Yesterday, the House Energy and Commerce’s Health Subcommittee and the House Ways and Means Committee held separate hearings where lawmakers pressed health insurance executives from UnitedHealth Group, CVS Health, Elevance Health, Cigna and Ascendiun (parent company of Blue Shield of California), on two issues that continue to generate bipartisan concern: the burden of prior authorization requirements and the role of hospitals and insurers in health care costs. 

While the hearing broadly examined health insurance affordability, much of the discussion focused on how vertical integration and utilization management practices like prior authorization can delay care, increase administrative costs, and strain providers and patients alike. 

Prior Authorization 

Members of Congress described prior authorization as a persistent source of frustration for clinicians and hospitals, citing reports of delayed treatments, increased paperwork, and staff time diverted away from patient care. Lawmakers argued that, while insurers often frame prior authorization as a tool to control costs, the process has become overly complex and frequently applies even to routine and evidence-based services. 

Insurance executives defended prior authorization as a mechanism to promote high-value care and patient safety. Several witnesses emphasized ongoing efforts to streamline the process, reduce turnaround times, and exempt providers with strong performance records from certain requirements. However, lawmakers remained skeptical, noting that providers continue to report widespread delays and denials that can undermine access to timely care. Rep. Dr. Kim Schrier (D-WA) stated, “Your companies are charging more, paying less, and then delaying or denying care due to abusive demands for prior authorizations. And I hear the same from hospitals, from physicians. They are telling me that they are forced to hire more people to deal with your paperwork than nurses.” 

The conversation also turned to how these administrative burdens contribute to rising health care costs. Hospital representatives and advocates have long argued that prior authorization drives up overhead costs, requiring significant investments in staffing and technology to manage insurer requirements – costs that ultimately affect patients and communities. 

Hospital Community Impact 

Lawmakers examined the issue of hospital community benefit and how not-for-profit hospitals reinvest resources into the communities they serve. Several members highlighted the essential role hospitals play as anchor institutions, particularly in rural and underserved areas, by providing uncompensated care, supporting public health initiatives and maintaining access to critical services regardless of a patient’s ability to pay. 

Some lawmakers questioned whether insurer practices, including narrow networks and aggressive utilization management, can undermine hospitals’ ability to fulfill their community benefit obligations. Hospitals facing delayed reimbursements or denied services, they argued, have fewer resources to devote to community health programs, workforce investments and safety-net services. 

Insurer executives acknowledged the importance of community benefit and emphasized partnerships with providers aimed at improving population health and reducing disparities. They pointed to value-based care models, care coordination programs and investments in preventive services as ways insurers contribute to broader community health goals. 

Vertical Integration Drew Scrutiny 

Lawmakers also raised concerns about the growing vertical integration of insurers, pharmacy benefit managers, and provider groups, questioning whether consolidation is delivering promised efficiencies or contributing to higher costs and reduced competition. CVS Health owns insurer provider Aetna and CVS Caremark, its PBM. UnitedHealth Group owns UnitedHealthcare, its insurance arm, and Optum, its PBM, which also employs doctors. Cigna, another insurer, owns Express Scripts, a PBM. In an exchange with David Joyner, the CEO of CVS Health, Rep. Ocasio-Cortez said that CVS, through Caremark, manages around 30% of all prescriptions filled in the U.S. “Mr. Joyner, that is quite a bit of market concentration,” Ocasio-Cortez said.  

The hearing underscored growing congressional interest in aligning insurer practices with broader health policy reform. While no immediate legislative proposals were advanced, the discussion signalled that prior authorization reform, administrative simplification, and greater oversight of insurance policies will remain front-burner issues for Congress.