Full Committee Hearing with Health System CEOs

The committee will come to order. Good morning, and I'd like to thank each of our witnesses for voluntarily agreeing to appear before the committee this morning. Today's hearing is a continuation of the committee's larger effort to get to the root causes of why health care is so outrageously expensive. for patients and why so many Americans lack access to health care. CEOs representing some of the nation's largest hospitals are before us. But let me be clear, the entire health care system, hospitals, insurance companies, drug manufacturers, pharmacy middlemen, all bear responsibility for the high-cost patients' patients' face. First, hospitals, and in particular, The doctors, nurses, and medical professionals who work there treat vulnerable and do it with some of the most advanced medicine in the world. Our communities are better off with hospitals in them, but large health systems have taken advantage of that reality. The corporatization of American hospitals means that our local hospitals and physicians have been replaced by mega-corporations that put quarterly earnings over quality care and grow larger simply for the sake of growing larger. Hospitals with more than a hundred beds have a higher profit margin than Delta Airlines, Target, or Disney. Let me repeat that again. Hospitals with more than one hundred beds have a higher profit margin than Delta Airlines, Disney, and Target. Turns out charging an arm and leg for health care is more lucrative than the happiest place on earth. When CEOs of some of the largest health insurance companies came before this committee earlier this year, they pointed the finger at hospitals as the culprit. This committee isn't interested in hearing about how the high prices your businesses charge are somehow someone else's fault. The blame game didn't work with insurers, and it won't work today with us. Simply put, hospitals are charging an insane amount for care. Hospital prices have skyrocketed three hundred percent in just over two decades, more than any other sector of our economy. Not one sector was even close. Hospital consolidation and mergers that lead to ever-growing market power are fueling the borderline extortionary prices hospitals charge charge patients. Today there are forty-five hundred hospitals, and two thousand of them have undergone, undergone a merger since two thousand. The result is that today ninety percent of hospital beds are part of a health, health system. The place and scale of mergers have led the market concentration. That puts patients at the mercy of hospital empires. When hospitals have no competition, it's no wonder that the sky seems to be the limit for prices. A family in California was charged nearly three hundred thousand dollars to treat their toddler's snake bite. Three hundred thousand dollars for a toddler's snake bite. A man in Florida had an emergency CT scan that the hospital billed for thirteen A follow-up scan at a different location cost him only seventy-nine bucks. Another Alab- Alabama woman was sued for the full cost of her appendix procedure plus interest, nearly thirty-seven thousand dollars. After faithfully paying the bill every month for three years, she told her husband that the burden of the lawsuit was so great that she wished she had passed away at the hospital rather than deal with the lawsuit. Those stories illustrate how these systems prey on patients who have few options for care in their time of need. Patients are not getting better for the higher prices either. Study after study found that hospital mergers are not generally associated with better health. In rural America, hospital mergers may sustain access in some communities. But I have seen firsthand how profit-seeking health systems view struggling rural hospitals as nothing more than a gateway to more patient referrals. It's no wonder rural Americans are sicker, have higher rates of chronic disease, and die earlier as a result. What's worse, a complex set of legal loopholes and open-ended taxpayer subsidies, manipulated by sophisticated hospitals, have become a key part of a business model that fuels ever larger systems, eliminates competition, and drives higher prices. Urban hospital chains double-dip and classify themselves as both urban for higher wage index reimbursements and then reclassify as rural for another set of government benefits. That's absurd. One example that this committee has been focused on is the ten percent of new residency slots that Congress set aside in twenty twenty for rural hospitals. Of the hundred and twenty slots allocated to rural hospitals, only thirty have actually gone to truly rural communities. In total, urban hospitals have taken ninety-seven percent of all new residency slots, far more than Congress ever intended. It's unacceptable for large, wealthy urban hospitals to take what rightfully belongs to truly rural communities, when those communities already suffer from lack of access to care. Regardless of a hospital's geography, we've seen health systems leverage payment differentials between hospital-owned clinics and independent physician offices direct more money to their corporate coffers. The higher reimbursement for hospital-owned clinics incentivizes consolidation and encourages hospitals to buy up more independent practices. It's no wonder today half of the US physicians are employed by larger systems like hospitals. Unsurprisingly, this business practice practice also raises costs for patients receiving the exact same service. For example, An ultrasound costs a hundred and sixty-four dollars when provided by a physician. It costs three hundred and thirty-nine at a hospital outpatient department. A biopsy costs about a hundred and fifty dollars when performed by a physician. It costs eight hundred dollars at a hospital outpatient department. Congress, including this committee, has taken efforts to right the wrong and ensure patients and taxpayers pay lower prices for the same service with the same quality. But every time we try to advance these so-called site-neutral policies, big hospitals, they fight us. They fight us tooth and nail. For-profit hospitals are are legally required to put shareholders over patients, but so-called non-profit hospitals rarely act much different. Tax-exempt hospitals deliver charity care that is consistently worth less than the tax breaks that they receive. These non-profit hospitals receive a twenty-eight billion dollar tax break, while only spending roughly sixteen billion on charity care a year. The difference fuels a spending spree totally unrelated to providing health care like real estate investments, stadium naming rights, green energy initiatives initiatives and political activism. Large hospital systems also manipulate the three forty B drug pricing program to keep steep drug discounts for themselves instead of passing the savings to low income patients there is little evidence that the two hundred ninety billion dollars in disc- discounts given to hospitals under the three forty B program since Obamacare was reinvested in patients. Even worse, there is evidence that that hospital abuse of three forty B actually direk directly led to increases in Obamacare premiums. Today I expect we will hear how from these hospital executives, their opinion on how insurers and drug makers contribute to the affordable cost of health care. But this committee will be asking and expect answers to why hospital prices make up by far the largest share of the insurance premium increases that grew three times faster than earnings. This hearing is not the end of the road for our investigation into the unaffordable cost of health care. The American people are fed up with outrageous prices that seem artificially high. They're right. Hospital prices are unjustified. This committee will continue to fight to lower health care costs for working families. The first step is to get answers and expose the truth. And that's exactly why you are all here today. I'm pleased to recognize the ranking member, Mister Nill, for his opening statement.

