let's try to get things straightened out, Ms. Geens, uh, for folks back home. Can you briefly explain how hospital prices are set with all the different insurance plans that individuals have and if these are the prices that the hospitals post?

Yeah, thank you for the question. A number of different ways, uh, through negotiated rates, uh, that may be straightforward dolly dollar values, something like a case rate or based on a specific fee schedule. And then you get into more nuanced options, maybe it's a percentage based on the claim specific total charge or a per diem rate, depending on the number of days the patient is in the hospital. Then there's additional exceptions for high acuity care, known as stop-loss or outlier clauses. All of these percentages of Medicare, you know, percentages of statewide fee schedules, any number of these, one, two, or all of them could exist in these payer-provider negotiated, right, uh, contracts. And so what you see in the files is both a list of the charges, but also those negotiated rates. So, you know, for a consumer, the ability to download that information and understand meaningfully what does that mean based on your own cost sharing amount is quite difficult. That's a high barrier to entry.

So there's not a standard price that each hospital insurance company plans start their negotiations from? Or is there a price they start from and then they negotiate from there?

Yeah, there's typically, particularly if the hospital is already in network with the

And you, I think you've already answered that it's d- that makes it all the different things that go on make it makes it difficult for hospitals to post these prices because of the variables. Is that accurate?

Most of them are posting the rates, and the challenge then for groups like us and and like Mister Grimminger shared is taking that information, which is accurate at that granular level, and then translating that into, so what does it mean for an employer who's looking for care? What does it mean for a patient who's looking for care? And that's where I think that translation layer of taking something that's inherently machine readable, and making it more consumer-friendly, particularly if the underlying data is accurate, which we're seeing, then we have a better chance of helping patients understand what it costs.

So what we need to do is get that that standard price out there so then people can have some idea. Now, I just have to bring this up and my team back here is rolling their eyes, cuz we've talked about it before. I pulled into the gas station uh at Rayfein, Virginia. There's about five or six of them. They have their price posted. But then There's a a touch screen. And when I pulled into the this week I chose the shell. They had one of the lowest prices. And and then they gave me like four or five different rewards programs I could be a part of. And I chose the Kroger program and got ten cents a gallon off. Can we can we not create something? I know the comp is more complicated than the four or five uh options that shell offered me uh as to, you know, uh their own program, the Kroger program that they're affiliated with or others, but can we not with, and you mentioned AI in your opening statement, can we not use AI so that me as the consumer who's not as familiar with uh purchasing something that I may need in the future, God forbid, a a knee transplant or knee replacement or something um i- can we not have it so that, you know, I plug in that I'm with Anthem, uh Blue Cross Blue Shield, Covicare, and have the price pop up so I can see what's going on?

Yeah, I mean, first and foremost, Kroger doesn't exist in South Carolina, so I'm I'm jealous that you had that discount at the gas station. But secondly, I think you're exactly right.

Well,

The

and they all have them, sheets and and uh circle K, I mean, I've got all kinds of memberships.

Um, uh, uh, yeah, and I think secondly to your point, the idea is the clinical complexity uh that goes into all these underlying different data points, tied to what is actually on a claim is not a level of information that a patient is going to have access to. You go to the gas station, you know which of the two types of gases you're gonna get, and then you get to pick a rewards program. So from our perspective, the onus is on the industry to create open license and more patient-friendly service packages so they can say, I need a knee replacement, I have anthem. That's what our consumer cost tools do, and not go through all the machinations of what are the specific codes behind that, um, and making the patients just end at just, I need a knee replacement, I have this insurance.

And my time is just about up, but don't you think AI can help us with that?

Absolutely, and

So we're right around the corner from being able to do this, so everybody can know what's going on. I have to yield back. I apologize, and I may have questions for the record. I now

Thank you.

uh now go to uh Doctor Ruiz for his five minutes of questioning.

Thank you, Mr. Chairman. Uh, the majority has called yet another hearing to present their ideas to lower costs for patients. Well, here's the thought. If you really want to make healthcare more affordable and more accessible for people, you don't cut a trillion dollars from Medicaid. You don't impose more red tape paperwork and make sick people jump through even more hoops. And you don't negligently let the premium subsidies people rely on to afford coverage expire. You just don't. The title of this hearing boasts, quote, lowering health care costs, unquote. But the nine bills under consideration today miss the mark. Transparency is greatly needed.

Are you ready?

But requiring hospitals and insurance companies to publicly display just how much patients are getting ripped off, isn't going to stop patients from being ripped off. In fact, competition thrives when there's a choice. And in a lot of healthcare systems, there is no choice. You have to go to the hospital that your insurance company requires you to, or see the doctors that they require you to. And as an emergency physician, I can tell you that when you're in an emergency, somewhere, you have no choice. You come into the emergency department, you get that MRI, that CAT scan. You're not choosing when they're trying to provide you that kind of emergency care. Publicly disclosing prices isn't going to keep safety net hospitals from shutting their doors because they can't afford the latest republican cuts, over six hundred billion dollars of decreased revenues to hospitals. More than four hundred rural hospitals across the country are at risk of closure now, including several in the congressional district I represent. So where's the choice when your only hospital in a rural area has closed? And now you have to drive even further during an emergency. Suddenly your risk of of permanent injury or death from stroke or heart attacks has skyrocketed. So we all agree that health care has become unaffordable and less accessible. But we need to dig deeper to address that growing problem, especially since it has been exacerbated by Republicans' fabricated health care crisis driven by that one big beautiful bill better known as the big ugly law mr. poli which would have a more direct impact on healthcare access and affordability making prices public or restoring aca enhanced premium tax credits for millions of americans

thank you for the question without question restoring the enhanced premium tax credits would bring affordability immediately to uh millions of americans who need uh Um, and also price transparency is critical as is ownership transparency because, in addition to providing uh out of pocket protection for protection for consumers, we also have to address the root drivers of why premiums are so high in the first place.

So, I again I liken this to the patient that comes into the emergency department with uh m- multi-organ failure and a rash, right? L- like let's say a diabetic coming in in a coma. You have to treat the emergency first. And the emergency is the ACA tax credits expiring and the near trillion dollar cuts to Medicaid. You have to deal with that. Otherwise, you're only dealing with the rash. Yeah, we have to deal with the rash at some point, but you have to save the patient's life first. OK? This hearing is about dealing with the rash and ignoring that the patient is dying. because of the crisis that they created. So again, Miss Tripoli, which would have a more direct impact on healthcare access and affordability? Making prices public or reversing the one trillion dollar Medicaid cuts?

We absolutely have to reverse the trillion dollars of cuts to healthcare, including the disproportionate impact it had uh has had and will continue to have on Medicaid at the same time we do need price transparency uh to address the root drivers of the affordability crisis.

So with the near one trillion dollar Medicaid cuts that's gonna lead with and the ACA tax credits expiring uh that's gonna leave fifteen million people uninsured. They're gonna be uncompensated care and we heard from insurance company CEOs in this hearing in this hearing room that the hospitals are gonna renegotiate their prices to cover the uncompensated care they're going to pay those prices and so they're going to and they already have increased premiums for everybody a yield back

German yields back now recognize the gentleman from ohio mister balderson for his five minutes of questioning

thank you mister chairman thank you all for being here this morning this afternoon uh my first question is for miss skeens uh thank you for being here As machine readable files for hospital and insurance pricing have continued to improve, can you give us an example of how your company has been able to leverage this more actionable data to improve market competition and help consumers and employers shop for care?

Thank you for the question. To your first part, that's right, we primarily see the accuracy of the data play out in the elimination of needing to go back and forth to verify what the correct rate is. when payers and providers are negotiating for a fair market value rate. From an employer perspective, alongside other data sets like claims data, it allows them to see the different scenarios that their specific employee group is high utilization and, you know, and essentially adding the ability to look at the price data, weigh it alongside quality data, and ensure that they are upholding their fiduciary responsibilities to providing that care. And then from a consumer perspective, uh I would touch just briefly on this this recent boon in the way patients are engaging with AI to ask what the cost of their care is. We've started to see that um feeding through for example with our work with New York City where the machine readable file data itself powers the prices that patients are receiving when they use our cost comparison tool, alongside the ability to input which insurance they have. so that they don't have to actually go through the files. They can see one rate, an accurate rate, and then with the understanding of their own cost sharing, see what it costs them. The idea is then that could scale. Uh, if that underlying data is accurate in AI uses, that patients will will have access.

OK, thank you. Uh, follow-up to that. As Congress looks to strengthen price transparency requirements, what concrete s- what concrete steps should we consider to improve the usability of this data?

Thank you for the question. There's a number of things that are currently not available in the data that we think are crucial for understanding the full cost of care. The first of that is either stop-loss or outlier reimbursement. Uh, this is, you know, upwards of a hundred billion dollars worth of cost every year for patients who are extremely sick or needing high acuity services. That's not currently a requirement in either the hospital or the payer machine readable files but particularly for employers. matters significantly for understanding how to best cover their employees. There's also a gap in drug coverage reporting that would be helpful to add, and then ensuring anything specifically tied to non-dollar value rates, so percentage-based reimbursement, algorithm-based reimbursement, we wanna make sure that however that is codified in the uh in in the rules that pass, that information is required, the calculus is required, so that we understand the dollar value of the rate.

