▶ 0:19:27The committee will come to order. Good morning, and I'd like to thank each of our witnesses for voluntarily agreeing to appear before the committee this morning. Today's hearing is a continuation of the committee's larger effort to get to the root causes of why healthcare is so outrageously expensive for patients, and why so many Americans lack access to CEOs representing some of the nation's largest hospitals are before
▶ 0:19:57us. But, let me be clear, the entire healthcare system, hospitals, insurance companies, drug manufacturers, pharmacy middlemen, all bear responsibility for the high cost patients patients face. First, hospitals, and in particular, the doctors, nurses, and medical professionals who work there treat and do it with some of the most advanced medicine in the world.
▶ 0:20:24Our communities are better off with hospitals in them. But, large health systems have taken advantage of that The corporatization of American hospitals means that our local hospitals and physicians have been replaced by mega corporations that put quarterly earnings over quality care, and grow larger simply for the sake of growing Hospitals with more than 100 beds have a higher profit margin
▶ 0:20:55than Delta Airlines, Target, or Disney. Let me repeat that again. Hospitals with more than 100 beds have a higher profit margin than Delta Airlines, Disney, and Target. Turns out charging an arm and a leg for healthcare is more lucrative than the happiest place on Earth.
▶ 0:21:19When CEOs of some of the largest health insurance companies came before this committee earlier this year, they pointed the finger at hospitals as the culprit. This committee isn't interested in hearing about how the high prices your businesses charge are somehow someone else's fault. The blame game didn't work with insurers, and it won't work today with us. Simply put, hospitals are charging an insane amount for care.
▶ 0:21:48Hospital prices have skyrocketed 300% in just over two decades, more than any other sector of our economy. Not one sector was even close. Hospital consolidation and mergers that lead to ever-growing market power are fueling the borderline extortionary prices hospital charge charge patients.
▶ 0:22:11Today, there are 4,500 hospitals, and 2,000 of them have undergone undergone a merger since 2000. The result is that today 90% of hospital beds are part of a health health system. The place and scale of mergers have led to market concentration that puts patients at the mercy of hospital empires.
▶ 0:22:39When hospitals have no competition, it's no wonder that the sky seems to be the limit for prices. A family in California was charged nearly $300,000 to treat their toddler's snake bite. for a toddler's snake bite.
▶ 0:23:02A man in Florida had an emergency CT scan that the hospital billed for A follow-up scan at a different location cost him only 79 bucks. Another Alaba- Alabama woman was sued for the full cost of her appendix procedure plus interest, nearly $37,000, after faithfully paying the bill every month for 3 years.
▶ 0:23:31She told her husband that the burden of the lawsuit was so that she wished she had passed away at the hospital rather than deal with the Those stories illustrate how these systems prey on patients who have few options for care in their time of need. Patients are not getting better for the higher prices, either. Study after study found that hospital mergers are not generally associated with better health.
▶ 0:24:00In rural America, hospital mergers may sustain access in some communities, but I have seen firsthand how profit-seeking health systems view struggling rural hospitals as nothing more than a gateway to more patient It's no wonder rural Americans are sicker, have higher rates of chronic disease, and die earlier as a result.
▶ 0:24:24What's worse, a complex set of legal loopholes and open-ended taxpayer subsidies, manipulated by sophisticated hospitals, have become a key part of a business model that fuels ever-larger systems, eliminates competition, and drives higher prices.
▶ 0:24:44Urban hospital chains double-dip and classify themselves as both urban for higher wage index reimbursements, and then reclassify as rural for another set of government benefits. That's absurd. One example that this committee has been focused on is the 10% of new residency slots that Congress set aside in 2020 for rural hospitals.
▶ 0:25:12Of the 120 slots allocated to rural hospitals, only 30 have actually gone to truly rural communities. In total, urban hospitals have taken 97% of all new residency slots, far more than Congress ever intended.
▶ 0:25:31It's unacceptable for large, wealthy urban hospitals to take what rightfully belongs to truly rural communities when those communities already suffer from lack of access to care. Regardless of a hospital's geography, we've seen health systems leverage payment differentials between hospital-owned clinics and independent physician offices direct more money to their corporate coffers.
▶ 0:25:59The higher reimbursement for hospital-owned clinics incentivizes consolidation and encourages hospitals to buy up more independent practices. It's no wonder today half of the US physicians are employed by larger systems like hospitals. Unsurprisingly, this business practice practice also raises costs for patients receiving the exact same service.
▶ 0:26:26For an ultrasound cost $164 when provided by a physician. It cost $339 at a hospital outpatient department. A biopsy cost about $150 when performed by a physician. It cost $800 at a hospital outpatient department.
▶ 0:26:52Congress, including this committee, has taken efforts to right the wrong and ensure patients and taxpayers pay lower prices for the same service with the same quality. But every time we try to advance these so-called site-neutral policies, big hospitals, they fight us. They fight us tooth and nail.
▶ 0:27:13For-profit hospitals are are legally required to put shareholders over patients, but so-called nonprofit hospitals rarely act much different. Tax-exempt hospitals deliver charity care that is consistently worth less than the tax breaks that they receive.
▶ 0:27:32These nonprofit hospitals receive a $28 billion tax break while only spending roughly $16 billion on charity care a The difference fuels a spending spree totally unrelated to providing health care like real estate investments, stadium naming rights, green energy initiatives initiatives, and political Large hospital systems also manipulate the 340B
▶ 0:28:02drug pricing program to keep steep drug discounts for themselves instead of passing the savings to low-income patients. There is little evidence that the $290 billion discounts given to hospitals under the 340B program since Obamacare was reinvested in patients.
▶ 0:28:24Even worse, there is evidence that that hospital abuse of 340B actually direct directly led to increases in Obamacare Today, I expect we will hear how from these hospital executives their opinion on how insurers and drug makers contribute to the affordable cost of health care.
▶ 0:28:47But this committee will be asking and expect answers to why hospital prices make up by far the largest share of the insurance premium increases that grew three times faster than earnings. This hearing is not the end of the road for our investigation into the unaffordable cost of health care. The American people are fed up with outrageous prices that seem artificially high. They're right. Hospital prices are unjustified.
▶ 0:29:17This committee will continue to fight to lower health care costs for working families. The first step is to get answers and expose the truth, and that's exactly why you are all here today. I'm pleased to recognize the ranking member, Mr. Neal, for his opening statement. Thank you, Mr. Chairman. Rightfully feeling the heat of the public's anger, the majority is holding your third hearing on health care in as many weeks, all to deflect blame and responsibility.
▶ 0:29:46Families are not going to be fooled This is about their tax bill. They know that right now it's wildly unpopular and anything that can distract from the tax should be part of this conversation. Last year in America, the only real economic growth was in health care for obvious and good reason. It's based on the innovation that is taking place.
▶ 0:30:14A reminder to colleagues, technology helps to drive the cost of health care. Let me give you an example. From Springfield to Worcester, Baystate Medical Center, UMass Memorial, a 40-mile stretch, and this morning the addition of Mercy Medical Center, 40 miles, more than 30,000 people get up and go to work every day.
▶ 0:30:42Who wouldn't want the teaching hospitals that we have across this country? And I'm proud of the fact that we expanded GME slots in a bipartisan manner We will continue on the Democratic side to defend Medicare and Medicaid and the Affordable Care Act. An understanding that patients and families simply can't afford what's being offered to them as they watch profits for big corporations soar.