Thank you, Mr. Chairman. Uh, rightfully feeling the heat of the public's anger, the majority is holding their third hearing on health care in as many weeks, all to deflect blame and responsibility. Families are not gonna be fooled easily. This is about their tax bill. They know that right now it's wildly unpopular and anything that can distract from the tax bill should be part of this conversation. Last year in America, the only real economic growth was in health care. For obvious and good reason, it's based on the innovation that is taking place. A reminder to colleagues, technology helps to drive the cost of health care. Let me give you an example. From Springfield to Worcester, Bay State Medical Center, UMass Memorial, a forty mile stretch, and this morning the addition of Mercy Medical Center. Forty miles, more than thirty thousand people get up and go to work every day. Who wouldn't want the teaching hospitals that we have across this country? And I'm proud of the fact that we expanded GME slots in a bipartisan manner recently. We will continue on the Democratic side to defend Medicare and Medicaid and the Affordable Care Act, an understanding that patients and families simply can't afford what's being offered to them as they watch profits for big corporations soar. But trying to lower the cost of care or perhaps a better description would be to manage it, is a challenge now, largely because of their tax bill. Thirty-seven percent of Marketplace enrollees say they're cutting back on food and other necessities to afford health care coverage. We need to listen to them. I heard the argument that was offered just a couple of minutes ago. It's been my honor to represent the Sisters of Providence and the Mercy Medical Center through my lifetime. As I always point out, at seven years old, I left my Their achievements are remarkable. Those sisters of Providence, what they did for health care in western Massachusetts, the Pioneer Valley, and indeed across America is witness to the advances we've made in health care. Democrats know that it can be done, and we want further opportunities to make sure that health care in America is expanded to all members of the American family. Because of our fight, Medicare drug negotiations and Cap- we capped out-of-pocket in insulin costs, expanded senior benefits, we delivered years of record enrollment, and now only eight point five percent of the American people are without health insurance. Statistic. Every child in Massachusetts has health insurance. Ninety-seven percent of the adults in Massachusetts have health insurance. Four former governors and the current governor of Massachusetts, including Mitt Romney, And Bill Weld gathered but two weeks ago to celebrate our achievement. And you know what? Republican and Democrat, they all deserve credit for what they were willing to do when they had the opportunity. That's how you deliver for families. The president stamps his name on websites and hands out favors, but doesn't want to acknowledge the reality of how hard it is to manage health care costs. With the health care crisis, it's looming over millions of families. The fervor and attention that we've heard everywhere seldom addresses some of the root causes. Last year, we warned for months that their trillion-dollar tax cut bill was going to harm on the American health care system. They refused to acknowledge the questions that we raised. They ripped coverage from fifteen million people and pushed hundreds of hospitals to the brink. And then they complain about the problem after it's their tax bill It's gonna lead to these massive cuts. Health care is not a Democrat or a Republican issue, it's an American issue. Their challenge, based on rural health care, is simple, and we wanna help because many of us, myself included, we have rural health care challenges as well. I helped to reopen a hospital that was in desperate need of a rural, because of its rural setting, and today that hospital continues to deliver first class health care. All of this is based upon they set the fire and now they're calling the fire department. There is no plan. I've been here for a long time. There has never been a Republican agreement on health care, simply the critique of what we've tried to do in the affirmative. They keep trying to convince people that it's about just the providers. It's about many of their policies as well. Families are paying more for everything because they have decided to go along with these ill-considered proposals. There's a different path. Democrats believe in the power of legislating for a fairer tomorrow. We stand up against those who try to cut taxes

Taxes and

so that they can cut health care?

Apologies.

