Hearings on healthcare on Capitol Hill are increasingly dominated by grandstanding on both sides of the aisle. The heavily politicized nature of these events doesn’t lend itself to constructive problem-solving.
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Hearings on healthcare on Capitol Hill often devolve into partisan grandstanding on both sides of the aisle. The heavily politicized nature of these events usually doesn’t lend itself to constructive problem-solving.
At a January hearing, for instance, bickering politicians on both sides of the aisle agreed on one thing. painting a picture of bogeymen CEOs as healthcare villains, if you will. The Washington Post summed it up as follows:
“Despite partisan divide over solutions, Republicans and Democrats join in berating health insurance executives for rising premiums, denial of care and their multimillion-dollar compensation.”
Designed as oversight, House and Senate hearings have brought in pharmacy benefit manager, insurer, drug company and hospital executives to testify. Undoubtedly, holding these individuals accountable for their actions and decision-making is an important function of these sessions. But lawmakers often appear more focused on badgering witnesses (as if they’re on trial as defendants) or repeating often diametrically opposed political positions than attempting to find bipartisan policy solutions.
This may be great for politically charged soundbites, but it begs the question, what’s the point of these hearings? At a high level, lawmakers may want to have as a backdrop to each hearing the objectives laid out in the Triple Aim framework developed by the not-for-profit Institute for Healthcare Improvement: Improve population health, enhance patient experience and reduce healthcare cost growth.
It’s no secret that absolute and per capita healthcare costs are very high in the United States. This wouldn’t be as much of a problem if the system produced correspondingly excellent health outcomes. But overall, it doesn’t. The U.S. ranks at or near the bottom among peer nations on measures such as reduction of avoidable mortality.
The disconnection between the large amount of money the U.S. spends on healthcare and the country’s subpar overall outcomes isn’t a partisan issue. Nor are the high costs of healthcare for many patients owing to a particular measure pushed by one party or the other. And it’s not due singularly to stakeholder actions, however problematic certain behaviors may seem. Rather, it’s because of systemwide dysfunction that can’t be resolved by finger-pointing or pinning the blame on one group or another.
Accordingly, reforms are needed. But they’re not coming in the form of a teardown of an existing pillar such as the Affordable Care Act. It’s the law of the land. And it’s comparatively popular among constituents.
However, at a January hearing in which health insurance executives testified, Republicans declared that the ACA was the source of trouble as it was causing rising costs. And in a tit for tat, Democrats defended the ACA and blamed Republicans for voting to end the extended ACA subsidies for millions of people.
KFF conducted a survey this spring of Americans who were enrolled on the ACA marketplace exchange in 2025. Since Congress failed to extend enhanced federal subsidies that had made ACA coverage affordable for many in recent years, the survey found that premiums went up for the vast majority of respondents and often considerably. And many people reported struggles with paying medical bills.
Yet lawmakers haven’t budged from their initial positions on the ACA. Compromise doesn’t appear to be on the table. It’s almost as if facts on the ground don’t matter, namely that constituents nationwide are hurting financially with millions ditching healthcare coverage altogether due to costs and now simply hoping for the best, that is, not to get sick.
Illustrations of Congressional inertia and a tendency to resort to predetermined talking points aren’t confined to politically sensitive topics such as the ACA. Even during somewhat dry fact-finding sessions political campaign themes are brought up or even information with no apparent relevance to the topic at hand.
For instance, at a House hearing last month on hospitals, health systems and rising costs, Democrat John Larson (D-Conn.) introduced Medicare for All as a supposed elixir. Needless to say, such a radical change isn’t imminent. There isn’t nearly sufficient support for Medicare for All in Congress. Why then even bring it up in a meeting with hospital executives?
Meanwhile, Republican Jason Smith (R-Mo.) talked about hospital margins being greater than those achieved by Delta Airlines, Target and Disney, all three companies in totally unrelated industries with vastly different cost structures.
It’s refreshing, however, that hospitals are getting scrutiny in Congress. After all, hospital costs account for the greatest share of overall healthcare expenditures, which translates into ever-increasing premiums for consumers as insurers pass on increased medical service spending. Increasing prices of procedures, labor costs and myriad facility fees are helping drive up spending on hospital inpatient care, which for several decades has risen about twice the rate of inflation, outpacing physician and outpatient services as well as prescription drugs. An increase in uncompensated care due to the increasing numbers of un- and underinsured also impacts hospitals negatively. Furthermore, health system mergers have eliminated many community hospitals. Meanwhile, the emergence of mega conglomerates hasn’t curbed costs, or led to an improvement in quality of care.
But as legislators grilled hospital executives, at times they appeared to be talking at cross purposes.
Nevertheless, this particular hearing revealed the potential for a mutual understanding on a few issues. Lawmakers from both parties agreed on the problems at hand of high hospital expenditures and patient access barriers such as prior authorization. They also identified several areas of possible bipartisan overlap. This includes pursuit of a site-neutral payment system in which Medicare reimbursement amounts would be standardized, regardless of whether a service is delivered in a hospital outpatient department, independent physician’s office or ambulatory surgery center.
Several areas of common ground notwithstanding, the session on hospital care and costs offered only limited room for compromise or even approaching most objective issues without a political lens. And this seems peculiar to observers. Not just at this hearing, but other meetings on healthcare, too.
The financial pressures associated with healthcare affect practically every American household, in the form of cuts in coverage, rising insurance premiums, out-of-pocket costs for things like prescription drugs or emergency room visits. This ought to be front and center at every hearing. After all, lawmakers represent the American public, both in districts in their home states and at the national level.
Instead, the hearings tend to function as venues for adversarial political messaging and electoral gain rather than legislative consensus-building to identify and eventually solve the large problems affecting U.S. patients. Waging political battles doesn’t address the constituents’ burdens stemming from the healthcare system, financial and otherwise.