▶ 0:31:13But trying to lower the cost of health care or perhaps a better description would be to manage it is a challenge now largely because of their tax bill. 37% of marketplace enrollees say they're cutting back on food and other necessities to afford health care We need to listen to them. I heard the argument that was offered just a couple of minutes ago. It's been my honor to represent the Sisters of Providence and the Mercy Medical Center through my lifetime.
▶ 0:31:42As I always point out, at 7 years old I left my appendix there as well. Their achievements are remarkable. The Sisters of Providence, what they did for health care in Western Massachusetts, the Pioneer Valley, and indeed across America is witness to the advances we've made in health care. Democrats know that it can be done and we want further opportunities to make sure that health care in America is expanded to all members of the American family.
▶ 0:32:10Because of our fight, Medicare drug negotiations and cap we capped out of pocket and insulin costs, expanded senior benefits, we delivered years of record enrollment, and now only 8.5% of the American people are without health insurance. Statistic, every child in Massachusetts has health insurance. 97% of the adults in Massachusetts have health insurance.
▶ 0:32:35Four former governors and the current governor of Massachusetts including Mitt Romney and Bill Weld gathered but 2 weeks ago to celebrate our achievement. And you know what? Republican and Democrat, they all deserve credit for what they were willing to do when they had the opportunity.
▶ 0:32:53That's how you deliver for The president stamps his name on websites and hands out favors, but doesn't want to acknowledge the reality of how hard it is to manage health care costs. With the health care crisis is looming over millions of families, the fervor and attention that we've heard everywhere seldom addresses some of the root causes.
▶ 0:33:16Last year, we warned for months that their trillion-dollar tax cut bill was going to harm on the American health care system. They refused to acknowledge the questions that we raised. They ripped coverage from 15 million and pushed hundreds of hospitals to the brink. And then they complain about the problem after it's their tax bill that's going to lead to these massive cuts.
▶ 0:33:42Health care is not a Democratic or Republican issue, it's an American Their challenge based on rural health care is simple, and we want to help because many of us, myself included, we have rural health care challenges as well. I helped to reopen a hospital that was in desperate need of a rural because of its rural setting, and today that hospital continues to deliver first-class health care.
▶ 0:34:09All of this is based upon they set the fire and now they're calling the fire There is no plan. I've been here for a long time. There has never been a Republican agreement on health care. Simply the critique of what we've tried to do in the affirmative. They keep trying to convince people that it's about just the providers.
▶ 0:34:30It's about many of their policies as Families are paying more for everything because they have decided to go along with these ill-considered proposals. There's a different path. Democrats believe in the power of legislating for a fairer tomorrow. We stand up against those who try to cut so that they can cut health care.
▶ 0:34:52We need to be talking about real solutions that bring costs down for workers and families and that starts with reversing the harm of what they did in their tax bill. And you in the room today are going to be asked questions because of their policies as it relates to the tax bill. We should have a conversation about the tax bill and then we can get on to some of the questions that perhaps are legitimately posed to all of you this morning. Thank you, Chairman.
▶ 0:35:20Thank you, Ranking Member Neal. I will now introduce our witnesses. Um Mr. Sam Hazen is the Chief Executive Officer um of HCA Healthcare. Mr. Mr. Wright Lassiter is President and Chief Executive Officer of Common Spirit Health. And we have Dr. Brian Donnelly is President and Chief Executive Officer of New York-Presbyterian. And we have Doc- Dr. Michael Waldrum is Chief Executive Officer of the ECU Health.
▶ 0:35:51Um we have Mr. Brad Woodhouse is President of Protect Our Care. Thank you all for joining us today. Your Your written statements will be made part of the hearing record and you each have 5 minutes to deliver your remarks. Um Mr. Hazen, you may begin when you are
▶ 0:36:09Chairman Smith, Ranking Member Neal, and members of the committee, thank you for this opportunity to testify on health care affordability. I'm Sam Hazen, Chief Executive Officer of HCA Healthcare. I've been with the company for 43 years and throughout my career, I've remained grounded in a simple belief. Healthcare is deeply personal and essential to everyone. I was raised in the coal mining communities of rural Kentucky where access to care was often limited by distance, income, and infrastructure.
▶ 0:36:39Those experiences reaffirmed my commitment to high-quality healthcare accessible and cost-effective for all. I'm honored to lead HCA Healthcare, a network of 190 hospitals and more than 2,500 sites of care. Last year, HCA served 47 million patients including many in rural and underserved communities. Our Our hospitals operate 24 hours a day, 365 days a year.
▶ 0:37:09They are designed to operate under extreme conditions and remain open and responsive throughout public health emergencies like the COVID-19 pandemic, hurricanes such as Hurricane Helene, and other disruptions.
▶ 0:37:23We provide critical, life-saving services, and we care for every patient who comes through our emergency room doors regardless of their ability to Last year alone, we provided approximately $4.5 billion in uncompensated care including charity care and financial assistance for uninsured patients. That number reflects commitment to our mission and the essential role our hospitals play in communities across the country.
▶ 0:37:53The reality of our system today is Healthcare in this country has never been better nor more advanced, but it is also too expensive for too many people. Whether it is the price of a prescription, insurance premiums, or an unanticipated emergency room visit, the financial pressures associated with healthcare affect every American We ask this committee to consider three ways to address the affordability challenges.
▶ 0:38:21First, one of the most effective ways to address this challenge is to ensure stable and affordable health insurance coverage. When patients have reliable coverage, they have greater access and can seek care earlier, manage chronic conditions more effectively, and avoid costly emergency Coverage is an essential starting point, but coverage alone is not enough.
▶ 0:38:46Providers must also deliver care more efficiently, with higher quality, and greater consistency. At HCA Healthcare, we are investing in technologies, workforce development, and care delivery models that improve outcomes, expand access, and reduce unnecessary costs. We are working to give patients better information about the cost of their care, while recognizing that true transparency requires coordination across the entire system.
▶ 0:39:16Second, fair competition matters, too. When providers compete on quality, service, and access, it drives better patient care and lowers costs. Certificate of need laws, originally intended to control costs, now do the opposite, limiting competition, constraining supply, and increasing Revisiting these laws would encourage innovation and improve access, especially in underserved areas.
▶ 0:39:46we also see firsthand the toll of administrative complexity. Insured patients and providers routinely face barriers, including prior authorization and payment disputes disputes, such as care denials and underpayments. These frictions translate directly into delayed diagnosis, reduced access, and higher costs. HCA is attempting to work with payers to address some of these challenges, and I am encouraged by early progress.
▶ 0:40:15At the same time, hospitals must comply with hundreds of overlapping and sometimes conflicting federal and state requirements. While these regulations promote quality, their volume can often create inefficiencies that divert time and resources away from the patients they are meant to protect. In conclusion, the best way to improve health care in the United States is for all participants to work together toward the shared goal of building a system that serves everyone.
▶ 0:40:43At HCA Healthcare, we are committed to playing an active role in that effort. Thank you again. I look forward to our discussion today.
▶ 0:40:51Thank you, Mr. Lassiter. You are now
▶ 0:40:57Chairman Smith, ranking member Neal, and members of the thank you for the opportunity to testify on an issue that affects every health care affordability. I'm Wright Lassiter, president and CEO of Common Spirit Health.
▶ 0:41:13I'm proud to be here representing our Catholic, nonprofit health system that operates 158 hospitals across 24 including 41 rural facilities, and among them 29 critical access hospitals, making us one of the nation's largest rural health care providers. Guided by a mission to serve all, especially those who are most we provide 25 million patient visits each year.