We need to be talking about real solutions that bring costs down for workers and families, and that starts with reversing the harm of what they did in their tax bill. And you in the room today are gonna be asked questions because of their policies. as it relates to the tax bill. We should have a conversation about the tax bill, and then we can get on to some of the questions that perhaps are legitimately posed to all of you this morning. Thank you, Chairman.

Thank you, Ranking Member Nill. I will now introduce our witnesses. Uh, Mister Sam Hazen is the Chief Executive Officer um of HCA Healthcare. Mister Mister Wright Lassiter is President and Chief Executive Officer common spirit health and we have doctor brian donnelly as president and chief executive officer of new york presbyterian and we have doc doctor michael waldrum as chief executive officer of the ecu health um we have mister brad woodhouse as president of protect our care thank you all for joining us today your your written statements will be made part of the hearing record and you each have five minutes to deliver your remarks Uh, Mr. Hazen, you may begin when you're ready.

Chairman Smith, Ranking Member Neal, and members of the committee, thank you for this opportunity to testify on health care affordability. I'm Sam Hazen, Chief Executive Officer of HCA HealthCare. I've been with the company for forty-three years, and throughout my career I've remained grounded in a simple belief. Health care is deeply personal and essential to everyone. I was raised in the coal mining communities of rural Kentucky, where access to care was often limited by distance, income, and infrastructure. Those experiences reaffirmed my commitment to high-quality health care, accessible and cost-effective for all. I'm honored to lead HCA HealthCare, a network of one hundred and ninety hospitals and more than twenty-five hundred sites of care. Last year, HCA served forty-seven million patients, including many in rural and underserved communities. Our our hospitals operate twenty-four hours a day, three hundred and sixty-five days a year. They are designed to operate under extreme conditions and remain open and responsive throughout public health emergencies, like the COVID-19 pandemic, hurricanes such as Hurricane Helene and other disruptions. We provide critical, lifesaving services, and we care for every patient who comes through our emergency room doors regardless of their ability to pay. Last year alone, we provided approximately four point five billion dollars in uncompensated care, including charity care and financial assistance for uninsured patients. That number reflects commitment to our mission and the essential role our hospitals play in communities across the country. The reality of our system today is clear. Health care in this country has never been better, nor more advanced, but it is also too expensive for too many people. Whether it is the price of a prescription, insurance premiums, or an unanticipated emergency room visit, the financial pressures associated with health care affect every American household. We asked this committee to consider three ways to address the affordability challenges. First, one of the most effective ways to address this challenge is to ensure stable and affordable health insurance coverage. When patients have reliable coverage, they have greater access and can seek care earlier, manage chronic conditions more effectively, and avoid costly emergency interventions. Coverage is an essential starting point, but coverage alone is not enough. Providers must also deliver care more efficiently, with higher quality and greater consistency. At HCA Healthcare we are investing in technologies workforce development and care delivery models that improve outcomes, expand access, and reduce unnecessary costs. We are working to give patients better information about the cost of their care, while recognizing that true transparency requires coordination across the entire system. Second, fair competition matters too. When providers compete on quality, service, and access, it drives better patient care and lowers costs. Certificate of need laws, originally intended to control costs, now do the opposite, limiting competition, constraining supply, and increasing prices. Revisiting these laws would encourage innovation and improve access, especially in underserved areas. Third, we also see firsthand the toll of administrative complexity. Insured patients and providers routinely face barriers, including prior authorization, and payment disputes disputes such as care denials and underpayments. These frictions translate directly into delayed diagnosis, reduced access, and higher costs. HDA is attempting to work with payers to address some of these challenges, and I am encouraged by early progress. At the same time, hospitals must comply with hundreds of overlapping and sometimes conflicting federal and state requirements. While these regulations promote quality, Their volume can often create inefficiencies that divert time and resources away from the patients they are meant to protect. In conclusion, the best way to improve healthcare in the United States is for all participants to work together toward the shared goal of building a system that serves everyone at HCA Healthcare we are committed to playing an active role in that effort thank you again I look forward to our discussion today.

Thank you, Mister Lassiter, you are now recognized.