Alright, thank you very much. Well done. Um, Mister Grimminger, uh, as Congress looks to ways to strengthen healthcare price transparency, can you explain how employers are already using this data? First question. For example, how are they using it to steer employees towards higher quality providers, pursue direct contracting arrangements, or build tiered provider networks, and what does that ultimately mean for the cost of their employers' care?

Thank you very much for your questions.

Yeah, that's a bunch of questions right there, but if you could be - Thank you.

Sure. Um, so, w- we've seen in uh the the research that we've done is we've surveyed employers that folks that have ax- better access to the data are in fact using it in meaningful ways so I'll give you one of the - one of the things you mentioned sort of steering toward higher c- uh quality lower cost providers if you are able to look at and - and really be able to digest and understand the data that we come out - that comes out of Turquoise you can see where just within your own insurance network, which hospitals are priced lower than maybe the ones that you currently have, or that you see most of your patients going to. Then you can direct patients using usually cost sharing changes to say instead of going to hospital X for your knee replacement, we wanna encourage you to go to hospital Y because we know that the negotiated prices are substantially lower. You can um look and say, wow we've seen a hospital that has really high quality and relatively low cost, let's see if we could create a center of excellence program. where we actually provide um, you know, meaningful direction for employees to go to that specific hospital to receive care. The end result uh is we are seeing lower overall trend for those uh imp- those uh those employers that are able to engage in those kinds of practices. But I also wanna be clear, that is sort of a a marginal one or two percent, you know, trend change off of some of the highest healthcare trend that we're seeing in the United States today. Um, these i- these changes are important, but in the end being able to make those things are still somewhat at the margins.

OK. Thank you very much, Mr. Chair, and I yield back.

Chairman yields back now to recognize the gentlelady from Michigan Ms. Dingell for her five minutes of questioning.

Thank thank you, Mr. Chair, and thanks to both you and ranking member Degat for holding this important hearing. Because health care t- cost transparency is really important. Patients are navigating an unreasonably complicated system and paying outrageous bills that don't seem to reflect the level of care they receive. Total health care spending and insurance premiums continue to increase at rates much faster than the economy. The rest of the economy. Families are then left to face impossible decisions between care and other household necessities. While patients struggle, major companies are buying up various entities in the health care supply chain, consolidating power, gaming our broken system, to inflate costs, deny care, and pad their bottom lines. You know that this is called vertical integration. Vertical integration allows companies to enrich themselves with taxpayer money, avail laws meant to hold companies accountable. I I've uh seen too many examples of this in recent months, and point blank vertical integration harms patients, taxpayers, and independent doctors and pharmacists, who cannot compete with massive consolidated companies. We need meaningful reforms to address this, not to have big plans and secret deals with drug companies that we've heard about recently all with few substantive details that explain how they will tangibly benefit patients. So, um, Miss Tripoli, let me start with you. In your testimony, You mentioned the need for greater transparency around health-related ownership information, which I agree with you. What gaps currently exist in oversight and reporting requirements for ownership across the healthcare industry, and how could stronger disclosure requirements improve accountability, patient care outcomes, and the cost for consumers?

Thank you so much for the question. I think by and large there is so much consolidation happening in in the system horizontal vertical integration as well, but it is essentially a giant black box. Um we actually don't we have very very little information into these smaller transactions that are not raising to the level where they would trigger uh trigger federal oversight and antitrust enforcement and laws. And so they're flying underneath the hood. Um they're I think uh Doctor Ippolito called them stealth stealth mergers and acquisitions which I love that term cause that's exactly what they are. So we actually need the the discussion draft that we that is um for today's hearing on ownership transparency. That is a piece of legislation that would help to break that wide open and give us very critical information about how these mergers and acquisitions are actually occurring, who owns the care, and then um we would have a much greater information at scale for federal and state regulators to actually intervene on these healthcare transactions.

Um, thank you. I just, I don't think people, I had a sister who was hospitalized and people don't understand that even the medical practices are being brought up by the hospital. and the ca- it's ju- it's impacting patient care. So, I would like to ask you, how does the lack of transparency surrounding ownership among all the entities impact the quality of patient care? Specifically, I mean, it is impa- I I can give you some examples, but I'd like you to give it to me.

Mm-hmm.

And how does it make it easier pro- for providers to jack up prices? And for some of these corporate s- entities to deny care or say you don't need it and for and how do patients dispute these decisions

absolutely i because it's a black box and because we don't actually have this information there's actually not a ton of oversight federal or at the state level oversight or regulation about these types of transactions to flag them and to to investigate them about whether there's gonna be a benefit to the community or whether it is in fact just going to increase prices and reduce access to care and in some cases as the case with private equity and venture backed capital backed uh purchases, the real estate that the facility is sitting is sitting on is more profitable than the business itself and so they close it down and they sell off, they can sell off the the property itself. So we need the transparency data so we can know what's happening under the hood, and then we can allow federal and state regulators to intervene and analyze what's happening in these markets, and address the very deep consolidation that's occurring and driving up the cost of care.

So I'm down to twenty eight seconds, so I'm gonna ask you and Roddy, and what more does Congress need to do to tackle the negative impacts? But not only when you when cap, private capital are taking over, they are telling how long a doctor can spend time with, they're telling whether they can give them further care, they are making medical decisions. And people do not know that it's venture capitalists that are making medical decisions. Thank you, thank you for your work on this, and I yield back, Mister Chair.

Appreciate the gentlelady yielding back, and now recognize Doctor Marinette Miller-Meeks for her five minutes.

Uh, thank you very much, Mister Chairman, for holding this extremely important hearing, and I wanna thank our witnesses for being here today. Health care costs continue to place significant financial strain on American families, employers and taxpayers. It's why I introduced and the House passed the Lower Health Care Premiums for All Americas Act to address these issues, and why one of the bills we're considering is Lower Costs, More Transparency Act of twenty twenty six, which this committee has previously passed. While patients are often encouraged to shop for care and make informed decisions, too many still lack access to clear, timely and usable information about the cost of services. I look forward to discussing these proposals that aim to improve transparency across the health care system and strengthen accountability for providers and insurers and most importantly empower consumers with the information they need to make informed choices. Doctor Ippolito, did the unaffordable care act or Obamacare hasten and promote consolidation and vertical integration that my colleague just mentioned.

Um, I think it probably weakly encouraged it through things like uh coordinated care and the emphasis on that that was seen at that time as as beneficial for coordinating and improving proving outcomes.

Hospital outpatient departments, did that increase cost of care? I mean, there were many of us who predicted that this would occur, and it's occurred in an accelerated pace and rate. Uh, Doctor Whaley and Doctor Grimminger, um, you each noted how employers can leverage price data along with their own claims data to ultimately make healthcare costs more affordable for their employers. Should employers have access to um covered employees' claims data to uh help employers to better negotiate premiums uh from insurance companies?

Absolutely, and it's necessary for them to be responsible for douche areas.

And how um how have you seen employers shift care to lower cost settings or providers using price transparency data?

I provide several examples of my testimony. Uh, one example comes from the thirty two b j health fund, which used their own data to recognize that a single provider was charging prices that were excessive and they used their own data to exclude that provider from their network saving their plan over a hundred million dollars.

And Mister Grimminger.

Um, the example that uh that Doctor Whaley provided is an excellent one. Uh, we've seen smaller employers uh do similar things. There's a belief sometimes that only large employers have sort of market um, you know, are being able to be market movers. But we found that in uh smaller locations we've even seen employers engage in sort of tiered pricing strategies, in which you'll say with keeping the open network, saying we found that this hospital is overpriced in this particular service, and we're gonna use a tiered copay to try to drive people to a lower cost setting that's equally high quality.

Uh, Miss Gaines says price transparency, data usability, and machine readable files improve. How can innovators leverage artificial intelligence or I'd prefer to call it augmented intelligence to help consumers or employers find insights from this data to lower their healthcare costs.

Thank you for the question. I think it's about meeting consumers where they are, which is understanding a data set that's machine readable is inherently not where consumers are going to find the answers to their questions. So can we take it a step further and bundle all of the known clinical uh policies, procedures, code sets that flow into the data in the machine readable files, and create open license bundled service packages, whereby a patient can say, I need an MRI, and then they can get accurate pricing data flowing into the conversation they're having with whatever AI agent of their choosing.

Mr. Grimmier, as a physician I've seen firsthand, my archenemesis, the challenges prior authorizations can create throughout our insurance companies, be they private or public. And today we're considering discussion drafts that would require commercial health plans to provide greater transparency,

Uh, so first I'll just say we very much uh support the discussion gra- uh draft. You know, I think the employer pers- perspective on um on prior authorization utilization management is a nuanced one, right? Um, we have seen too often where uh physicians may inadvertently or potentially intentionally prescribe drugs that are higher priced than what's otherwise necessary pers- or uh, try to do uh services that are unnecessary and may actually be harmful to patients. That's a rarity, but we think it's important that there is actually an opportunity to say, timeout, let's look at something else. That being said, we do believe that the significant use of Prioroth is often simply to just delay care, create float for the insurance plan, uh, and then ultimately they're gonna ninety percent of the time say yes. understanding how often Prior Auth is being used, not just by the carriers that we may be contracted with, but by other carriers will then provide more information for employers to say, you know, I don't like the way that we're doing it internally, we found there's this other carrier over here, we have their data, we wanna shift to them because we think that they're doing this better.