▶ 0:41:42We are one of the nation's largest Medicaid providers, and we deliver one out of every 42 babies in this country. Health systems play a critical role in affordability by integrating hospitals, clinicians, and care teams to reduce duplication and improve outcomes. Health systems support information technology, electronic health records, and data integration.
▶ 0:42:06We also create operational efficiencies, improve purchasing and contracting so more resources can flow to patient care. That is especially important in rural and underserved communities where stand-alone hospitals often lack the ability to spread fixed costs, invest in innovation and technology, or sustain essential services when reimbursement falls short and expenses Since forming in 2019, CommonSpirit has
▶ 0:42:36reduced operating costs by $3 billion through scale, efficiency, and We have also used that scale to strengthen quality and safety across our health system. CommonSpirit has exceeded the national average for CMS hospital quality star ratings for 5 straight years.
▶ 0:42:55We provide more than $5 billion in community benefit annually, including the unpaid costs of governmental We are consistently using new approaches to improve care and strengthen For instance, our sepsis surveillance program helped save more than 3,600 lives last year and reduce stays in the ICU by more than 33 hours per patient.
▶ 0:43:19Our AI initiatives generate more than $100 million in savings on an annual basis by improving efficiency and reducing administrative burden. Our virtual integrated care program provides real-time remote support to nursing teams, helping us address workforce shortages and support high-quality care. Virtual nurses help safely discharge more than 16,000 patients, freeing up bedside nurses from thousands of hours of paperwork.
▶ 0:43:51health care affordability is being strained by four powerful forces: rising supply and technology technology payer behavior, and regulatory burden. Labor alone has risen more than 20% in the last 5 years and now represents more than 54% of our operating expenses.
▶ 0:44:13Prices of pharmaceuticals, medical supplies, and and advanced technologies each grew by more than 10% last year. For example, our spending on IV fluids has increased by more than 14% since 2024. Payer pressure is also intensifying.
▶ 0:44:35Billing for Medicare Advantage patients is about 25% more expensive than for traditional Medicare patients, pulling staff, time, and resources away from patient care. Commercial insurers increasingly deny claims or underpay for services Medicare Advantage plans are the most Today, we have $4.3 billion in unpaid Medicare Advantage claims, with nearly 1 billion of that
▶ 0:45:05being more than 150 days past due for care that Common Spirit has delivered to patients in communities that you represent. Medicare and Medicaid represent nearly 70% of our patient volume, yet Medicare reimburses approximately 80% of our cost to care for those Medicaid underpayment is also an access issue, especially in rural communities that typically have higher rates of unemployment and poverty.
▶ 0:45:34When public When public coverage falls short and more people become uninsured, uncompensated care rises, pressures on hospitals intensify, and access becomes harder to sustain. Regulatory burden for Common Spirit adds another $1 billion of cost to our expenses on an annual basis. Those are resources that otherwise could be placed directly towards patient care. We cannot solve affordability alone.
▶ 0:46:02Hospitals, providers, payers, and the government must work together to ensure timely payment for care delivered, adequate reimbursement for Medicare and Medicaid, relief from from unnecessary regulatory burden, and stronger accountability for health plans. Thank you for the opportunity to be part of the discussion today.
▶ 0:46:20Thank you, Mr. Donley. You are now
▶ 0:46:23Good morning, Chairman Smith, Ranking Member Neal, and distinguished committee My name is Brian Donley, and I serve as president and CEO of New York I'm also a doctor with more than 20 years of experience caring for patients. I joined New York Presbyterian 3 years ago as the chief operating officer, and I assumed the CEO role 12 weeks ago. I was raised in Pittsburgh, and caring for people was a central part of my upbringing.
▶ 0:46:53My mother is a nurse, and my father was a community pharmacist. They instilled in me that healthcare is grounded in empathy, respect, and the sacred trust between a patient and a I come before you today as both a doctor and a health system leader deeply focused on compassionate, high-quality, accessible, and affordable I want to begin by acknowledging what New York Presbyterian patients and patients across this
▶ 0:47:23country are The cost of care is a real and growing I recognize that hospitals are one part of a broader healthcare system that contributes to these costs, and I take that responsibility seriously. New York Presbyterian is committed to working with policy makers, payers, pharmaceutical companies, and the many other healthcare stakeholders to find solutions that make care more affordable and more accessible to Americans.
▶ 0:47:55New York Presbyterian is one of the nation's oldest academic systems. With 10 hospitals, nearly 45,000 employees, and more than 2 million patients served annually. We are among the largest providers of care to Medicaid patients in New York. And we serve patients from all 50 We care for some of the most complex and vulnerable individuals in the country.
▶ 0:48:20In fact, our children's hospital provides some of the highest acuity of care of any children's hospital in the For 250 years, our approach has been grounded in an enduring set of commitments, including putting our patients first, investing in our people, and maintaining deep connections to the communities that we serve. Our mission is straightforward.
▶ 0:48:45To provide the highest quality of care to all patients, regardless of their ability to pay. But delivering on that mission comes with real financial pressures. We are facing substantial cost pressures, such as labor, supplies, and With drug costs alone rising by 25%.
▶ 0:49:06Compounding these challenges, government payers do not reimburse the full cost of We also face growing administrative burdens driven by the current insurance environment that creates unnecessary cost and frustration for both patients and providers. In response, we are focused on four key areas to make care more affordable for our patients. First, we are doubling down on high-quality care.
▶ 0:49:33Because when care is better, it's not only not only do patients do better, but care is less costly. That means fewer readmissions, fewer hospital-acquired infections, and fewer complications. Second, when it's right for the patient, we are shifting care to lower cost settings through hospital-at-home programs, virtual nursing, ambulatory care, and telehealth.
▶ 0:49:57Third, we are using technology to drive efficiency by cutting waste, improving productivity, and reducing administrative burden, especially around insurance denials and prior And fourth, we are investing in our communities to reduce chronic disease.
▶ 0:50:16We are working with partners on programs that improve health upstream, and therefore help prevent avoidable Beyond patient care, New York Presbyterian provides significant community benefit. Last year alone, this totaled $2.4 more than 20% of our operating expenses, supporting important community-based services and school-based health centers that serve 28,000 children in New York City public schools.
▶ 0:50:44These investments are core to our mission, but they rely on a sustainable financial foundation. Affordability in healthcare requires a shared responsibility of all stakeholders. The 45,000 dedicated people of New York Presbyterian are committed to caring for patients with compassion, to advancing treatments that save lives, and to strengthening the communities we We stand ready to work together to make high-quality healthcare more accessible
▶ 0:51:15and more affordable for all Americans. I appreciate this opportunity to engage in a meaningful discussion so that we, together, can be better for the patients and communities that we care for and that you represent. Thank you.
▶ 0:51:30Thank you, Dr. Waldrum. You're now
▶ 0:51:35Good morning, Chairman Smith, Ranking Member Neal, and members of the My name is Mike Waldrum. I'm a critical care physician and chief executive officer of ECU Health, a nonprofit, mission-driven health care system located in rural Eastern North Carolina. I'm off I'm honored to offer testimony before you today on health care affordability and share the realities of sustaining access in our region.
▶ 0:52:04The barriers facing rural health systems are real and structural. I look forward to working with this committee on solutions that strengthen access and affordability to ensure people living in rural communities are not disadvantaged simply because of where they live.