Chairman Smith, Ranking Member Neal, and members of the committee, thank you for the opportunity to testify on an issue that affects every individual, healthcare affordability. I'm Wright Lassiter, President and CEO of Common Spirit Health. I'm proud to be here representing our Catholic nonprofit health system that operates one hundred and fifty-eight hospitals across twenty-four states. including forty-one rural facilities and among them twenty-nine critical access hospitals, making us one of the nation's largest rural health care providers. Guided by a mission to serve all, especially those who are most vulnerable, we provide twenty-five million patient visits each year. We're one of the nation's largest Medicaid providers, and we deliver one out of every forty-two babies in this country. Health systems play a critical role in affordability by integrating hospitals, clinicians, and care teams to reduce duplication and improve outcomes. Health systems support information technology, electronic health records, and data integration. We also create operational efficiencies, improve purchasing, and contracting so more resources can flow to patient care. That is especially important in rural and underserved communities, where stand-alone hospitals often lack the ability to spread fixed costs, invest in innovation and technology, or sustain essential services when reimbursement falls short and expenses rise. Since forming in twenty nineteen, Common Spirit has reduced operating costs by three billion dollars, through scale, efficiency, and innovation. We have also used that scale to strengthen quality and safety across our health system. Common Spirit has exceeded the national average for CMS hospital quality star ratings for five straight years. We provide more than five billion dollars in community benefit annually, including the unpaid costs of governmental programs. We are consistently using new approaches to improve care and strengthen operations. For instance, our sepsis surveillance program helped save more than three thousand six hundred lives last year and reduced stays in the ICU by more than thirty-three hours per patient. Our AI initiatives generate more than one hundred million dollars in savings on an annual basis by improving efficiency, and reducing administrative burden. Our virtual integrated care program provides real-time remote support to nursing teams, helping us address workforce shortages and support high-quality care. Virtual nurses help safely discharge more than sixteen thousand patients freeing up bedside nurses from thousands of hours of paperwork. Today, health care affordability is being strained by four powerful forces. Labor, rising supply in technolog- technology costs, payer behavior, and regulatory burden. Labor alone has risen more than twenty percent in the last five years, and now represents more than fifty-four percent of our operating expenses. Prices of pharmaceuticals, medical supplies, and and advanced technologies each grew by more than ten percent last year. For example, our spending on IV fluids has increased by more than fourteen percent since twenty twenty-four. Payor pressure is also intensifying. Billing for Medicare Advantage patients is about twenty-five percent more expensive than for traditional Medicare patients. pulling staff, time, and resources away from patient care. Commercial insurers increasingly deny claims or underpay for services provided. Medicare Advantage plans are the most challenging. Today, we have four point three billion dollars in unpaid Medicare Advantage claims, with nearly one billion of that being more than one hundred and fifty days past due for care that common spirit has delivered to patients and communities. that you represent. Medicare and Medicaid represent nearly seventy percent of our patient volume, yet Medicare reimburses approximately eighty percent of our cost to care for those patients. Medicaid underpayment is also an access issue, especially in rural communities that typically have higher rates of unemployment and poverty. When public c- when public coverage falls short and more people become uninsured, Uncompensated care rises, pressures on hospitals intensify, and access becomes harder to sustain. Regulatory burden for common spirit adds another one billion dollars of cost to our expenses on an annual basis. Those are resources that otherwise could be placed directly towards patient care. We cannot solve affordability alone. Hospitals, providers, payers, and the government must work together to ensure timely payment for care delivered. adequate reimbursement for Medicare and Medicaid, relief from unnecessary regulatory burden, and stronger accountability for health plans. Thank you for the opportunity to be part of the discussion today.

Thank you. Mister Donley, you are now recognized.

Good morning, Chairman Smith, Ranking Member Neal, and distinguished committee members. My name is Brian Donley, and I serve as President and CEO of New York Presbyterian. I'm also a doctor. with more than twenty years of experience caring for patients. I joined New York Presbyterian three years ago as the Chief Operating Officer, and I assumed the CEO role twelve weeks ago. I was raised in Pittsburgh, and caring for people was a central part of my upbringing. My mother is a nurse and my father was a community pharmacist. They instilled in me that health care is grounded in empathy, respect, and the sacred trust between a patient and a caregiver. I come before you today as both a doctor and a health system leader, deeply focused on compassionate, high-quality, accessible, and affordable care. I want to begin by acknowledging what New York Presbyterian patients and patients across this country are experiencing. The cost of care is a real and growing concern. I recognize that hospitals are one part of a broader health care system that contributes to these costs. And I take that responsibility seriously. New York Presbyterian is committed to working with policymakers, payers, pharmaceutical companies, and the many other health care stakeholders to find solutions that make care more affordable and more accessible to Americans. New York Presbyterian is one of the nation's oldest academic systems. With ten hospitals, nearly forty-five thousand employees, and more than two million patients served annually. We are among the largest providers of care to Medicaid patients in New York, and we serve patients from all fifty states. We care for some of the most complex and vulnerable individuals in the country. In fact, our children's hospital provides some of the highest acuity of care of any children's hospital in the nation. For two hundred and fifty years, our approach has been grounded in an enduring set of commitments, including putting our patients first, investing in our people, and maintaining deep connections to the communities that we serve. Our mission is straightforward, to provide the highest quality of care to all patients, regardless of their ability to pay. But delivering on that mission comes with real financial pressures. We are facing substantial cost pressures, such as labor, supplies, and pharmaceuticals. with drug costs alone rising by twenty-five percent. Compounding these challenges, government payers do not reimburse the full cost of care. We also face growing administrative burdens driven by the current insurance environment that creates unnecessary cost and frustration, for both patients and providers. In response, we are focused on four key areas to make care more affordable for our patients. First, we are doubling down on high-quality care. Because when care is better, it's not only not only do patients do better, but care is less costly. That means fewer readmissions, fewer hospital-required infections, and fewer complications. Second, when it's right for the patient, we are shifting care to lower-cost settings through hospital-at-home programs, virtual nursing, ambulatory care, and telehealth. Third, we are using technology to drive efficiency by cutting waste, improving productivity, and reducing administrative burden, especially around insurance denials and prior authorization. And fourth, we are investing in our communities to reduce chronic disease. We are working with partners on programs that improve health upstream, and therefore help prevent avoidable hospitalizations. Beyond patient care, New York Presbyterian provides significant community benefit. Last year alone, this totaled two point four billion dollars, more than twenty percent of our operating expenses, supporting important community-based services and school-based health centers that serve twenty-eight thousand children in New York City public schools. These investments are core to our mission, but they rely on a sustainable financial foundation. Affordability in health care requires a shared responsibility, of all stakeholders. The forty-five thousand dedicated people of New York Presbyterian are committed to caring for patients with compassion, to advancing treatments that save lives, and to strengthening the communities we serve. We stand ready to work together to make high-quality health care more accessible and more affordable for all Americans. I appreciate this opportunity to engage in a meaningful discussion so that we together can be better for the patients and communities that we care for and that you represent. Thank you.