A- and or claims denial, I'll add that in as well. Uh, thank you very much, I yield back.

Gentlelady yields back, I now recognize uh, gentlelady from California, Miss Baragon, for her five minutes.

Uh uh thank you, Mr. Chairman. I think uh this is a an important hearing and I appreciate that we're doing it today. Um, Miss Tripoli, do you think um it's important for patients to have timely and accurate access to information about their own health and medical records?

Absolutely, I think one of the challenges right now in the healthcare system is that the data doesn't follow the patient. So you show up in the MedStar hospital system and your data sits there, but if you see a primary care doctor at the GW facility a couple weeks later, your data is in two different places and so it makes it much more difficult for the providers to coordinate your care and make sure that they can meet your health needs.

Do you think there's any connection or tie to that and um a cost of of healthcare or transparency?

I think in general there's absolutely a need for for a there are a lot of different areas in the healthcare system where we need greater transparency over prices, over ownership data. We also do need a lot more work on sort of the back-end complexity of the system, um making sure that there's uh data sharing across providers, interoperability standards so the data can flow, with p- patient privacy protections of course. Um, all of those tools together help to streamline and improve the experience of the healthcare a co- health care system for the American people, lower healthcare costs, make sure they can get the care that they need.

Do you have any idea why a um why somebody w- like a doctor or um a a a provider would not want to provide timely access to a a patient their health healthcare file in the notes?

uh uh off the top of my head i'm not sure uh what i do know is that there are data vendors that block data from flowing to providers that is a business practice that's a huge problem in in terms of data access um my understanding and experience is by and large providers wanna be able to uh leverage the data about their patient population to to to deliver the the care that they need um but there might be other

Mm.

So, the reason I'm asking is, um, it's, it, I had an experience recently where, um, I was trying to, uh, uh, get access to my mother's hospice, uh, file, her, her medical records, uh, to consider whether to, um, move her to another hospice program. But for whatever reason, I was told that it would take a long time if I wanted to get her medical file, but if I transferred her, the other company that would take over could get her immediately. And, um, I've heard some some theories on why that's the case. Um, and, you know, this c- this company called Compasses, um, I wouldn't say has a stellar record, Um, but does anybody here wanna opine on why - why that may be the case, that it's hard for a patient to get their medical file?

I mean, the one thing, and then of course other pan- witnesses should respond too, but I think the one thing of course is if the patient stays in that practice, that is volume that they can then bill for. So I think there is an infat- financial incentive to keep patients with the providers that they're seeing. Um, and there are hurdles in terms of getting, uh, providers to share data. Th- some of that is the complexity of the system in itself.

Uh, do you think that Congress should pass legislation to ensure that all Americans have access to their comprehensive digital health records in real time?

Absolutely.

Well, thank you. This this is National Health Data Week, and it's a week of action focused on demonstrating the power of health data to drive positive outcomes for patients as the owners um of their health care information. Patients, I think, should have access, timely access to their medical records and and any notes about And without unnecessary administrative or financial burdens, I can tell you I was shocked when I had heard about, oh, well we got to go through legal and this and that. But if I give it to another hospice company right away, they can get it uh right away. Miss Tripoli, I wanna um ask you, uh it's been touched upon a little bit, um in your testimony you point out that colonoscopy can range at the University of Mississippi Medical Center from seven hundred and eighty-two dollars to two thousand one hundred and forty-four dollars depending on insurance and I recently heard a story about a colonoscopy procedure that was affected by differences in reimbursement across care settings. Why is it that patients sometimes pay almost three times as much for the same procedure? And how would greater price transparency help families avoid these unnecessary cost?

Absolutely. I mean, the biggest predictor is consolidation. These prices are set based on who has more, which institution has more market power, the hospital system or their insurer. And the reality is that the vast majority of hospital markets are highly consolidated. Um, and so that is the a major reason why we're seeing not only the prices are so high, but we see for a single service like a colonoscopy or a knee surgery, incredible variation across the country, across the state, within a particular plan.

Great. Thank you. I yield back.

Jen Lee yields back. I now recognize the gentleman from Pennsylvania, Mister Joyce, and and if you would take an, we're gonna give you an extra fifteen to thirty seconds to talk about sunscreen for a quick second.

Well, thank you, Mr. Chairman, and thank you to this committee. I am pleased to report that the FDA's approval of Benzotrinazole, the first new sunscreen ingredient in over twenty years in America. This came out of this committee in with bipartisan support. Mr. Chairman, it shows what we can do when we work together, and I'm proud as a board-certified dermatologist to report how important new sunscreens are in preventing skin cancers. Something that we've seen over the last decades, the rise in sins in in skin cancers in young individuals. Talking about working together, I would like to continue uh for talking about what we're doing and we're doing together with increasing transparency in health care. For far too long, patients and purchasers of insurance products have been kept in the dark about the true cost of medical care. While we have made important strides both administratively, through legislation and passed in this committee, we know that much more needs to be done. In November of twenty nineteen, HHS issued rulemaking that requires hospitals to publish prices as of January, twenty twenty one. Hospitals are required to publish a machine readable file of five types of standard charges for all items and services. They are also required to create a consumer-friendly shoppable list of three hundred items and services, including seventy identified by CMS. While I am pleased to see data from my home state of Pennsylvania indicates that over ninety percent of Pennsylvania hospitals are in compliance with key components to these roles a November twenty twenty-four report issued by HHS estimated that forty-six percent of all eligible US hospitals were not complying with the HPT role requirements. Less than fifty percent? That's unacceptable. I was further concerned to see the announcement from Secretary Kennedy and Administrator Oz that there are over five hundred hospitals still out of compliance. Mister Whaley, do you feel that the current transparency requirements are f- sufficient and being adequately enforced to give patients an accurate view to enable them to shop effectively for care when possible?

I think they are good start, but not sufficient, and as you noted, not being sufficiently enforced.

Miss Tripoli, do you concur with that assessment? It's not an adequate amount. Do you agree?

Absolutely. It's why we need the codification of the legislation being considered today.

And I think that is important legislation, again, that we can consider and implement in a bipartisan fashion. Miss Tripoli, you also cited hospital consolidation of independent physician practices as a key driver of increasing healthcare costs. Would you view policies that incentivize independent practices as an important safeguard against the rising healthcare costs that we continue to see throughout America?

I think absolutely we want to address that uh incentive for big systems to buy up physician practices the best policy solution to address that is to advance this comprehensive site neutral payment policy.

Mister Whaley, in your testimony you described physician-owned hospitals showing a substantial reduction in outpatient costs, when compared to their non-physician owned counterparts. Would repealing the prohibition of physician owned hospitals be a good initial step to stop that rising cost?

I think it would be a good step to improve affordability and add competition.

Finally, I am pleased to see provisions of the seniors timely access to care act surrounding prior authorization denial rates included in this hearing today. While I urge passage of this critical legislation overall, Mister Ipp- Mister Ippolito, can you elaborate on why public disclosure of denial rates is a benefit to the American patient?

Sure. I mean, uh, surveys have shown clearly people care a lot about denial rates, they care a lot about prior authorization rates, yet they can't really observe that. So it would be a natural uh feature to make clear to patients when they actually choose a plan, so they can tell us how much are they willing to pay to have less denials, less prior authorization.

When you have the input from the patient, does that allow you to provide better coverage, better insight, and better education of the patient of what policies cover?

Well sure, as a first-order thing, it tells the insurance companies how to design plans that people actually want. And that strikes me as a first-order uh importance.

I think that first order of importance, that message is not lost on us here today in the committee. Mister Chairman, I thank you for the additional time and I yield back.

Chairman yields back, now recognized. Miss Kelly of Illinois for her five minutes of questioning.

Thank you, Chair Griffith, and Ranking Member DeGette for holding today's hearing, lowering health care costs and improving health care access for all Americans is something everyone excuse me, should be able to get behind. Yet this administration has been misleading the public about their work to make health care less accessible and more expensive. A great example is passing the one big ugly bill, taking away one trillion nearly one trillion in funding from Medicaid under the false narrative of fraud, waste and abuse. Doctor Whaley, for a family way in which they get an MRI or lifesaving procedure, for example, the current price transparency posting can be difficult to navigate and understand what the out of costs will be what policies would you recommend to close that gap?

I as I highlight my testimony, it's important to not just think of price transparency as a way to inform patients' making decisions, but actually how networks are designed and choices are made upstream of the patient. So the patients say insurance plan or employer can actually exclude high-priced and low-quality providers from the network.

Thank you. Miss Tripoli, my district encompasses urban, suburban, and rural communities, and we are seeing significant financial strain on rural critical access hospitals and a loss of services in these areas. How might hospital and physician pricing transparency reforms

I think price transparency, uh, when we get it right, is a benefit to consumers across the country, including, uh, rural residents, uh, living in your district. Um, and I think will pr- provide a great value. I think, uh, rural hospitals should be able to comply, many of them are. Um, and I think the - the - the main question here is like if - if these hospitals can generate a bill and send it to a patient then they should be able to, tell us what the price is before the patient gets the care.

Hmm.