▶ 0:52:26My hope is that this testimony shines a light on ECU Health's experience on delivering care to 1.4 million people living in a vast rural region about the size of I have dedicated my life to helping people in need and in places where I can make the greatest impact taking care of the sickest and most complex patients.
▶ 0:52:52I moved to Eastern North Carolina specifically to work on the issues that rural communities face and that's why I'm here with you today. I recognize and I appreciate the monumental task before Congress to address rising health care costs while protecting access to care. But the challenges we face we continue face continue to mount.
▶ 0:53:18It is urgent we go beyond a solution to solve the rural health care I have trained and worked in some of the nation's most prestigious health care I have also seen the other side. Patients who lack access to even basic health care needs.
▶ 0:53:40I've invest I've witnessed the damage to and hardworking rural citizens when access to care diminishes are concentrated in urban markets. I've experienced how healthcare operates under very different conditions and constraints and how those differences shape healthcare access and outcomes.
▶ 0:54:10This is the story of two healthcare markets in our Urban and rural. The realities of rural healthcare are older populations flat or declining growth and patients spread across vast, challenging landscapes.
▶ 0:54:36In Eastern North Carolina, if you if Eastern North Carolina were its own state, it would rank among the country's poorest and sickest. These realities, coupled with regulatory pressures, have driven hospitals and clinic closures. Consolidation in our market is not driven by preference. It is how we survive.
▶ 0:55:04As some exit and others enter with profit-driven agendas systems like ECU Health are left to serve as the safety net. The result is reduced access, worsening outcomes, and increasing costs. These dynamics are not theoretical. This is the reality of the rural healthcare crisis in America.
▶ 0:55:30Despite the persistent headwinds, ECU Health has sustained access across our 29 county region through a hub and spoke model where our community hospitals are supported by the resources generated by our academic medical center. We have grown into a nine hospital system with more than 1200 providers not in pursuit of scale but out of community necessity.
▶ 0:55:57We are transforming our rural academic regional system of care to lower costs, sustain and grow access to essential services and support the economic vitality of rural communities. We have made significant progress, but we have much work to do.
▶ 0:56:18As this committee considers federal health care policy, I encourage you to design solutions that are tailored to the 66 million people living in rural Policies that do not account for the differences between urban and rural markets leave risk leaving those communities behind. We know this work cannot be done alone. We stand ready to partner with you on a solution. Thank you.
▶ 0:56:46Thank you, Mr. Woodhouse. You are now
▶ 0:56:48Thank you so much, uh Chairman Smith, Ranking Member Neal, and distinguished members of the committee. Thank you for the opportunity to testify today. My name is Brad Woodhouse. I'm the president of Protect Our Care. Our mission is to make high-quality, affordable health care a right and not a privilege for everyone. I'm here today because that mission is under threat. We are facing a health care affordability crisis.
▶ 0:57:12HR 1 made the largest cuts to health care in American history to fund tax breaks for billionaires and big corporations. No amount of finger-pointing can distract from the reality that HR 1 cut 1 trillion from Medicaid and the Affordable Care Act, which will rip life-saving coverage away from 15 million Americans, including seniors, children, and people with disabilities.
▶ 0:57:38That same bill handed out 730 billion in tax breaks to corporations and 890 billion in tax breaks to millionaires. Today, nearly a year later, roughly 4 million people have already lost their health care, but that's not all. Costs are skyrocketing for millions of Americans. Families are being forced to make impossible choices between paying for groceries and seeing a doctor. And small businesses are closing their doors.
▶ 0:58:05The ripple effect of these cuts has catapulted health care to the number one issue in America. Recent Gallup poll showed that the availability and affordability of health care topped the chart of American worries about key issues, ranking higher than the economy and inflation. One of the biggest impacts of HR1 is on our nation's hospitals. Following the passage of HR1, Protect Our Care launched a Hospital Crisis Watch.
▶ 0:58:31It's a interactive map on our website that tracks hospitals, nursing homes, and other care facilities that have shut down, cut services, or or are at risk due to HR1's devastating cuts to health care. When a hospital closes doors, everyone feels the pain.
▶ 0:58:47Patients have to travel further for care, families face longer wait times in overwhelmed emergency rooms, moms are left without maternity care, putting their lives and their babies' lives at risks, and entire communities will be left without access to care while CEOs and billionaires get another tax cut. Here are some key numbers from our Hospital Crisis Watch tracker.
▶ 0:59:10As of this morning, 889 hospitals, clinics, and nursing homes have either shut down, cut services, or are at risk of doing so since Congress passed HR1. That includes nearly 60 hospital wards which have shuttered, including 30 maternity wards, uh over 240 clinics have been forced to close, and over 400 hospitals remain at deep risk of closure or cuts.
▶ 0:59:37And everyone is paying the price because Congress put tax cuts for billionaires and big corporations above the needs of working people. When a hospital closes, costs rise by an estimated $500 per hospital stay in a nearby facility. This means higher health insurance premiums for everyone, regardless of where they get their coverage. As the sixth largest employer in the country, hospitals are key economic drivers, especially in rural America.
▶ 1:00:03But because Congress passed the largest cuts to health care in history, nearly 500,000 health care workers could lose their jobs. Communities are so desperate uh to save their local hospitals that counties and states from California to Alabama are raising property taxes to stop their hospitals from closing. Uh as our map shows, the consequences of HR 1 are already playing out, and the things will only get worse in the years to come as these cuts come into full force.
▶ 1:00:31Here are a few stories illustrating the impact of the cuts and closures that have occurred since HR 1 In Nebraska's 3rd Congressional District, a nursing home, a primary care clinic, and a critical dialysis unit were all forced to shutter, and five hospitals remain at risk of cuts or closures. A rancher in that district from Hay Springs is now spending 9 hours each week driving to and from Scotts Bluff for his dialysis.
▶ 1:00:58In New York's 24th Congressional District, a dialysis unit was closed there. Now patients are scrambling to find a new place to get life-saving treatment. Five hospitals in that district are also at risk of closure or cuts. In Ohio's 7th Congressional District, five clinics were forced to close due to these Medicaid cuts, leaving families with fewer options for care.
▶ 1:01:21Look, Protect Our Care has been crisscrossing America to sound the alarm on how these cuts are pushing hospitals to the brink, stripping care from communities, and putting lives at risk. Every day presents a chance to stop this healthcare crisis, but this administration has not lifted a finger to deliver relief to the American Congress should be focused on making healthcare more affordable and accessible, not ripping it away to give tax breaks to the rich. Thank you for the opportunity to be here, and I look forward to your
▶ 1:01:51Thank you. I thank you all again for being here. I'll now begin the question question and answer session with the vice chairman of our health subcommittee, Mr. Buchanan. Thank you, Mr. Chairman, and I want to thank all of our witnesses. Uh I want to shift gears a little bit in my 5 minutes and get your input, so that's kind of where I'm going to go. Uh Bill Frist was here in front of us We had a hearing.
▶ 1:02:16Bill Frist was here, and he talked about the landscape of obesity and related the diseases that define America. Then he said the surest and safest way to maximize your your health is food as medicine. So, he took took for hour or two talk about food as So, I believe personally in myself, and something we didn't talk about, nobody brought it up, but I'm sure, you know, we were we were focused on the other stuff. I believe that prevention and eating real food is the key to making healthcare more affordable.