Thank you, Doctor Waldron. You are now recognized.

Good morning, Chairman Smith, Ranking Member Neal, and members of the committee. My name is Mike Waldrom. I'm a critical care physician and Chief Executive Officer of ECU Health, a nonprofit, mission-driven health care system located in rural eastern North Carolina. I'm off- I'm honored to offer testimony before you today on healthcare affordability and share the realities of sustaining access in our region. The barriers facing rural health systems are real and structural. I look forward to working with this committee on solutions that strengthen access and affordability to ensure people living in rural communities are not disadvantaged simply because of where they live. My hope is that this to- testimony shines a light on ECU Health's experience on delivering care to one point four million people living in a vast rural region about the size of Maryland. I have dedicated my life to helping people in need and in places where I can make the greatest impact taking care of the sickest and most complex patients. I moved to eastern North Carolina specifically to work on the issues that rural communities face, and that's why I'm here with you today. I recognize and I appreciate the monumental task before Congress to address r- rising health care costs while protecting access to care but the challenges we face we continue face continue to mount. It is urgent we go beyond a one-size-fits-all solution to solve the rural health care crisis. I have trained and worked in some of the nation's most prestigious health care s- organizations. I have also seen the other side, patients who lack access to even basic health care needs. I've invest- I have witnessed the damage to communities and hard-working rural citizens when access to care diminishes as resources increasingly are concentrated in urban markets. I've experienced how health care operates under very different conditions and constraints and how those differences shape health care access, affordability, and outcomes. This is the story of two health care markets in our country. urban and rural. The realities of rural health care are complex. Sicker, older populations, flat or declining growth, and sp- patients spread across vast, challenging landscapes. In eastern North Carolina, if ev- if eastern North Carolina were its own state, it would rank among the country's poorest and sickest. These realities, coupled with regulatory pressures, have driven hospitals and cl- clinic closures. Consolidation in our market is not driven by preference. It is how we survive. As some exit and others enter with profit-driven agendas, systems like ECU Health are left to serve as the safety net. The result is reduced access, worsening outcomes, and increasing costs. These dynamics are not theoretical. This is the reality of the rural health care crisis in America. Despite the persistent headwinds, ECU Health has sustained access across our twenty-nine county region through a hub-and-spoke model where our community hospitals are supported by the resources generated by our academic medical center. We have grown into a nine hospital system with more than twelve hundred providers, not in pursuit of scale, but out of community necessity. We are transforming our rural academic regional system of care to lower costs, sustain and grow access to essential services, and support the economic vitality of rural communities. We have made significant progress, but we have much work to do. As this committee considers federal health care policy, I encourage you to design solutions that are tailored to the sixty-six million people living in rural communities. Policies that do not account for the differences between urban and rural markets leave risk leaving those communities behind. We know this work cannot be done alone. We stand ready to partner with you on a solution. Thank you.

Thank you, Mister Woodhouse. You are now recognized.