And I was just saying this to someone um that I had, it wasn't a rural hospital but a procedure and I didn't realize until I went there and they said oh oh you owe this amount of money, right before right before I had the procedure. So uh yeah I was I was quite shocked. But thank you um to the witnesses and for being here, but in order to improve the lives and health of all Americans, we need to build on the bipartisan work we've accomplished with the No Surprises Act and the previous

General Lady yields back, and now I'll recognize the gentleman from Michigan, Mister James, for his five minutes of questioning.

Well, thank you, Mister Chairman. I appreciate you holding this hearing today and a special thank you to our hard-working staff uh working on uh on getting this to uh a position where we give it to the people, getting a hearing today. Um, Congress is not doing enough to lower the cost of health care. We can help people save money by passing my bipartisan and bicameral patients deserve price tags legislation. The idea behind this legislation is simple. It will make it easier for patients to price compare when getting medical treatment, so they can pick the lowest cost option, just like they do in every other aspect of their lives. People drive out of their way to fill up on cheaper gas. They check different websites for the best price before making an online purchase. They price compare before buying a flight. They get an estimate before making house repairs. So why can't the people price compare before getting a medical procedure? Because it's too hard. The people are forced to blindly pay whatever it costs because hospital prices are confusing and hard to find. The system is too complicated by design. It's a confusopoly. As a result, patients end up paying hundreds of thousands of dollars more for the exact same services and the same level of care with the same billing codes. Patients Deserved Price Tax was part of a bipartisan, lower-cost, more transparency legislation the House approved last term. It's not controversial. It passed the committee under suspension. The ranking members supported it, and then passed the House three twenty to seventy-one. But the Senate, under Chuck Schumer, let the bill die. This term, Senators Marshall and Hickenlooper are working on an identical version of this bill. They have ten Democrats and ten Republican senators as cosponsors. That's one fifth of the entire Senate already on board. In twenty twenty five, President Trump issued an executive order to make America healthy again, which included an April one deadline for health care providers to comply with existing but unenforced price transparency laws. Yesterday, HHS Secretary Kennedy announced that the grace period had ended and that the Trump administration is enforcing hospital price transparency. I applaud that leadership from the President and from the Secretary, and I applaud that action. My Patients Deserved Price Tax bill will make that change permanent and provide stronger enforcement for that mechanism for the American people. The Senate has members from both parties on board. My bill has members of both parties on board. The White House supports this. HHS and RFK Junior support this. Passing this bill again in the House should be a no-brainer. We can and we must get this done for the American people. The great health care plan that President Trump put out in January has four main tenants. Lower drug prices, lower premiums, hold big insurance companies accountable, and maximize price transparency. My price transparency act, again, is bipartisan and bicameral. This legislation bolsters each of those pillars. Patients deserve price tags with lower health care costs by requiring hospitals to clearly label prices so that patients can make informed decisions about where they get treated to save money and increase quality of care. I urge the committee to pass this popular, bipartisan, bicameral bill that will lower health care costs for everyone. Thank you all for being here today. My first question is for Ms. Tripoli. From the patient perspective, what happens to a working family that cannot see the price of their care prior to perce- perceiving it? How does this opacity feed the medical debt crisis that's affecting an estimated one hundred million Americans?

In my oral testimony and in my written testimony, I shared some examples of consumers who have serious medical conditions, are living paycheck to paycheck, and um needed the opportunity to to shop around for certain services, and basically find a dead, found a dead end. They talked to insurers, to doctors, they talked to everybody and no one could tell them how much something would cost. The result for Jessica, one of the story uh storytellers that we share her story of, is that she had to delay her care for months, maybe even years before she was actually able to get the service, all because she couldn't find the price.

That's unacceptable. We have a sick care cartel problem in the country, and we have to tear down the sick care cartels. to make sure that we are fighting for the people. I'm excited uh for the support and momentum behind this bill, and I'm looking forward to be getting this across the finish line. Again, Mister Chairman, thank you for your leadership on this matter. I yield.

Gentleman yields back. Now recognize the gentlelady from Washington, Doctor Shire.

Thank you, Mister Chairman. Uh, thank you, ranking member DeGette, and thank you to our witnesses for being here today. I have a constituent named Lawrence. Uh he's from Granite Falls, Washington, which is a rural town in my district. He and his wife are super studious and diligent, and when they qualified for Medicare they did their homework and they reviewed all the plans available to make sure that they would find the best one, with the coverage that they needed. And they settled on a Humana Medicare Advantage plan, and eventually found a medical home uh at a clinic forty minutes away. That's just when you live in a rural area, that's how far away it is. And Lawrence's doctor's clinic is owned by Optum, which is a subsidiary of uh United Health Group. Last year, Optum announced that it would no longer be in network with Humana starting January first of this year so Lawrence would not be able to see his doctor. Um, faced with having to either find a new provider or um or find new insurance, he ended up having to switch to a United Medicare Advantage plan to just

i think that's a clear concern of the payvider type model, where a insurer, in particular a medicare advantage insurer,

particular

Medicare advantage insurer can acquire can acquire a physician practice and essentially say to that physician, you can only treat my patients. And so if you're a patient on, say, a rival insurance plan, then you either have to change your doctor or lose access to your care, or switch to a plan which maybe is more expensive.

And so this behemoth just k- keeps growing. Like, it's already a monopoly and it becomes more of a monopoly. Um, United Health Group CEO, Steven Hemsley, when he came before this committee, Uh, he told us that United's vertical integration, the ownership of the clinics, the doctors, the pharmacy benefit managers, the pharmacy, he told us that it drives down prices. Is that true?

We've seen no evidence that that's the case.

Nobody else has seen evidence of that either. Thank you. This is a gigantic problem with our healthcare system. Um, United Health Group is the poster child, uh, is a company with more than four hundred billion dollars in annual revenue. It owns one in ten physicians in this country. Uh, it is a the company that is the poster child, the biggest abuser of prior authorization that delays or denies care, frankly, as part of its business model. And this company is gobbling up the health care system and jacking up prices for all of us. Um, not only can they force beneficiaries into their own plans, they also get paid based on how sick they say a patient is, and they purposely make patients look sicker in order to pad their pockets even further. Uh and um it's a lot easier to exaggerate uh how sick somebody is if you own the doctor and the medical record system and the way that a problem list is generated, and add sometimes meaningless diagnoses that just sound really bad. Um research shows that patients are labeled as sicker when the insurance company also owns the provider. Um, this is the definition of a monopoly and market manipulation, and this is what consolidation looks like. It's a huge part of what is driving up cost for patients. Um, my constituents are sick of it. I'm sick of it. Uh, I think I can speak for every doctor in Congress who's sick of it. Um, and and this committee needs to take even bolder and more meaningful steps to to stop this. So, um, Mr. Whaley and Ms. Tripoli, um, why is transparent ownership reporting important for health care entities and what should this committee be doing to go further to break up united health and other health care monopolies

So for the example you raised, it's very likely that the patient in your district has no idea that their uh doctor had been acquired by an insurance company and likewise the state of Washington probably didn't know and Medicare through CMS also probably didn't know and so if we are going to design policies to address this type of consolidation we need to know actually who owns any any individual doctor.

Start with transparency and knowledge. Miss Tripoli.

I would just add that one of the things we're also seeing in these vertically integrated plans and and UnitedHealth is a perfect example, is that they're actually financially like offering bonuses to their providers to upcode to make their patients' peer a peer sicker and there's documentation and evidence of that and in these vertical uh this vertical integration they're also able to uh pay above market rates their provider to the parent entities and k the delta so that they can actually appear on paper that they're meeting medical loss ratio requirements. But in fact, they're actually um subverting the federal requirement and um and and putting those to profits instead of to patient care. So I think some of the legislation for consideration today, strengthening encounter data, more transparency over medical loss ratio requirements and how plans in the MA program are spending their premium dollars, all incredibly tools to help us understand what's happening is the effects of consolidation for better intervene uh intervention.

And that insistence that consumer dollars be spent on health care has been absolutely abused and perverted by insurance companies who are now controlling doctors. Thank you. I I yield back.

Jenelada yields back. Now recognize Jenelada from Florida, Miss Kamink for her five minutes.

Well, thank you, Mr. Chairman. Thank you to our witnesses for appearing before us here today. I think we're all on the same page, which is rare in Congress. Both Republicans and Democrats, we all agree, the system's broken. So I think that's a great starting place for all of us here today. Because I think we all agree that patients deserve to know what health care costs are before they receive care, not weeks later, not when the bill arrives. And of course over the last several years, Congress and multiple administrations have enacted transparency requirements intended to give patients, employers, and policymakers a clear picture of those costs. Yet every day, Americans, heck, colleagues on this panel here, we've all talked about this, We still struggle to understand the prices, the coverage, and ultimately what we will owe for any procedure. Transparency, however, should not be the end goal. It's a part of it, yes, but the goal should be a more affordable, competitive, and accountable health care system, not a sick care system. As we consider additional transparency policies today, I am very interested in whether the information being disclosed is actually useful to patients and employers and whether it helps identify the drivers of rising health care costs and if it can empower consumers to make better decisions without adding unnecessary burdens that increase costs elsewhere. So, we're gonna do a quick round robin down the panel, starting with the first question, and I'm gonna ask you to be super brief, and just give the name of the bill, of all the proposals before us today that have been listed, which one is most likely to lower costs for patients and employers rather than simply produce more data? And I'll start with you, Miss Tripoli.

uh, Patience Deserves, Price Tags, and Ownership Transparency. Good deal.

