Article
What happened in the hearing
On April 28, the House Ways and Means Committee questioned the chief executives of HCA Healthcare, CommonSpirit Health, NewYork-Presbyterian and ECU Health about rising costs. Insurers had testified earlier in the year and largely pointed to hospitals. Chairman Jason Smith (R-Mo.) made clear the committee would not accept a similar shift of blame from providers.
Rep. Mike Thompson (D-Calif.) tied financial pressure on hospitals to last year’s federal spending cuts. Republicans focused on prices. Rep. Ron Estes (R-Kan.) highlighted that public and private payers pay more for outpatient care in hospital-owned settings than in independent offices, and that routine care can cost far more after a hospital acquires a clinic.
How the CEOs answered
The executives rejected the idea that consolidation drives their prices. They cited regulation, labor, technology, sicker patients and uncompensated care. CommonSpirit’s Wright Lassiter III put the system’s annual compliance cost near $1 billion and asked for standardized clinical data requests, fewer quality measures and a single claim format for Medicaid.
The AHA’s written statement made a similar case with numbers: labor is about 60% of operating costs, supply spending rose 9.9% in 2025 and drug spending rose 13.6%. It estimated hospitals spent more than $43 billion in 2025 collecting payments owed by insurers and said Medicare underpaid hospitals by more than $100 billion in 2024. The association opposed site-neutral cuts and changes to 340B.
The policy threads to watch
- Site-neutral payment. Interest is bipartisan, though comprehensive legislation has not passed.
- Rural reclassification. Lawmakers questioned urban hospitals that also hold a rural designation for Medicare, a status used by more than 40% of acute care hospitals other than critical access hospitals in 2023.
- Physician practice acquisitions. Members criticized deals they say reduce competition.
What this means for boards
The hearing gave lawmakers a template. Expect similar questions from state officials, employers and the press. Boards should be able to explain, in plain terms, how their prices compare with peers, what happened to prices after past acquisitions, how outpatient facility fees are set and what the organization does for patients who cannot pay. A defense built only on cost pressure did not persuade the committee.
Archive entry for May 2, 2026, added Nov. 11, 2026.