▶ 1:02:46The US is spending $5.3 trillion on healthcare, yet we're getting sicker as a nation. Six in 10 Americans, 95% of Medicare beneficiaries, have at least one chronic disease. Roughly half of the adult population is obese, and when you look at it, and the thing that makes me sad, we have 10 grandkids, but uh children, 20% of the obesity for kids are are obese, 20%, and 30 You know, what one young ones that would serve maybe in the military, 20
▶ 1:03:16to 30, basically there's 30% of obese. I believe the problem stems from unhealthy and ultra-processed food. We must prioritize prevention. In other words, don't get sick in the first place to the extent we can. Yeah, they said that if you have cancer and you catch it early and you do it, there's a good chance you're not going to have to deal with it. We must prioritize prevention as a key to reversing trends in heart disease, obesity, and diabetes.
▶ 1:03:47Hospitals not only treat people with that are sick, but hospitals can and should take more time to make sure that what we're doing is the right thing long-term. I want to applaud HHS its efforts to create a new food pyramid which prioritize real food and makes hospitals food healthier pledge. So, I guess one of the things I'd like to ask all of you, have you taken a look at that pledge and whether does that make sense to you in terms of signing on? If you haven't signed on, will you sign on?
▶ 1:04:19Anybody that's taken the pledge? Go Yeah, go ahead. Did you want to
▶ 1:04:26Yes, I vice chairman again, and so thank you for the comments. I would say that at Common Spirit Health, we follow the Make Hospital Food Healthier Pledge that HHS has put forward. We certainly believe in food as medicine as part of what we do to serve communities. In a number of communities where we serve, where there where there are food deserts, our facilities offer food pantries with fresh produce to provide those resources for those who don't have access.
▶ 1:04:56And so we certainly support the notion of healthy food, sir.
▶ 1:05:00Mr. Donnelly, go ahead. Just what's your thoughts on that? I know I touched base with you. We talked about a little bit, but I think it's huge.
▶ 1:05:08Yes, thank you, Congressman, for your advocacy of living healthier lifestyles. It is one of the four things that we're working on in order to develop more affordable care. Strong strongly agree with you and what we do is we're embedded in our communities. We work with our schools, we work with the faith-based organizations, we work with nonprofit organizations around teaching healthier lifestyles, around teaching proper nutrition, around teaching healthy exercise.
▶ 1:05:33We work with our schools so that we can reach people at a younger age because then the impact is longer lasting. They also work with their families.
▶ 1:05:42Do you find that statistic 20% of children are obese? Is that legitimate? Is that a number That's the number I've heard. It's outrageous to me.
▶ 1:05:50I don't know the exact statistic, but I know it's unacceptable and every one of us should understand the role that we can play and especially in health care in a preventative way because that
▶ 1:06:00are in the health business. We've got to get people healthy. Uh Mr. Hazen, do you want to give us your thoughts on
▶ 1:06:08Well, I think anything Congressman that we can do to make people healthier will drive down costs for sure in the system. Just to give you one perspective, one of the drivers we've seen in our organization over the last 10 years is the complexity of the patients we have to deal with have numerous complications, comorbidities, obesity, diabetes, and so forth and that forces more resource consumption.
▶ 1:06:32I've only got a couple of minutes seconds. Let me just say I I hear what you're saying. I want to try to help be able to not get to that level. Someone said that if you have a heart attack, 50% of people don't live to see the next day. How about not having a heart attack in the first place? I think a lot of it's diet related. Obviously, movement, exercise as well, but I that's kind of where I'm coming from. We all have a responsibility. We're spending five and a half trillion dollars, basically 5.3 trillion dollars in health care and we're getting sicker.
▶ 1:07:01That's got to change and change now. Thank you. I yield back.
▶ 1:07:06Mr. Neal.
▶ 1:07:06Thanks, Chairman. So, let me acknowledge just as I begin my questioning the hard working people who are part of this debate today, and members from 32 BJ SEIU from New England who do a great job for all of us every And they understand what's going to happen with the impact of the cuts that are coming to Medicaid and to the ACA.
▶ 1:07:30They, like all members of the American family, are going to be facing the reality of what the tax bill that the Republicans embraced will do. America needs 86,000 new doctors. That's where graduate medical education comes in.
▶ 1:07:48That's where our academic centers come Every member of Congress ought to spend a Friday night or a Saturday night in an emergency room to see what it's really like for people who arrive there without a lot of answers, or perhaps that mom with a sick child. Do members understand what disproportionate share hospitals do? The testimony was exceptional today.
▶ 1:08:16It's not about rural versus urban, it's about making sure that when a rural hospital perhaps can't solve a certain problem, that they might move to an urban setting or vice versa. Whereas noted here with perhaps lower cost, it could happen. But people that show up in an emergency room on a Friday or Saturday night, they are unlikely to be too concerned about cost. And that's where advocacy comes in.
▶ 1:08:45These cuts that are being proposed don't make any sense. So, let me say something about Baystate Medical Center again. Mass General Hospital. If you've got a sick child anywhere in America, I can recommend those hospitals to to The work that they perform is extraordinary. The members of the committee and Congress understand what technology has done to driving health care costs. Does anybody know what a the cost is of a linear accelerator?
▶ 1:09:16It's top-notch health care. And again, the argument today is we should justify these tax cuts by denying people basic health care in our hospitals? This committee, as I noted in my opening statement, on a bipartisan basis, we expanded graduate medical education opportunities to help address the issue of a shortage of 86,000 doctors across I am proud of what we've done
▶ 1:09:46over many years here by incrementally improving the opportunities for people as it relates to health care. But let's also be honest. The emergency room is a bad place to have to get health care. That's just the reality. And getting out front on a lot of these issues could be very helpful to the again, the American family. Your testimony has been right on target. So let me ask you, Mr.
▶ 1:10:13tell us about the 15 million Americans who are about to be denied health care because of the tax cut bill that our Republican colleagues have embraced.
▶ 1:10:21Sure, thank you, Chairman Neal. And as you know, Protect Our Care is all across the country. Um and we're collecting stories constantly about people who are facing uh facing these challenges. We've heard from uh farmers in Iowa, uh small business owners in Virginia, uh caregivers in Michigan who have had their health care jeopardized by these Um in some cases, particularly by uh the elimination of the tax credits.
▶ 1:10:49Uh we collected hundreds of stories of working Americans who are losing health care or making sacrifices to pay what is now double, triple, and quadruple uh their health care premiums. Let me give you two stories. Uh Janine Shackelford uh is a realtor in Youngstown, Ohio who was self-employed, was self-employed because the Affordable Care Act made her health insurance affordable around $200 a month. In 2026, her premiums jumped to $900 a month, more than her mortgage.
▶ 1:11:19She could no longer afford it, and she's been forced uh to leave quit her job, which was self-employed, to try to find a job with insurance. Rina uh Bombrey Graves is a home care worker in Woodbridge, Virginia who cares for two relatives with disabilities. She and her husband's premium spiked from $544 a month to over 1,300 a month. And you know what? They're just not going with health care right now. They simply can't afford it.
▶ 1:11:46So, there were Those are two stories, but there are dozens and dozens and actually hundreds that we've collected that are just like
▶ 1:11:52Thank you. So, I hope that all members of the committee might consider, perhaps on a Friday or Saturday night, getting in an ambulance and making a patient run to see what it's like for senior citizens, perhaps for one who is but there is a real emergency.
▶ 1:12:10I think that we're misunderstanding the realities of what a breast cancer imaging machine might cost, what a linear accelerator might cost, what the best doctors in the world and nurses and health care professionals might cost. This could be addressed in a bipartisan manner, absent what the big bill did. And I yield back my time.
