House Subcommittees Address Health Insurance Affordability Issues

On January 22, the House Energy and Commerce Subcommittee on Health and the Ways and Means Committee convened to tackle critical issues impacting health care affordability. Executive leaders from five prominent commercial health insurance companies—UnitedHealth Group, CVS Health, Elevance Health, The Cigna Group, and Ascendiun—provided insights on the growing costs and accessibility challenges tied to commercial insurance plans. During these sessions, the focus was on addressing the industry's regulatory compliance requirements and AI-driven prior authorization delays.

The American Hospital Association (AHA) presented statements to both committees, aligning the insurance market's dynamics with rising health care expenses. The AHA emphasized patient access issues, pointing out that the top seven commercial insurers collectively cover about 190 million individuals, representing two-thirds of the insured population in the U.S. This coverage spans a range of plans, including Medicare Advantage, employer-sponsored insurance, Medicaid managed care, and marketplace options.

The discussions also highlighted how horizontal and vertical integrations within the insurance industry have enhanced profits while influencing health care costs. A major concern was the impact of insurer practices, such as prior authorization, on timely medical care and provider operations. The association urged Congress to consider reforms in prior authorization processes, the establishment of timely payment standards for Medicare Advantage, and the strengthening of network adequacy standards, particularly concerning post-acute care, to advance regulatory compliance and improve payer and provider relations.