Challenges in Health Care Costs and Patient Access Amid Mergers

In a recent hearing held by the Subcommittee on Health, chaired by Congressman Morgan Griffith, discussions focused on the challenges of health care costs and patient access. The session evaluated the U.S. health care provider landscape, continuing a series on health affordability, following earlier dialogs with health insurance executives and prescription drug supply chain stakeholders.

The U.S. provider landscape is diverse, comprising hospitals, large health systems, independent physician practices, and group practices, which offer varied health services. Significant consolidation is prevalent in the provider market through physician practice acquisitions and health system mergers. This trend often reduces care options for patients, especially in rural states, posing access challenges and increasing community strains.

Vertical integration threatens the sustainability of independent practices, further narrowing the provider landscape. The Affordable Care Act restricts the expansion of physician-owned hospitals established before 2010, limiting provider options and potentially escalating service costs. Transparency issues persist with price variations, unclear billing, and limited patient insight into health service costs.

Programs like the 340B Drug Pricing Program were designed to help low-income patients. However, participation by larger hospitals and affiliated contract pharmacies obscures discount utilization, raising concerns about the extent of savings reaching patients. These transparency issues highlight the need for effective regulatory compliance to ensure program integrity.

The complexity of navigating medical bills, whether for unexpected procedures or routine appointments, complicates the landscape for patients unable to bear these costs. Inadequate competition and transparency in provider markets risk rising prices, emphasizing the necessity for patients to make informed decisions about their health care.

The hearing also included testimony from several organizations representing diverse health care providers, such as the American Hospital Association, the American Medical Association, and the American Academy of Family Physicians. Each offered insights into factors driving high health care costs. Additionally, specialty doctors and representatives from community health organizations provided perspectives aimed at making health care delivery and accessibility more affordable.