▶ 1:12:33In January, this committee heard from the CEOs of the biggest health insurance When asked what is driving up premiums for Americans, they pointed their finger at all of you, the hospitals. They They have a point. The data clearly shows that hospital prices have risen faster than any other part of the economy nearly 300% in just the past 20 years.
▶ 1:12:59And 1/3 of all US health spending is on hospital care more than any other part of the system, 1.6 trillion dollars a year. However, hospitals and health care providers are the ones delivering medical services. Um I believe every member of Congress has been in emergency room with a family member or a friend. So I don't think we have to like address that.
▶ 1:13:27I think we all understand health Um let's start with a show show of hands. Um I'm going to ask a few different questions. Raise your hand if you agree that insurance providers are too big and are taking advantage of health care That's for all of you. So two of you agree with that.
▶ 1:13:55Um raise your hand if your hospital or an association that you are a member of lobbied to expand the expanded Obamacare tax credits that would have funneled 400 billion dollars directly into the pockets of those same insurers. Only one of you. So two of you. Uh you just have to raise your hand at the same time when I ask it.
▶ 1:14:23If you don't agree with the statement, don't raise your hand, but if you agree with the statement, raise your hand. It's pretty pretty simple. So just one. Mr. Hazen. Um thank you for for being honest. This is one of the problems with health care.
▶ 1:14:39Hospitals, they blame insurers and drug companies, Democrats blame Republicans, Republicans blame Democrats, insurers blame hospitals and drug companies, drug companies blame PBMs and hospitals, but when it comes to fixing the system, the only thing you all agree is that it's it's some other people, other issues that's the increase.
▶ 1:15:07Raise your hands if you believe hospitals deserve to be paid more than independent physician practices for the exact same service. Thank you. This is another serious problem.
▶ 1:15:24Hospital empires are being financially incentivized to reduce access in rural communities and are working to game the systems to get the highest possible reimbursements, but when you talk about policies that create competition and more access for patients, you get vocal opposition from you and your Washington Medicare relies on outdated and misaligned reimbursements that pay more for the same services delivered in a hospital clinic than an
▶ 1:15:54independent physician's office. Let's talk about what that means for a senior living in my district in Festus, Raise your hand if her Medicare bill for a standard x-ray image would be higher in your hospital-owned clinic than if she went to her local doctor's office. Raise your hand if your hospital makes more revenue for that service than the doctor down the street.
▶ 1:16:28Now, raise your hand if you would support legislation that equalizes such payments at the doctor rate so folks can have more access to care and a bill that they can afford. A troubling development in Medicare over the last decade has been sophisticated wealthy hospitals and health systems in urban cities leveraging a loophole to classify themselves as rural even when they treat few if any rural
▶ 1:16:58patients. They do this to reap a windfall of benefits intended to support truly rural hospitals including higher residency training funding and easier access to heavily discounted drugs under the 340B program.
▶ 1:17:16A highly lucrative revenue stream for Rural classifications have risen from only three hospitals in 2017 to 425 by 2023. A 14,000% All of this is the expense of truly rural communities. Dr.
▶ 1:17:43Donnelly, as you know, I represent one of the most rural districts in Congress made up of farmers and ranchers who drive up to a more than an hour for basic care at a rural facility that is reimbursed 4% lower than the national You have chosen to self-classify your flagship hospital in your New York Presbyterian system as Meanwhile, you get reimbursed 40% higher than the
▶ 1:18:13national average. To be clear, there are zero farms there in Midtown Manhattan. I've been there and no crops are growing on East 68th Street next to your supposedly rural hospital campus,
▶ 1:18:29That's correct.
▶ 1:18:30So, how exactly do you justify this clear abuse of the Medicare program where big city hospitals drain the Medicare trust fund a billions of dollars meant to support truly rural independent hospitals.
▶ 1:18:43First of all, I'd like to thank you, Chairman, for your advocacy for rural hospitals. You know, as a physician, I can tell you that rural hospitals are critical to health care in this country. It's important that all of us concentrate to make them strong for the health of this nation. We are not a geographically rural hospital, but under CMS, we are designated a rural referral center. We are proud of the role that we play for rural hospitals.
▶ 1:19:09We see thousands of patients referred from rural hospitals when those patients and those doctors have nowhere to turn. We're proud to take care of those patients. We're also proud of the 2,500 residents that we train. 65% of them leave NYP and go across the nation, including into rural America, to take care of patients.
▶ 1:19:29How many rural patients, um, do you refer?
▶ 1:19:34We We receive referrals of We saw 8,000 patient visits.
▶ 1:19:39And how many patients visits did you have, um, all of last year?
▶ 1:19:43We had 2 million, uh, patients that we took care of. 8,000 doesn't seem a lot, but I'll tell you when you're one of those patients and you're one of those doctors and you have nowhere to turn for a really complex problem, I think those are some of the most gratifying patients that we have.
▶ 1:19:58So, do you think just because you served 8,000 patients out of 2 million that were rural that you should get the benefits of a rural independent hospital in Salem, Missouri, that's barely struggling to keep their doors open?
▶ 1:20:11I I think under the rules and regulations of CMS, uh, we we meet the, uh, qualifications to be designated a rural referral center.
▶ 1:20:19Do you think those rules should be
▶ 1:20:22Um, I I think if we look at opportunities to change those rules, we have to make sure that they balance, uh, the health of rural hospitals, but also the importance of urban hospitals that support rural health care. I'm just reminded by what health care professionals have told me all all the time is that health care follows the We're seeing that today just unfold that health care follows the dollar and people in rural areas have a lower life expectancy
▶ 1:20:52rate than those in rural areas because the dollar is not going into rural areas and they are dying. People are dying in rural areas because they're not getting access of rural health care. This is not urban versus rural. This is about every single American having access to health care, but they don't.
▶ 1:21:15They don't and the only way we will fix the system is if all the entities, the insurers, the hospitals, the drug manufacturers, the Democrats, the Republicans will come together and stop talking about other bills that have passed and focus on new bills that need to pass.
▶ 1:21:35Until we get to that point we're only going to see health care continue to skyrocket and health care companies, insurers, hospitals continue to have large profit margins. We saw United Health Care have the the the highest earnings ever reported last That is a broken system which we have to address. And so I'm I'm done, Mr. Dock.
▶ 1:22:04Well, thank you, Mr. Chairman. There are a number of the concerns that you've raised this morning that I share. I think hospital costs are high and they're soaring higher. The problem is when you talk about new bills that need to pass the bills you propose to address any of these problems don't get to the core of the problem.
▶ 1:22:22The leading bill that this administration pushed was to give more price disclosure information, which is unlikely to have a significant impact on desperate sick sick people seeking care. The site neutrality provision may have some merit. It's a fairly narrow focus.
▶ 1:22:42And at the same time, you talk about new bills that need to pass where there are actions this committee could take that would make a real difference, you obstruct and block consideration of the legislation. That's why I agree with Mr. Neal that this is more a deflection hearing than a hospital hearing. Let's talk about three areas that are being blocked and obstructed that could make a real difference in accord with the testimony we've heard this morning. The first one is stable coverage.
▶ 1:23:12This is a committee and administration that has done more to take away health care coverage from American people than any in American history. And what happens is as Mr. Hasson indicated, is that when people don't have stable coverage, when their Medicaid's taken away, when they can't afford their marketplace plan, they don't get treatment when they need it. And so they show up in the emergency And some of those folks are going to show up in the emergency room and they don't have anything to pay the bill.