The Patience Deserve, Price Tags Act.

Excellent.

I'll take ownership transparency.

Okay.

The the Patience Deserve, Price Tags Act, and in particular section seven.

Okay, excellent. Patience Deserve, Price Tags, Act, specifically the element around algorithm and percentage-based reporting in machine readable files. Excellent. You guys did so good on that one. Thank you. All right, second question. Round the panel again.

Congress has enacted hospital transparency requirements, insure insure transparency requirements, and transparency in coverage rules. Yet, health care costs, they continue to rise. So from your perspective, what is the single biggest reason that transparency has not translated into greater affordability for patients and employers?

Transparency alone is not gonna bring down prices, you also need to target

high hospital prices, high drug prices.

Excellent.

Employers and purchasers need access to their own claims data.

Uh, we have heavily subsidized purchasers buying in very consolidated markets.

Mm-hmm.

A market consolidation in anti-competitive practices by providers and health plans.

Yep. There's a missing but necessary translation layer to take the data from those machine readable files and get them into a more usable palatable format for

uh consumers and employers. Mm. I have something for the record that I'm gonna submit on that, so hang on to that, but again we're down the panel one more time. So, do we have an information problem or do we have an accountability problem?

We have both.

Okay.

I I agree there's both.

Both, okay.

Yep.

Yeah, both.

Both?

Sadly, I agree.

Both, okay. The whole system sucks, got it. Now, what information, since you all answered both, is missing that would help negotiate better prices.

Fundamentally, the negotiated rates, the actual price of healthcare is the most important piece of information to unveil for us to know how to better regulate.

Okay.

Employers and purchasers need to have data that on prices that are negotiated on their behalf and be held accountable for those prices.

Good.

Yeah, the most important is that employers who are the real decision makers in that market have to have the information they need.

Good.

As a guy representing employers, I agree. We need access to claims data. But we do need to be able to go further because we actually have to be

Yep.

purchasing in a competitive marketplace, which we don't have today.

Yep. I think there's a focus on the few data elements that are currently missing, that need to be codified. So stop-loss and outlier reporting, we haven't mentioned it briefly, but non-hospital entities should also be required to post their rates, uh, drug prescription rates as well, and then self-pay cash prices for those non-hospital entities.

Excellent. And you gave me the perfect segue. In my remaining thirty seconds, I wanna talk about the medical loss ratio. If consumers are paying rate premiums, most of the money should be going towards patient care. That would be common sense. We know common sense is not common, particularly on Capitol Hill. But as insurers have vertically integrated and acquired PPMs, pharmacies, provider groups, and other entities throughout the health care system, concerns have been raised that companies can satisfy the medical loss ratio requirements on paper while moving money within the same corporate family. So again, down the panel. Do consumers today have enough transparency to know whether their premium dollars are funding care or simply being transferred between affiliated entities? Yes, no.

Enough information? No, there's not enough.

No.

No, consumers, no.

Not at all.

Mm.

Consumers, no. Hot damn, we got it through.

General.

All right, Mr. Chairman, I yield back.

General, he yields back.

General, he yields back, now recognize General, Lady of Massachusetts, Miss Trahan for her five minutes.

Thank you, Mr. Chairman. A little over two years ago, Stewart Healthcare declared bankruptcy. Uh, Stewart was the largest private for-profit uh hospital chain in the country. When it collapsed, it was over a billion dollars in debt. Meanwhile, Stewart executives walked away with hundreds of millions of dollars, and left communities holding the bag. Hospitals closed overnight. Patients were turned away. In the district that I represent, Neshoba Valley Medical Center closed, eliminating nearly five hundred jobs and leaving a healthcare vacuum. Emergency transport times. from an average of twelve minutes to nearly a half an hour. Looking back, it's clear that this wasn't bad luck. It was the predictable result of a business model designed to extract value, not deliver care, and regulators who didn't have the tools to see it coming. Doctor Whaley, why was it so difficult for regulators to identify these risks sooner?

I I think in the case of Stewart specifically, regulators in the state of Massachusetts really had no idea until it was too late, until uh the hospital is already under distress. And so if they knew about the agreement prior, they could have potentially regulated the tran- the transaction. And we've seen similar lessons in other states where they're actually trying to get ahead of what might be the next steward.

Thank you. I mean, following up on that, ownership transparency is important, um, but only if we're connecting it to the real impacts that it has on patients. Doctor Whaley, briefly, would the transparency measures we're discussing help researchers and policymakers better link ownership models to patient outcomes, higher prices, and hospital closures.

Absolutely.

It's been two years since Stuart's collapse, and it's long overdue that we give regulators the tools to identify risks before communities lose essential health care providers. But the thing is, transparency can only take us so far.

There are a variety of factors, but I think uh obviously the financial status of the hospital, uh the volume of services that they're seeing, um the payor mix are all factors, and I would just say this business practice in itself that you're referring to, right, as these are small transactions that are happening, the whole purpose of private equity in this case, their whole business model is to target vulnerable hospitals, um and to target as many of them as they possible in the region so they can get the market control um and you know for short term profit increasing the bad debt for those

Mm-hmm.

so for those hospitals so it is incompatible with making sure that you're keeping access to care um that the patients can afford in their communities.

yeah it sounds like exactly the conditions the democrats on this committee were sounding the alarm about as republicans passed the big ugly bill the largest cut to healthcare spending in history followed up by refusing to extend the a. c. a. tax credits that families need to keep their healthcare coverage in massachusetts over twenty seven thousand people have already dropped coverage through the health connector because they simply can't afford their premiums. And as coverage losses grow, hospitals face more uncompensated care while also absorbing substantial funding reductions. All that adds up to a massive destabilization of hospitals, especially safety net hospitals with the most strained margins, and they're already starting to feel the pressure. Um, Miss Tripoli, are you concerned that the massive cuts facing hospitals right now are creating the conditions for more

i think the the hospitals that are most vulnerable financially vulnerable uh are these independent particularly rural independent hospitals those that are not associated or affiliated with these big systems and so they have smaller financial

yeah

margins and so when a cut happens or a change happens they are not able to absorb the impact as well as these big systems so those institute the those rural independence independent hospitals are financially vulnerable right now.

yeah so transparency is an is an important step i'll let's be honest, but what's keeping my constituents up at night isn't who owns the hospital, it's whether the care is going to be there when they need it. And it's whether their next prescription, premium, or copay is going to break the bank. So, I'm all for giving regulators more line of sight into health care ownership and more tools to protect patients. But we can't lose sight of the immediate challenge, which is ensuring that hospitals remain financially stable and that patients can afford care in the first place. So thank you for your testimony and I yield back.

Gently yields back. Now recognize the gentleman from New York, Mister Langworthy, for his five minutes.

Thank you very much, Mister Chairman, and I want to thank the committee for including my legislation, HR nine one one seven, the clear health care expense cost knowledge or check act as part of today's discussion. The check act is designed to lift the veil of secrecy surrounding health care costs, giving patients clearer information, bringing hidden costs out into the open. in creating better accountability throughout the system. In every other part of our economy, consumers can see prices before making a purchase. When you go to a restaurant, you get a menu, there's prices on it. When you walk through a grocery store, there's prices on every shelf. Health care should be no different. There should not be a surprise when you get a letter in the mail a month later. Uh, but with that, uh, Miss Tripoli, for the average patient trying to navigate the health care system today, what information is most often missing when they're trying to understand the cost of their care?

Um, I think just that, the cost of their care, their out-of-pocket costs. Like, what are they actually paying out-of-pocket? Um, as well as other information about what is the type of care that I'm gonna get, from this plan, when I'm selecting a plan. What are their prior authorization care denial rates? What's the quality of care that I'm gonna get? Can I see the production that I'm currently seeing? I think those are all very challenging data points for consumers to have, um, as they navigate the healthcare system.

Thank you. Too often patients open a bill and they're left with way more questions than answers. And one of the goals of the check act is to ensure that patients receive clear explanations of benefits in itemized medical bills so that they can better understand what they're actually being charged for, uh what their insurance actually covered, and what they owe. Uh, Miss Tripoli, how important is that type of transparency for patients trying to make informed decisions about their care and their finances?

Very important. Having an itemized bill on the back-end, patients uh to to double check right with their eob and what they've been what they're being charged so it is an important tool that consumers can use um but i would say that that in and of itself is not gonna be sufficient we still need broader price transparency across the system unveil prices overall and to bring down um healthcare costs uh by uh uh directly addressing the root drivers of what's driving at premiums in the first place

uh thank you and i think that's exactly why this matters when when prices remain hidden throughout the system no matter which leg of the stool within our healthcare system they are, it becomes much harder to understand who is being paid for what services and at what costs and when healthcare costs go up every part of the system seems to blame a different leg of the stool and hospitals they point to insurers insurers point to hospitals pbms point to manufacturers manufacturers point right back to the pbms and and maybe everybody's right maybe everyone is right and maybe they're all wrong but the only way to know is for everyone to if no one can follow the money no one can figure out why the cost are skyrocketing to the level they are mister mister grebinger the check act includes enforcement provisions intended to help ensure compliance with transparency requirements and provide employers and health plans with access to information that they are entitled to receive from your perspective have existing transparency requirements been consistently enforced and how important is enforcement in ensuring that those requirements produce actually meaningful results.