Thank you so much. Uh, Chairman Smith, Ranking Member Neal, and distinguished members of the committee, thank you for the opportunity to testify today. My name is Brad Woodhouse. I'm the President of Protect Our Care. Our mission is to make high-quality, affordable health care a right and not a privilege for everyone. I'm here today because that mission is under threat. We are facing a health care affordability crisis. H. R. One made the largest cuts to health care in American history to fund tax breaks for billionaires and big corporations. No amount of finger-pointing can distract from the reality that H. R. One cut one trillion from Medicaid and the Affordable Care Act, which will rip lifesaving coverage away from fifteen million Americans, including seniors, children, and people with disabilities. That same bill handed out seven hundred and thirty billion in tax breaks to corporations and eight hundred and ninety billion in tax breaks to millionaires. Today, nearly a year later, roughly four million people have already lost their health care. But that's not all. Costs are skyrocketing for millions of Americans. Families are being forced to make impossible choices between paying for groceries and seeing a doctor. And small businesses are closing their doors. The ripple effect of these cuts has catapulted health care to the number one issue in America. Recent Gallup polls showed that the availability and affordability of health care topped the chart of American worries about key issues ranking higher than the economy and inflation. One of the biggest impacts of H R one is on our nation's hospitals. Following the passage of H R one, Protect Our Care launched a hospital crisis watch. It's a interactive map on our web site that tracks hospitals, nursing homes, and other care facilities that have shut down, cut services, or at or are at risk due to H R one's devastating cuts to health care. When a hospital closes its doors, everyone feels the pain. Patients have to travel further for care, families face longer wait times in overwhelmed emergency rooms, moms are left without maternity care, uh, putting their lives and their babies' lives at risks, and entire communities will be left without access to care while CEOs and billionaires get another tax cut. Here are some key numbers from our hospital crisis watch tracker. As of this morning, eight hundred and eighty-nine hospitals, clinics and nursing homes have either shut down, cut services or are at risk of doing so since Congress passed H R one. That includes nearly sixty hospital wards which have shuttered, including thirty maternity wards, uh, over two hundred and forty clinics have been forced to close, And over four hundred hospitals remain at deep risk of closure or cuts. And everyone is paying the price because Congress put tax cuts for billionaires and big corporations above the needs of working people. When a hospital closes, costs rise by an estimated five hundred dollars per hospital, state and nearby facility. This means higher health insurance premiums for everyone, regardless of where they get their coverage. As the sixth largest employer in the country, hospitals are key economic drivers. especially in rural America. But because Congress passed the largest cuts to health care in history, nearly five hundred thousand health care workers could lose their jobs. Communities are so desperate uh to save their local hospitals that counties and states from California to Alabama are raising property taxes to stop their hospitals from closing. Uh, as our map shows, the consequences of H. R. one are already playing out and the things will only get worse in the years to come, if these cuts come into full force. Here are a few stories illustrating the impact of the cuts and closures that have occurred since H R one passed. In Nebraska's third congressional district, a nursing home, a primary care clinic, and a critical dialysis unit were all forced to shutter and five hospitals remain at risk of cuts or closures. A rancher in that district from Hay Springs is now spending nine hours each week driving to and from Scotts Bluff for his dialysis. In New York's twenty-fourth congressional district, a dialysis unit was closed there. Now patients are scrambling to find a new place to get life-saving treatment. Five hospitals in that district are also at risk of closure or cuts. In Ohio's seventh congressional district, five clinics were forced to close due to these Medicaid cuts, leaving families with fewer options for care. Look, Protect Our Care has been crisscrossing America to sound the alarm on how these cuts are pushing hospitals to the brink, stripping care from communities, and putting lives at risk. Every day presents a chance to stop this health care crisis, but this administration has not lifted a finger to deliver relief to the American people. Congress should be focused on making health care more affordable and accessible, not ripping it away to give tax breaks to the rich. Thank you for the opportunity to be here, and I look forward to your questions.

Thank you. Uh, thank you all again for being here. I'll now begin the question question and answer session with the Vice Chairman of our Health Subcommittee, uh, Mister Buchanan.

Um, thank you, Mister Chairman, and I wanna thank all of our witnesses. Uh, I wanna shift gears a little bit in my five minutes and get your input, so that's kind of where I'm gonna go. Uh, Bill Frist was here in front of s- we had a hearing, Bill Frist was here, and he talked about the landscape of obesity and related diseases that defined America. Then he said the surest and safest way to maximize your your health is food as medicine. So he took took for hour or two talk about food as medicine. So I believe personally and myself it's something we didn't talk about, nobody brought it up, but I'm sure you know we're we're focused on the other stuff. I believe that prevention in eating real food is the key to making healthcare more affordable. The US is spending five point three trillion dollars on healthcare, yet we're getting sicker as a nation. Six in ten Americans, ninety five percent of Medicare beneficiaries have at least one chronic disease. Roughly half the adult population is obese, and when you look at it, and the thing that makes me sad, we have ten grand kids, but w- uh children, twenty percent of the obesity for kids are are obese, twenty percent. And thirty and one young ones that would serve maybe in the military, twenty to thirty, basically there's th- uh thirty percent are are obese. I believe the problem stems from unhealth unhealthy and ultra-processed food. We must prioritize prevention. In other words, don't get sick in the first place to the extent we can. Uh, yeah, they said that if you have cancer and you catch it early and you do it, there's a good chance you're not gonna have to deal with it. We must prioritize prevention as a key to reversing trends in heart disease, obesity and diabetes. Hospitals uh not only treat people with that are sick, but hospitals can and should take uh more time to make sure that what we're doing is the right thing long term. I wanna applaud HHS, its efforts to create a new food pyramid, which prioritize real food and makes hospitals food healthier pledge. So I guess one of the things I'd like to ask all of you, have you taken a look at that pledge and whether does that make sense to you? Uh, in terms of signing on, if you haven't signed on, will you sign on? J- j- anybody that's taken the pledge? Go ahead. Yeah, go ahead. Did you want it?