▶ 1:23:43And the hospital can't pay its nurses and physicians and its staff and its administrative cost with an IOU. It needs to pass those costs along to all the rest of us who have decent insurance plans. The lack of stable coverage that is the direct responsibility of this committee and the Trump administration and those cuts is having a huge impact on hospital cost and on costs that are borne by all of us.
▶ 1:24:11The second area where this committee could do something but refuses to act and obstructs those of us who want to act is with regard to The Trump RX is as phony as a diploma from the failed Trump University. This committee is under a stranglehold by Big Pharma. It won't even hold a hearing on the actions of pharmaceutical manufacturers, and yet as Dr.
▶ 1:24:39Donnelly has pointed out and I'm sure it's true in some of the other systems, in 1 year the drug cost at his hospital went up over 25%. You cannot deal with high hospital costs unless you look at pharmaceutical cost, and this committee refuses to do it. And the third area where we can't get action is Medicare Advantage. And we've had testimony this morning about what a difference that makes. Uh let me ask you, Mr.
▶ 1:25:09Lassiter, a little more about that. Uh I've offered the bipartisan Prompt and Fair Pay. And when I talk about Republicans, I'm not talking about all Republicans. Uh Dr. Murphy, Dr. Harris, Chuck Edwards, Congressman Thompson have all joined in that effort to get prompt and fair pay. You mentioned that at your hospital, how many billion dollars is it that you have in bills that Medicare Advantage has not
▶ 1:25:36Uh thank you, uh Congressman Doggett. Um we have 4.3 billion dollars in unpaid
▶ 1:25:424.3 billion.
▶ 1:25:43unpaid claims from Medicare Advantage.
▶ 1:25:45Well, our bill is uh one that is focused on getting prompt and fair payment. We learned in prior hearings uh that sometimes Medicare Advantage doesn't even pay the the cost of traditional uh Medicare in reimbursing for health care services.
▶ 1:26:03Uh you mentioned your support for this Prompt and Fair Pay bill that we've introduced on a bipartisan basis in your written Uh can you describe some of the difficulties that you've been having
▶ 1:26:16Uh yes, sir. I would say yes, um I would say thank you to you and to Representative Arrington for uh for sponsoring the Prompt Pay Act Um we are supportive um as as I mentioned in my testimony, we have significant unpaid claims um and we have claims uh about a billion dollars that are over 150 days old.
▶ 1:26:40Uh I would say that um for Medicare Advantage, uh it costs us 25% more to get it to process a Medicare Advantage claim than it does traditional Medicare. Um and so and we also suffer, as you indicated, uh from the fact that the reimbursement level for Medicare Advantage uh patients often times does not cover the full cost of care.
▶ 1:27:04That is correct, sir. Thank you.
▶ 1:27:05Thank you.
▶ 1:27:08Mr. Smith. Thank you, Mr. Chairman, and thank you to our witnesses today. I know that uh that that I don't have to announce the the purpose we're having this hearing today, but uh certainly the numbers do speak for themselves. Want to first touch on Mr. Woodhouse's uh testimony where he alleges that the passage of the One Big Beautiful Bill caused a nursing home in my district to close. Now, that nursing home, uh CHI Health St.
▶ 1:27:35Francis Skilled Nursing Facility in Grand Island, is owned by Common Spirit. Incidentally, we've got uh the CEO of Common Spirit here, uh Mr. Lassiter. Thank you for being here. Did the passage of the One Big Beautiful Bill that uh actually cause that skilled nursing facility to close?
▶ 1:27:53Good morning, Representative Smith. Thank you uh for the question. Um that facility closed because of extremely low volume. Uh we operate a number of skilled nursing facilities in multiple communities. Uh we felt that we could provide the access to that skilled nursing service uh within the hospital and not within a separate skilled nursing facility and so it was closed because there was not sufficient volume to support the cost structure of an independent skilled nursing and
▶ 1:28:19Not because of the passage of the bill of that that was referenced. I'm not I'm not commenting specifically on on on his commentary. I'm I'm I'm giving you my answer as to why that silly closed.
▶ 1:28:31Okay, so perhaps there's a little a few facts on the ground that were omitted in the in the previous reference and and I I I understand you know debates that we have across America. I would hope that we would meet the expectations of the American people and that's to have a good conversation a back and forth a thoughtful conversation on how we can address many of the challenges that we face and so you know that certainly leads me to speak more directly in
▶ 1:29:02terms how hospital prices are set and why is the price of hospital services so high? How are prices determined? And obviously to to state the obvious if the price of health care is high the cost born by the payer of health care is is going to be high. If if providers charge high prices insurance companies must set premiums and deductibles accordingly.
▶ 1:29:24The average cost to insure a family of four in the US is a surreal $27,000 per year. Just average family of four. Average cost. And so why does insurance cost so much? High prices lead obviously to high high premiums. If you look at the at the chart behind me you can see that the price of hospital services has risen faster than any other area of the economy since 2001.
▶ 1:29:54It's not even close. Since 2001 average hourly wages have risen 131% pretty decent. Medical care services have risen 147%. The price of services has risen 281%. Again, 281% far greater than any other area of the economy.
▶ 1:30:17To be clear, there are issues in the health insurance industry, but how are insurers supposed supposed to keep premiums down if the cost of hospital services go up 281% in in 25 years. Thank you. Mr. Hazen, I'm going to direct the question to you since your written certainly references the need for affordable insurance coverage. Uh HCA charges commercial insurers more than three times the Medicare rate.
▶ 1:30:43How can insurers lower premiums if HCA charges three times the the Medicare
▶ 1:30:51Congressman, uh thank you for sharing the chart and thank you for that question. We uh believe uh all three drivers, let me start with that uh with respect to the hospital cost uh are evident at least in our markets. One is demand is growing significantly. In the last 10 years, we've seen 2.5% per year growth in demand for our services and services in general for health care.
▶ 1:31:15The second thing I would tell you is the complexity of care, which is connected to that uh chart, I believe, has grown significantly also. So, the patients we're taking care of are more complex and require more services.
▶ 1:31:29and new methods, new research, that that's that's not buying any savings?
▶ 1:31:33Well, I think it's the patient population, Congressman. They're sicker. And we talked about that earlier with complications, obesity, diabetes, and so
▶ 1:31:41the fact that I've I've got limited time here, I I do want to point out that data shows that market power is much more strongly correlated with uh high commercial prices as well. And if I had more time, I'd ask Mr. Donahue, is it merely a coincidence that the highest price hospitals operate in the least competitive markets? Can you answer in 11 seconds?
▶ 1:32:01I I'll just tell you I I feel that in New York City we operate in one of the most competitive health care markets in the country. Recent RAND data that was analyzed showed it to be the second most competitive health care market in the country. We have six major health systems in our neighborhood.
▶ 1:32:16But for those other markets where there's less competition, I mean there the trends seem seem fairly glaring.
▶ 1:32:25I wouldn't be familiar with the other markets. I'm certainly familiar with the New York New York market which is highly highly competitive.
▶ 1:32:32Okay. Well, I wish I had more time here to dig a little deeper here, but obviously there there trends here that concern all Americans and especially those who were told their care was going to be more affordable. Thank you. Yield
▶ 1:32:45Mr. Thompson.