Um, thank you for the question. Unfortunately, I think they have not been consistently enforced. Um, as we've seen, only a couple dozen hospitals have been uh had had pen- penalties against them for non-compliance with uh with the hospital price transparency rule I understand President Trump uh just suggested that they would uh define up to five hundred hospitals for lack of compliance. We think that stronger enforcement is necessary and we very strongly endorse

uh legislation to codify uh these rules and increase enforcement action.

Well thank you very much and I appreciate uh all of the witnesses' testimony here today and for this discussion and I wanna thank the committee for including my legislation the check act as part of today's hearing and with that, I will yield back.

Gentleman yields back, now I recognize the gentleman from Texas, Mister Vesey, for his five minutes of questioning.

Thank you, Mister Chairman, uh I'm really glad that we're here today to talk about something that I think everyone fields that we should be discussing, and that's health care transparency. I know that everyone wants to know why we have to pay so much money for our health care. Uh, and one thing that I can tell you for sure, uh, as much as we already pay for health care in this country, those costs are all are going to go up. Uh, as we all know, last year, Republicans, uh, gutted nearly one trillion dollars, uh, out of the American health care system. Uh, and no matter what insurance you have, where you live, or who you are, we're all going to pay the costs for that. uh because the money has to be made up somewhere and hospitals, particularly rural hospitals and safety net hospitals and providers, they're all going to bear the greatest brunt of those cuts. Uh gutting a trillion dollars out of our health care systems means that hospitals have to figure out how they're going to absorb those levels of uncompensated care, tighter margins, uh growing financial pressure. And that's really where private equity comes into the conversation. Uh over the last two decades, private equity or PE Uh, they've invested, um, roughly five billion in two thousand dollars to more than one hundred billion dollars in two thousand and twenty-four. And I wanna, uh, explain a second uh, uh, I just really wanna take a quick second to explain exactly what private equity is. These are the PE firms, our investment partnerships that buy companies and they restructure them to increase revenue and then sell them for a profit. And usually it's between, uh, three to seven years. And this business model is centered on maximizing returns for investors. And I want to be clear, uh, it's not always black and white. P E firms can provide capital to circling hospitals, improve operations, manage administrative functions, and in some cases help avoid closure for these facilities. If the choice is a hospital shutting its doors or someone stepping in to keep it operating, hospitals are going to make the decision they believe keeps care available in their community. Uh, that math is not hard to understand. Uh, but we also can't ignore what the evidence tells us. Uh, studies consistently show that private equity ownership in health care means higher prices, it means reduced staffing, it means worse patient outcomes, and fewer essential services. Again, these people are in the business of making money. Uh, and some firm uh load hospitals up with debt. Uh, others strip assets through sale-leaseback manage- arrangements and they force hospitals to pay rent on buildings they once owned. And because many of these arrangements are incredib- incredibly opaque, uh, patients often have no idea who actually owns the facility that they're walking into. Uh, and so as Republicans, uh, uh, uh, tout their health care cuts that will push more hospitals towards, uh, private investment, Congress should at least know who owns what, how these deals are structured, and what impact they are having on cost and quality. That's why tr- I think transparency is critical. As we consider ways to improve ownership transparency, we should be reporting, we should make these reporting requirements pose as little burden as possible to hospitals. And the last thing we should do uh is pal a new administrative burdens onto providers that are already struggling to keep the doors open. And I wanted to ask Doctor uh Whaley, your research found that uh PE acquisitions are associated with higher provider prices, particularly when firms buy up practices within the same market. Can you explain how these roll-up strategies increase health care costs for patients?

Sure. So, prices between hospitals and physicians and and insurers are typically negotiated. And the way you negotiate better prices is you just get bit bigger and have better negotiation uh power. And so what happens in many cases with private equity is there is a single transaction that might be too small to be uh scrutinized regulatorily. And then there's a second one that adds on top on that and by and by, it essentially adds cumulative market power that leads to higher prices, and is passed on to patients through higher out-of-pocket costs.

Yeah.

Wow, wow, wow. Uh, Miss Tripoli, uh, Families USA has raised some serious concerns about the role of PE in health care. Would you agree that hospitals facing financial distress, particularly under deep Medicaid cuts, may increasingly feel pressure to turn to PE investment just to keep their doors open?

It's certainly possible, and just given the fact that con there is so much consolidation in the market

Yeah. Wow, wow. Uh, I also wanted to ask, would you agree that ownership transparency is the first step in understanding when private equity is stabilizing care and when it may be making health care more expensive and less safe?

Absolutely, ownership transparency is critical. It's a giant black box right now. We need that data so that we can not only understand what's happening in terms of these transactions the effects on communities. Um, but that also so federal and state regulators can actually intervene and evaluate and investigate these transactions before they happen.

Yeah.

Thank you. Thank you very much, Mister Chairman. You're back.

Uh, thank the gentlemen for yielding back, uh, just trying to figure out the right order here, but according to my team it's it's uh the gentleman from Ohio, Mister Landsman, is up for his five minutes of questioning.

Thank you, Mister Chair, and thank you all for being here. Um, Mister Tripoli, you talked about the corporate takeover of healthcare in your testimony and made a really compelling argument that part of fixing this is the transparency question or issue, meaning that if there was full transparency on benefits and costs and prior authorization, everything, uh that uh, you know, we would be able to address this. as a country, as a congress, in ways that uh we currently aren't. Um the the the part part of where this is playing out is Medicare Advantage, and so I wanted to get into that with you. In general though, would you say that this corporate takeover of health care is increasing costs?

Yes.

What about care? Is care getting better? Is it the same? Is it getting worse?

It is in some places staying stagnant, but on many key indicators it's getting worse.

Profits. Uh, you know, uh, are they making money?

Yes, these corporate institutions, whether it's plans, systems, drug companies are making profit.

Let's get into Medicare Advantage because the Transparent CP should be much easier for us with Medicare Advantage. They're using, it is private health insurance, correct?

Yes.

Do you think, based on all your research, that everybody who enrolls understands that it's private health insurance?

I think there's some, probably some level of understanding, but what that means in terms of the comparisons, I think there's an overwhelming number of choices for seniors when they go to enroll, um, on the Medicare Advantage side and on the traditional Medicare side. And so it is a lot to navigate through for seniors and to make a choice that's gonna make sense for them.

Do you think there's sufficient understanding as based on your research, what they're getting from from Medicare Advantage versus what they could be getting, uh, if they actually had in my Medicare, which is, you know, not private health insurance, it's Medicare. Do you think there's full understanding? Maybe they understand that it's private insurance, but do they understand the differences in terms of benefits, in terms of the network, in terms of pre- pre-authorization? uh rates i mean that uh are those comparisons provided to seniors

i think the comparisons provided are very challenging to navigate plus if you bring in agents and brokers who have a financial incentive to steer patients and seniors into certain ma plans for their own financial gain it complicates the issue and so we do have many examples of seniors who think they're getting a supplemental benefit and then roll into an ma plan and get there and only find out that in fact that supplemental benefit doesn't exist Um, so that that is the reason we need a lot of transparency over MA, um, and and a whole variety of data points so that consumers and seniors, when they're going to shop, they actually can make a much more informed decision and are not only only steered by agents and brokers financial incentives.

I would think that the American people would not only understand but expect the federal government to require a a a private insurer who's using the the name Medicare uh to provide all of the data necessary uh so that seniors have a full understanding of what they're buying, which is full transparency in terms of costs, full transparency in terms of benefits, what benefits actually get used versus the the amount of money they're spending on the marketing of these benefits, the comparative uh advantage uh uh when it comes to the networks, you know, pre-authorization rates, those kinds of things should be immediately available to seniors. That would make a big difference in terms of them deciding what's best for them. Correct?

Correct.

Um, how do you think this committee, we've, there's a whole host of bills, what do you think the most important thing this committee should do as it relates to Medicare Advantage and this issue of transparency?

There's a couple things that are being, some of the discussion drafts, all the discussion drafts actually on Medicare Advantage, that are for today are would be incre- incredibly important. More uh transparency information around care denials, uh better and stronger encounter data, and I would recommend including an enforcement mechanism to apply financial penalties on MA plans who don't comply with who are already required to. Report encounter data, that helps crack down on the coding abuses, um and helps to get to a much more sane MA payment accurate payment system. Um as well as I think increased transparency over medical loss ratio and how MA plans

Uh, super helpful, before I yield back, uh, our bill, Medicare Advantage Consumer Protection Transparency Act would require MA plans to be transparent, submit detailed information to CMS about the supplemental benefits usage, offered usage of supplemental benefits, number of patients, uh, covered, uh, denials and pre-authorization requests, I think you spoke to those, uh, with that and you yielded back.

Gentlemen, he is back. Appreciate it, and now I recognize the gentleman from Florida, Mister Bill Rock, his first five minutes of questioning.