Yes, uh, Vice Chairman Buchanan, so thank you for the comments. Um, I would say that, um, at Common Spirit Health we follow the Make Hospital Food Healthier pledges that, uh, HHS has put forward. Uh, we certainly believe in, uh, food as medicine as part of, uh, what we do to serve communities. uh in a number of communities where we serve, where there i- where there are food deserts. Um our facilities offer food pantries with fresh produce to provide um those resources for those who don't have access. And so we certainly support uh the notion of of healthy food, sir.

Mister Donnelly, uh go ahead, just what's your thoughts on that,

Yes.

I know I touched base with you, we talked about it a little bit,

We

but I think it's huge.

Yes. Yes, thank thank you Congressman for your advocacy of living healthier lifestyles. It is one of the four things that we're working on in order to develop uh more affordable care. Strong, strongly agree with you in what we do is we're embedded in our communities, we work with our schools, we work with faith-based organizations, we work with non-profit organizations around teaching healthier lifestyles, around teaching proper nutrition, around teaching healthy exercise. We work with our schools so that we can reach uh people at a younger age, because then the impact is longer lasting. They also work uh with their families.

You find that statistic, twenty percent of children are obese, is that legitimate, is that a number? That's the number I've heard, it's outrageous to me.

I I I don't know the exact statistic, but I know it's unacceptable and every one of us should understand the role that we can play and especially in health care in a preventive way, because that decreases

You guys are in the health business, we've gotta get people healthy. Uh, Mister Hazen, you wanna give us your thoughts uh on that?

Well, I think anything, Congressman, that we can do to make

Yeah, I've only got a couple of minutes, seconds. I've only got a couple of minutes, seconds. Let me just say, I I hear what you're saying. Let me just say, I I hear what you're saying. I wanna try to help people uh be able to not get to that level. I wanna try to help people uh be able to not get to that Someone said that if you have a heart attack, fifty percent of people don't live to see the next day. How about not having a heart attack in the first place? I think a lot of it's diet related, obviously movement exercise as well, but I that's kind of where I'm coming from. We all have a responsibility. We're spending five and a half trillion dollars, basically five point three trillion dollars in health care, and we're getting sicker. That's gotta change and change now. Thank you. I yield back.

Mister Neal.

Thanks, Charmin. So let me acknowledge just as I begin my uh questioning the hard-working people who are part of this debate today, and that's members from Thirty-Two, BJ, SEIU from New England, who do a great job for all of us every day, and they understand what's gonna happen with the impact of the cuts that are coming to Medicaid and to the ACA. They, like all members of the American family, are going to be facing the reality of what the tax bill the Republicans embraced will do. America needs eighty-six thousand new doctors. That's where graduate medical education comes in. That's where our academic centers come in. Every member of Congress ought to spend a Friday night or a Saturday night in an emergency room to see what it's really like for people who arrive there without a lot of answers, or perhaps that mom with a sick child. Do members understand what disproportionate share hospitals do? The testimony was exceptional today. It's not about rural versus urban. It's about making sure that when a rural hospital perhaps can't solve a certain problem that they might move to an urban setting or vice versa, whereas noted here with perhaps lower cost, it could happen. But people that show up in an emergency room on a Friday, Saturday night, they are unlikely to be too concerned about cost. And that's where advocacy comes in. These cuts that are being proposed don't make any sense. And let me say something about Bay State Medical Center again. And Mass General Hospital. If you've got a sick child anywhere in America, I can recommend those hospitals to you. The work that they perform is extraordinary. Do members of the committee and Congress understand what technology is done to driving health care costs? Does anybody know what a c- the cost is of a linear accelerator? It's top-notch health care. And again, the argument today is we should justify these tax cuts by denying people basic health care at our hospitals This committee, as I noted in my opening statement, on a bipartisan basis, we expanded graduate medical education opportunities to help address the issue of a shortage of eighty-six thousand doctors across America. I am proud of what we've done over many years here by incrementally improving the opportunities for people as it relates to health care. But let's also be honest. The emergency room is a bad place to have to get health care. That's just the reality. And getting out front on a lot of these issues could be very helpful to, again, the American family. Your testimony has been right on target. So let me ask you, Mr. Woodhouse. Tell us about the fifteen million Americans who are about to be denied health care because of the tax cut bill that our Republican colleagues have embraced.

