Top executives at the nation's leading managed care companies told members of Congress that rising costs are the root cause behind healthcare unaffordability.
CEOs of five major managed care insurers testified before a House Energy and Commerce subcommittee on Jan. 22 as part of a series of hearings dealing with the cost of healthcare.
Over the past two years, much attention has been to the high cost of prescription drugs, rising health insurance premiums and difficulties in obtaining coverage. A number of publicly traded insurers, including UnitedHealth Group Inc., have been put under the spotlight for their practices.
UnitedHealth CEO Stephen Hemsley during the hearing said its coverage is competitively priced and soaring premiums are the result of a broader rise in medical costs.
"The cost of health insurance is driven by the cost of health care," Hemsley said. "It is a symptom, not a cause."
Premium rates are based on how much care is used and how much is charged for that care, according to Hemsley. When the price of care goes up and care activity increases, the cost of health coverage necessarily follows.
"Our industry is one of the few stakeholders in the health care ecosystem incentivized to keep the cost of care as low as possible while still maintaining high-quality health outcomes for people and helping them avoid getting sick in the first place," Hemsley said. "And it is a virtuous circle."
Hemsley's comments were largely echoed by his fellow CEOs, including Elevance Health Inc.'s Gail Boudreaux and The Cigna Group's David Cordani.
"When the prices charged for care and prescription drugs rise, and when more services are delivered, those costs flow through to premiums, deductibles and other out-of-pocket expenses," Boudreaux said in prepared remarks. "Premium rates are based on expected medical costs, and sustained affordability depends on addressing these underlying drivers across the system."
ACA tax credit conundrum
The hearing was punctuated an ongoing debate over whether to extend COVID-era Affordable Care Act tax credits, which helped subsidize the premiums of millions of Americans who purchase coverage through the public marketplace. Congressional Democrats have pushed for a continuation of those credits, which were the target of Republican-led cuts and led to the longest ever federal government shutdown when an extension was not included in a budget bill.
Several Senate Democrats eventually broke rank in November 2025, voting to pass a budget bill that did not include an extension. While a few House Republicans have since voted to support a credit extension, a lack of support from the Senate and President Donald Trump leave its fate murky.
Families on the ACA plans face an affordability crisis, said Rep. Jason Smith, the Republican chairman of the House Committee on Ways and Means. Pointing to the rise in premiums and high out of pocket maximums for ACA members, Smith said the crisis impacts not only those using the exchanges, but also those who receive insurance through private employers.
"The private employer marketplace that you all participate in and that more 160 million Americans whom you also provide coverage for, is experiencing the largest premium increase in 15 years," the Missouri congressman said.
Later in the hearing, a recent effort by President Trump to address the affordability crisis was broached. Trump last week unveiled outlines of health policies he wants Congress to consider, including a proposal to send money directly to Americans for health savings accounts.
The idea received pushback from Democrats during the Jan. 22 hearing, with Rep. Frank Pallone of New Jersey, describing the idea as "out of touch" and unlikely to put a dent in health care costs.