Thank you, Mr. Chairman, appreciate it very much. Uh, health care affordability remains one of the biggest challenges facing patients in the state of Florida and across the country. I think all of you know that. Every year, families face high premiums, higher deductibles and higher out-of-pocket costs, while employers uh struggle to keep coverage affordable for their workers. At the same time, uh our health care system has become increasingly complex. Patients often have little visibility into the cost of care before they receive it and employers often lack access to the information they need to evaluate the cost and quality of the coverage they provide I think we can all agree on that. These challenges can be especially difficult for communities like those I represent in Florida florida's twelfth congressional district which includes the nature coast and the tampa bay area as well uh again as healthcare markets become more concentrated uh patients in suburban and rural communities can face fewer choices higher costs and greater challenges accessing care to home uh close to home uh it's a big issue the transportation issue is a huge issue in florida At the same time, independent physicians, community providers, and smaller health care facilities often struggle to compete against larger systems. For Congress to adr address these challenges effectively, we need a clear understanding of how prices are set, how health care markets are changing, and how those changes affect affordability and access to care. So, I want to thank all the presenters today, and thank you, chairman for uh holding this hearing and i have a question for doctor whaley uh your testimony notes the higher prices are often not associated with better quality outcomes if quality is not the primary driver what factors are contributing to higher prices in many markets or

we we know that prices are high and variable and are not linked to quality or not linked to things like cost shifting But instead a key contributor is consolidation and market power.

OK, the the follow-up is how can more transparent pricing information help employers direct their employees toward high quality lower cost providers? And do you have any examples you can share from your research where employers have been able to leverage this data?

One example comes from the thirty two b j health fund, which was able to get access to their own claims data. And when they looked at their data, they realized that there was one hospital network that was particularly and excessively higher priced. And so they used their data and actually decided to exclude that hospital in favor other hospitals in their market. And as a result, they saved a hundred million dollars, which they passed on to their their workers and their families.

Thank you. Next question is for Mr. uh Grimminger. I hope I got that right. Your testimony notes that many employers lack access to complete information about the health plans they fund. Uh, and the question is, what barriers are preventing employers from obtaining that information?

Uh, thank you very much, Congressman. You got the name right. Um, in general, what we see is that the the health plans themselves or their TPAs, um, just simply refuse to provide access or if they do, they will often put up other significant barriers. They'll say we can only provide kind of a higher level of access at sort of an aggregate level, or we're gonna charge you a substantial amount of money, uh, if you wanna have full access to your own claims data. Rarely is it just a straight up no, it's often a, you know, here's what we can provide and if you wanna pay more or you wanna sue us, we'll provide more than that. Um, this is why we're so supportive of the Patiences Over Price Tags Act, because we think it would finally get rid of the game that employers have themselves having to play.

All right, very good. Uh, Mr. Chairman, I'll go back. Thank you.

Gentleman yields back. Now I recognize the gentlelady from New York, Miss Ocasio-Cortez, for her five minutes of questioning.

Uh, thank you so much. Um Madam Chairman, just one moment. Okay, thank you. Um I also wanna thank the committee leadership for including my bill in today's hearing as well. Uh, and I want to talk about an aspect of Medicare advantage today that we actually haven't focused on much um this Congress, and that's on the agents and brokers who sell medicare advantage plans now doctor willie when someone turns sixty five they are often inundated with all sorts of information about the different medicare advantage plans available to them correct

that's correct

and so people i mean you turn on daytime television and uh you got all these celebrities you've got joe nameth and William Shatner talking to you about mel- uh, Medicare Advantage plans, you get lots of mail. People really start getting tons of marketing about these plans. And because of the money, the amount of money that these for-profit insurers invest in marketing, many people don't understand, to my, uh, colleague from Ohio's point, that Medicare Advantage is not Medicare. It is corporate for-profit managed insurance. Correct?

Correct.

Now, Doctor Whaley, if I'm turning sixty five and I don't know the difference between Medicare and Medicare Advantage, I'm faced with sorting through dozens of these plans in marketing. And that's where we encounter this issue of agents and brokers. Uh, Doctor Whaley, in theory, agents and brokers work with everyday people, uh, enrolling in a Medicare plan that are there to help them pick the best plan for their health, right? Ostensibly.

I I I think that's how we'd like it to work.

Ostensibly, that is how it's supposed to be set up. Um, what gets complicated is that the agents and brokers are paid by the health insurers for enrolling individuals in specific plans. That means that their decision-making could potentially be clouded by compensation offered by these for-profit health insurers. And in fact, some of these individual companies, say you have a Blue Cross Blue Shield Medicare Advantage plan or uh uh any other kind of company Unite United Healthcare managed uh MA plan they often will provide these kinds of kickbacks to the brokers that are enroll people in their preferred plan right and what are some examples of the compensation

That's correct.

provided to these agents and brokers when they enroll individuals in any given Medicare Advantage plan.

They can include direct fees of up to hundreds of dollars, or they can include things like uh conferences ed ski trips and all that type of stuff.

So like trips, you said, and and almost it's almost like a back door commission type of set up, right?

I I think that's a good assessment.

And so you're you're supposed to have the agents and brokers that are talking to your mom or your grandparent saying we'd like to enroll, we think this plan is what's best for you. But what that person doesn't know is that United Healthcare is saying we'll give you a vacation if you enroll people in our plan, or we'll give you a couple of extra hundred dollars if you enroll someone in a Blue Cross Blue Shield or United plan, or any other uh number of plans. And in your testimony you stated that agents and brokers have received received ten billion dollars in this kind of compensation in twenty twenty-two alone, right?

That's correct.

That's ten billion dollars in taxpayer money. That's being a lot of it is being funneled through these corporations. And so that is money that is not going to care. It's going to perks and trips to Boca and financial incentives for brokers to enroll people out of traditional Medicare and into for-profit Medicare Advantage plans. That's almost three times ten billion is almost three times what they were compensated in twenty fourteen. So not only is this amount a lot, it is exploding. And Doctor Whaley, they actually aren't fiduciaries either, these agents and brokers, so they have no obligation. to the people that they are allegedly supposed to help, correct?

Unfortunately, that is correct.

So I have a sensible piece of legislation uh that would make a lot and I know there are a lot there are a lot of good agents and brokers out there but from a policy-making perspective we shouldn't be relying on people to just do the right thing. Um we do have compensation today that uh or rather uh legislation today that limits and redefines what those caps are so that we can introduce some accountability into this system, and I hope we can have some bipartisan agreement on that. Thank you.

Gentlelady yields back. Now recognize the gentlelady from Indiana, Ms. Hauschin, for her five minutes.

Thank you, Mr. Chairman. Uh, this hearing advances an important part of the subcommittee's ongoing effort to improve healthcare affordability and empower patients to make informed decisions. And the diagnosis hasn't changed. Prices are high, widely variable, and not connected to quality. In most markets consumers can compare prices before making purchases, but in health care that information remains opaque, difficult to access, and even harder to understand. Hospital prices has have outpaced inflation by more than double over the last decade two decades. And as big systems have consolidated, independent physicians have been squeezed. Their reimbursements haven't kept pace with the cost of running a practice, so they sell to larger systems reducing competition in the marketplace, and causing prices to go up yet again. Now, transparency is not the whole answer. Every witness here agrees on that, I would think. But the precondition uh of transparency is connected to every other issue and every other answer. You cannot have a competitive m- competitive market when one side of the table can hide the price. That's why legislation like the Patients Deserved Price Tags Act is so important. Transparency only works if it is complete, accurate, and enforceable. By requiring hospitals, insurers, and other health care entities to publicly disclose pricing information in a standardized format, and by imposing consequences for those who fail to comply, this bill would help hold industry participants accountable while giving patients the information they need to make informed decisions about their care. This legislation ensures that transparency requirements are not mere suggestions but enforceable obligations that bring greater accountability to the healthcare marketplace and I'd like to thank my colleague, Congressman John James, for his work on the bill. We spend a lot of energy asking hospitals to post their prices and rightly so, but the plan a family chooses is one of the most consequential decisions that they make and they often make it blindly uh and make it blind to how aggressively

Well, it's a measure of generosity, just like how many hospitals are in the

Mm.

which hospitals are in the network, how high is the cost sharing, all of those things matter to patients. Uh, we've seen surveys where patients are very clear. They care a lot about prior authorization and denials, but if it's not observable to them, they can't signal their preferences to insurers. They can't direct them to t- to design the plans they want. So it seems first-word-only.

Thank you. And you've cautioned that reporting requirements should be kept as simple as possible, something like an above average, average, below average rating, so people can easily understand it. Could you walk us through what that useful plain language might look like for disclosure versus a just a kind of data dump that that complies but doesn't really tell patients anything.

Yeah, one of the lessons we've had over time is that um consumers, they do respond very, very clearly to price signals, but they do it much better when they have relatively straightforward signals. When we have a choice to go in-network versus out-of-network, we all tend to go in-network because it's cheaper. When we have a choice between a brand drug and a generic drug, the vast majority of us pick the brand or the the generic drug cuz it's much cheaper, right? It's the exact same concept. Keep it simple and people respond to the instance.

And simplification would be important because we wouldn't wanna have transparency that that they might just throw all the data at us and then we're still in the dark in terms of our ability to understand what's in what what we're looking at.

Yeah, I still have some confidence that a third party could could deal with that and, and simplify it for us,

Got it.

but it would be much better f- just from the get-go, do it the best way possible.

As simple as possible. Uh, Doctor Gr- or Mister Grimminger, your members are the employers footing the bill. The draft would make insurers publish how much of every premium dollar actually goes uh to care versus overhead and retained profit. From where you sit, would that change which carriers employers would be willing to buy from?