Sure. Thank you, Chairman Neal. And as you know, Protect Our Care is all across the country. Um, and we're collecting stories constantly about people who are facing, uh, facing these challenges. We've heard from, uh, farmers in Iowa, uh, small business owners in Virginia, uh, caregivers in Michigan who have had their health care jeopardized by these cuts. Um, in some cases particularly by, uh, the elimination of the tax credits. Uh, we collected hundreds of stories of working Americans who are losing health care or pay what is now double, triple and quadruple uh their health care premiums. I'll give you two stories. Uh, Janine Shackelford uh is a realtor in Youngstown, Ohio who is self-employed, was self-employed because the Affordable Care Act made her health insurance affordable, around two hundred dollars a month. In twenty twenty six her premiums jumped to nine hundred dollars a month, more than her mortgage. She could no longer afford it and she's been forced uh, to leave, quit her job, which was self-employed, to try to find a job with insurance. Rina, uh, Bumbray Graves is a home care worker in Woodbridge, Virginia, who cares for two relatives with disability. She and her husband's premiums spiked from five hundred and forty-four dollars a month to over thirteen hundred a month. And you know what? They're just not going with health care right now. They simply can't afford it. So there were, those are two stories, but there are dozens and dozens and actually

Yeah.

hundreds that we've collected that are just like that.

Thank you. So I hope that all members of the committee might consider, perhaps on a Friday or Saturday night, getting in an ambulance and making a patient run. To see what it's like for senior citizens, perhaps for one is confused, but there is a real emergency. I think that we're misunderstanding the realities of what a breast cancer imaging machine might cost, what a linear accelerator might cost, what the best doctors in the world and nurses and health care professionals might cost. This could be addressed in a bipartisan manner, absent what the big bill did. And I yield back my time.

In January, this committee heard from the CEOs of the biggest health insurance companies. When asked what is driving up premiums for Americans, they pointed their finger at all of you, the hospitals. They they have a point. The data clearly shows that hospital prices have risen faster than any other part of the economy, nearly three hundred percent in just the past twenty years. And one third of all U. S. health spending is on hospital care more than any other part of the system, one point six trillion dollars a year. However, hospitals and health care providers are the ones delivering medical services. Um, I believe every member of Congress has been in emergency room with a family member or a friend. So I don't think we have to, like, address that. I think we all understand health care. Um, let's start with a show, show of hands. Um, I'm gonna ask a few different questions. Raise your hand if you agree that insurance providers are too big and are taking advantage of health care providers. It's for all of you. So two of you agree with that. Um, raise your hand if your hospital or an association that you are a member of lobbied to expand the expanded Obamacare tax credits that would have funneled four hundred billion dollars directly into the pockets of those same insurers. Only one of you. So two of you. Uh, you just have to raise your hand at the same time when I ask it. If you don't agree with the statement, don't raise your hand, but if you agree with the statement, raise your hand. It's pretty pretty simple. So, just one. Mister Hazen. Um, thank you for for being honest. This is one of the problems with health care. Hospitals, they blame insurers and drug companies. Democrats blame Republicans, Republicans blame Democrats, um insurers blame hospitals and drug companies, drug companies blame PBMs and hospitals, but when it comes to fixing the system, the only thing you all agree on, really, um is that it's it's some other people, other issues that's the increase. Um, raise your hands if you believe hospitals deserve to be paid more than independent physician practices for the exact same service. Thank you. This is another serious problem. Hospital empires are being financially incentivized to reduce access in rural communities and are working to game the systems to get the highest possible reimbursements but when you talk about policies that create competition and more access for patients you get vocal opposition. from you and your Washington representatives. Medicare relies on outdated and mis-aligned reimbursements that pay more for the same services delivered in a hospital clinic than an independent physician's office. Let's talk about what that means for a senior living in my district in Festus, Missouri. Raise your hand if her Medicare bill for a standard X ray image would be higher in your hospital-owned clinic than if she went to her local doctor's office. Right? Raise your hand if your hospital makes more revenue for that service than the doctor down the street. Now raise your hand if you would support legislation that equalizes such payments at the doctor rate, so folks can have more access to care and a bill that they can afford. Unfortunate. A troubling development in Medicare over the last decade has been sophisticated wealthy hospitals and health systems in urban cities, leveraging a loophole to classify themselves as rural, even when they treat few, if any, rural patients. They do this to reap a windfall of benefits, intended to support truly rural hospitals. including higher residency, training, funding, and easier access to heavily discounted drugs under the three forty B program, a highly lucrative revenue stream for hospitals. Rural classifications have risen from only three hospitals in two thousand seventeen to four hundred and twenty-five by twenty twenty-three, a fourteen thousand percent increase. All of this is the expense of truly rural communities. Doctor Donley, as you know, I represent one of the most rural districts in Congress, made up of farmers and ranchers who drive up to a more than an hour for basic care at a rural facility that is reimbursed four percent lower than the national average. You have chosen to self-classify your flagship hospital in your New York Presbyterian system as rural, meanwhile you get reimbor- reimbursed forty percent higher than the national average. To be clear, there are zero farms there in Midtown Manhattan. I've been there. And no crops are growing on East sixty-eighth Street, next to your supposedly rural hospital campus, correct?