Yeah, I think I think it would, and I I um I love the legislation, you know, there's a lot of things that go into a decision that an employer's will make about which plan they're gonna uh choose to use, you know, overall coverage, qual- quality of the uh of the uh employers, how much we're paying in premiums. But I think it's really critical for us to know effectively just how competitive is this organization uh and how uh how much of the money is just going to overhead, that we don't know about.

Thank you. This seems pretty common sense to me, um but I do appreciate your thoughts and your engagement on the issue. I look forward to continuing to working with all of you as we hopefully move this uh legislation forward. Thank you. I yield back.

General, I yield back now, recognize the gentleman from Massachusetts, Mister Arkan Klaus, for his five minutes of questioning.

Thank you, Chairman. Uh, this question actually anybody can take it. I didn't see any mention in the testimony about uh, NADAC reporting, National Average Drug Acquisition Cost reporting. Um, but if we're gonna get traction on transparency for drug pricing, particularly for reimbursement to pharmacists and for co-pays for patients, we gotta understand what the actual cost of goods sold is. And right now, Natac reporting for pharmacies is voluntary, it's um inconsistent, subject to games uh being played. And, you know, I've got legislation under the Pharmacists Fight Back Act and and there's been other examples of bipartisan legislation to make Natac reporting mandatory and also to broaden its scope so that we actually just understand um what the actual uh, acquisition cost is of these drugs. Is, do any of you wanna speak on the importance of NADAC reporting, Mister Grebinger?

Um, thank you very much Congressman. I, I'm a big fan of, of NADAC as a, uh, as a benchmark. Um, as you all, as you know, most of the other benchmarks that are available out there, WAC, um, average sales price, et cetera, are highly gameable. NADAC you can, uh, game, but it is actually based on a survey of sort of what a, um, sort of, uh, unleveraged pharmacy is able to buy a drug for. Um. Just as we heard uh earlier, you know, that the way in which hospital prices uh are negotiated is highly variable, and so the kind of output is very difficult to understand how we got there. Same thing very much occurs on the uh on the drug side.

Yep.

I love the idea of getting to a standard place, and I think NADAC is the right place for it.

Minnesota recently uh promulgated some rules on NADAC reporting, which I think are probably the the most expansive of any of the fifty states. This is very wonky, so I I don't expect if you don't have any comments that's fine, but does anybody wanna talk about whether Minnesota could be a basis for a national lot? Miss Uh, Skinis, I think you had comments.

Yeah, thank you for the question. I think in general, the stance at Turquoise is if the data is available, let's grab it and analyze it and see what additional transparency can be gleaned from it. Uh, there there's a lack of information around prescription drug pricing and and transparency. So any of that, you know, even if it's one state, then we can start there and expand accordingly.

Yep. Anybody, anyone has specific comments on Minnesota? Well, we're we're talking about transparency and simplicity, uh, and is an important element of health care. So I gotta talk about three forty V, which may be the least transparent, least simple element of our drug pricing, uh, system. And, uh, you know, there's been a lot of, uh, light and heat on this, partly because of the proposed rebate program from the administration, because of discussions here in Congress, both House and Senate, on on what can be done. Mister Greminger, do you and and I'll let others as well wanna comment on how we should be thinking about the three forty B program.

Um, as you know I have a lot to say about this program, but I will say, just as it relates to the rebate program, and it actually highly relates to what's going on in this hearing. Employers have ax- have a difficult time accessing their own claim list data right now.

Yep.

We have almost no ability to understand the imp- uh the degree to which three forty B is impacting us, in part we, whenever a drug is told through three forty B, we lose access to the rebates, the discounts that we would otherwise get, the the um cost of that is significant, and yet it's almost impossible for an employer to track.

Yes.

The rebate model or similar legislation would enable employers to finally understand what's going on and then try to create plan design to mitigate the impact.

Doctor Whaley.

My own research shows that if you're a cancer patient who gets care at a three forty B hospital, the mark-up on your drugs is almost seven hundred percent. And so while I think it's you know appropriate for hospitals to get revenue i think it's very open and challenging question of whether or not cancer patients should be the ones essentially financing the hospital

yeah um we we've talked a lot about transparency and simplicity for prices which agreed i think it's also and increasingly just as salient to my constituents is about process and in particular prior authorization in addition to not understanding how a bill came, also not understanding why you're being denied care is immensely frustrating for people. Um, and I would just highlight, I don't have a question based on this, but I would highlight that not included in these bills is really strong, bipartisan prior authoriz- prior auth legislation, um, being, that has been proposed by my colleague Susan DelBene from, uh, the state of Washington. I, myself, am gonna be putting forward prior authorization legislation. uh for MCO's and Medicare part D. But people really deserve electronic, in real time, evidence-based, human in the loop, accountable prior auth decisions. Um because right now the single biggest use of AI in healthcare that I can see is basically insurance companies playing games with it to deny care and it, that would be such a disappointing outcome um from what could I think be a helpful technology but right now it's being used for revenue cycle management, we gotta change that arc. I yield back.

Gentleman yields back, now I recognize the gentlelady of Texas, Miss Flesher, for her five minutes of questioning.

Thank you, Mr. Chairman, and thank you to our witnesses. This has been um a very h- a very useful hearing, and I think we've covered a lot of ground here. Um and it's a hugely important topic, something that I hear about from my constituents all the time, and you've heard I think a lot of bipartisan agreement today, um as there has been on this topic for a long time, so I do hope that we can move forward on some of the thoughtful recommendations and ideas that we've heard not only today but over the last several years. Um, and as this hearing comes to a close, I just I do want to take a minute to, um, bring it back to where where we started, which is we are in a healthcare affordability crisis, and transparency is a part of the answer, but it isn't all of the answer. And, um, I so appreciated the comments from, uh, Mister Auchincloss, now about prior authorizations. That's something I hear from my constituents, both the physicians and the patients. Uh, I represent a lot of physicians. I represent Houston and have the district um right outside the Texas Medical Center, so I have a lot of physicians I represent who are so frustrated that they can't give the patients the care they need. Um, and they spend so much of their time trying to get authorization for the care they know their patients need through the insurance companies. And I think it's this Overall transparency, we had a a conversation just the other day about the challenges and and kind of the shorthand um of Medicare for all, which of course is just the payer side of the equation, and there's so much else that we don't understand, and I think it's a shorthand for health care for all. Everyone should have access to affordable health care, and they should be able to get the care they need and understand the costs, the rationale, um, the coverage options that they have, so the conversation about Medicare advantage also hugely important. Um, but as we know, health care costs continue to go up even with all of these good legislative ideas, and we cannot ignore the fact that a huge part of the reason these health care costs are going up is because this is an ecosystem, and the decisions that this Congress has made in the last year, year and a half to drastically cut funding for Medicaid, uh, which the estimates are that ten million Americans are gonna lose health care coverage because of those cuts. Um, but also the elimination of the tax credits relating to the Affordable Care Act's enhanced premium tax credit program in my district that was a hundred and twenty-five thousand people who were relying on those tax credits. And so they're facing increased costs, they're getting worse plans for more money and less coverage because they can't afford their health care. And it's estimated that that's more than four million Americans that are gonna be in that situation. Um, and they don't even cover those numbers don't cover the people who are forced to change their plans because they're all becoming more unaffordable. Um, I know too hearing from the folks who, uh, work in our hospitals, uh, in Texas where we already have the highest uninsured rate, country as I'm sure you all know that those rates are going up even more um and that our hospitals are seeing an increased number of uninsured patients and that's increasing their uncompensated care costs all of this is an ecosystem and what decisions we make in one area affect decisions in another and so as we work to address costs and transparency we also have to address what is driving up costs, and it's it's just one piece of it and so Um, I do think it's critically important, I feel like we've heard a lot of really interesting and important um testimony today. And so, Miss Tripoli, I just wanna end um the hearing and and my time with you with a question. If you, I know you've answered a lot of questions already today, but if you could just um answer whether there's anything you feel like we didn't touch on in the hearing today um about how healthcare consumers that you work with and your organization works with have been impacted by these healthcare cuts, If there's anything that we haven't covered in this hearing today that you think is important for us to know or any most salient points you just wanna make sure that we have clarity on as we end this hearing.

Thank you. I mean, I would say first and foremost consistent what we have talked about today is that there is a suite of legislation discussion draft a discussion today much of it which should move forward and is an important step in addressing the affordability crisis not sufficient but a majorly important step. Second, in terms of the cuts, um, we know that the cuts obviously the trillion dollars of healthcare cuts in are having an incredible harm on people up to ten million people are are likely to lose coverage we just saw an interim final rule come out from the administration just couple of weeks ago going even further than hr one putting paperwork upon paperwork for beneficiaries to uh maintain their medicaid coverage um and we are now gonna see uh they were already seeing the effects of uh what happened with the expiration of the enhanced premium tax credits over a million people less enrolled this year than last year because those tax credits did expire and as new the final data comes out over the next over the summer we expect to see that much much higher. So this is and there are signi- there is significant harm um that's ongoing and that we will continue to see this year from the H R one bill that was enacted last year, as well as uh the failure to extend the premium tax credits.

Thank you, Miss Tripoli, and uh with that I've gone over my time, so I thank you, Mister Chairman, for allowing me to ask that final question as we close the hearing. Thank you and I yield back.

General A yields back, and that concludes our qu time of questions. I would ask unanimous consent to insert

Yay, thank you, Andrew.

Thank you.