▶ 1:32:46Thank you, Mr. Chairman. Thanks to our witnesses who took time to be with us Mr. Chairman, we're here today to discuss the affordability of health care and I share some of your concerns. Some of the issues that you raised today, but it's recent Republican policies that are making health care affordability worse When you cut a trillion dollars from the health care system, it forces providers to cut services and in some cases shut
▶ 1:33:16down altogether. And as has been pointed out by a number of folks, this is going to be especially difficult in rural areas. Congressional Republicans say they only cut Medicaid, but the ripple effect will make health care accessibility more difficult for Our expert witnesses who run hospitals understand what Republican cuts will do to the delivery of health care. Mr.
▶ 1:33:41Hazen in his testimony said, and I quote, "Ensuring patient access to Medicaid, Medicare, and the individual insurance marketplace is one of the most direct and efficient ways to lower health care costs." And yet, congressional Republicans cut a trillion dollars from Medicaid and failed to extend the premium tax credits uh that helped millions of American better afford their insurance coverage.
▶ 1:34:11This doesn't assure patient access, it hampers it. Congressional Republicans kicked 15 million people off their insurance so they could give their billionaire donors a tax break. And it should be noted they also added over 4 trillion dollars to our national debt. These impacts will be devastating for hard-working Americans. Mr.
▶ 1:34:35Lassiter, who runs uh Woodland Memorial Hospital, which coincidentally is in my district, talked about the Medicaid cuts in HR 1's impact on his health care system. He said that when people become uninsured, access becomes harder to sustain. That's a quote. And I can translate that for Republicans are cutting Americans' health care and kicking 15 million people off of their insurance.
▶ 1:35:05And now hospitals will eliminate services and some will close. I can't say whether that will happen to any of the systems that the witnesses today represent, but I can promise you it'll happen. And our rural communities will be hit especially hard. Another witness here today, Dr. Waldrum, explained how rural health care will be impacted by cuts in HR 1.
▶ 1:35:33He said, quote, "When the only hospital within 60 miles closes, care doesn't become cheaper, it becomes unavailable." Mr. Chairman, you've heard me say this for a year, since we've been dealing with the big bill, HR 1, and I hope now that the expert witnesses that you called here to testify are sounding the alarm, it'll folks listen.
▶ 1:36:01Republicans' healthcare cuts will devastate healthcare access across our nation, and especially in rural areas. People won't stop getting sick, they won't stop getting injured. They'll just stop getting treatment, and some will Many will be sicker, and treatment will cost more. Also, the Republicans could give billionaires and corporations a big tax break, and as I said, add $4 trillion to our national debt.
▶ 1:36:31Someone said, I think maybe it was Mr. Waldron, that food is medicine. Was it you? So, if people don't have access, does everybody agree with that, food is So, if we don't have good food, good eating habits, people are going to get sicker. So, just to show of hands, I'll use the chairman's method here. Show of hands, who thinks that cutting $186 billion from SNAP benefits is going to make people healthier?
▶ 1:37:07So, no one thinks that, I'm glad. Do your hospitals have separate services for Medicaid, uninsured, and privately insured patients? No, nobody? So, when a hospital closes or eliminates a service, does that mean everyone in the local community loses healthcare Everybody's nodding yes. So, it doesn't matter how they pay for it, if they have truckload of money, or the best insurance coverage in the world, they're going to be hurt.
▶ 1:37:38Thank you, Mr. Chairman. Thank you, witnesses. I yield back the balance of my time.
▶ 1:37:42Mr. Kelly.
▶ 1:37:43Thank you, Chairman. Thanks for holding this today. First of all, thank you for taking a day out of your lives to come here. So, Dr. Donley, I'm going to assume you say you grew up in
▶ 1:37:52I did.
▶ 1:37:52So, my family, the McTie family, was in the fruit and vegetable business. You may have purchased there and and the uh started off on the on the railroads, and then my dad started uh in 1953 a little town called Verona with a one-car showroom and about five service bays, which uh I was able to purchase from him. Uh and now my sons run it. Uh we're Pittsburgh proud. I am, too. Yeah, well, listen, you know, everything we're talking today is math.
▶ 1:38:18And when you hear about there's no coverage in the rural areas, just because this is what I've done all my life. in 1970, there were over 6,000 Chevrolet Today, there's 2,800. Some people say, "Where'd they go?" Well, they're not in the country anymore cuz the market wasn't big enough for them to be in business. You're going through the same thing. The market's not big enough in rural areas to have people out there.
▶ 1:38:47You've got a facility, you've got people there, you've got people who clean the place or do all the stuff, and I don't think people understand it all comes down to math. Everything we're talking about is math. And when we talk about all these different costs, we're talking about taxpayer-funded health care. Uh I don't know how you keep up with cost. I mean, we can't. We're trying, but we can't. This year, we're going to spend 1 and 1/2 million dollars in health care coverage for the people that work at the dealership.
▶ 1:39:15So, we have huge deductibles, and I'm always fascinated that uh and the same thing, we also have a body shop. Until you reach your deductible, uh I the insurance company doesn't kick in. And so, when I hear about all these things you have to write off, I get that. I get all that because it is math. It's math. Uh but moving forward, if you can just tell us, I mean, what is the answer? Is it more government support? Is the cost of all this taking place because there's no taxpayer putting more money into the system.
▶ 1:39:47I if if you can't exist in a small market, that's not because you don't want to be there, it's because you can't afford to be there. You can't have the people in the lobby looking for help when you don't have a doctor or a nurse to take care of them. It's just that simple.
▶ 1:40:04So, when I hear all this stuff going back and who it is that did this or who it is that did that and we cut costs and we took health care away from people and millionaires and billionaires are getting all these tax I want to be a billionaire because I need a tax break. And I don't give a damn what it is. It's every single thing we do in life, we pay taxes on. The locals get you, the state get you, the feds get you and they all start the same talk the same top dollar and take a percentage of it. Every time you go out and buy something, there's a tax on it.
▶ 1:40:34I'm just trying to figure out how the hell much more money do we have to have taxpayers assisting in and order to keep your businesses open. And I sure as hell hope they don't start screwing around with the car dealerships because you know what? I've got too many people I got to pay every 2 weeks and I don't want anybody running a business that's 30 to 39 trillion dollars in debt telling me to how run run my business. Now, all of you took a day out of your life to come here today. What could we do? What could we actually do if each of you could just take a few minutes or a few seconds and say, what could we do?
▶ 1:41:03I'm glad we're having this but it's You're not in rural areas because you can't afford to be there. The cost of operation is actually ruining everybody but please, if you can start Mr. Hayes and then go down that. I want to hear from Mr. Donley because he's a Pittsburgher and go Steelers.
▶ 1:41:20Thank you, Congressman. Three things and we said this. One is coverage. Coverage is absolutely essential to rural markets, it's essential to urban markets, it's essential to Americans for affordability, for access, and for good health. That's number one. Number two is more competition. There are opportunities in some communities where certificate of need laws prevent access in a capital flowing into rural markets. That's number two.
▶ 1:41:50And then number three, and we've talked about this, is it's really complex administratively, regulatory, and if we can find ways as a system, government, private sector, and so forth, to simplify things, it makes it easier for all people. One quick point and I'll pass it. We have 35 rural hospitals. And since the pandemic, we've acquired eight hospitals in this large company that I have the privilege to run, five were rural hospitals.
▶ 1:42:20So, we five of eight we've acquired, two bankrupt or almost bankrupt.
▶ 1:42:26Thank you.
▶ 1:42:30Thank you, Congressman, for the question, and I'll try not to replicate what my colleague to the right said, but but let me just start off with regulatory burden is a significant issue for us. You indicated that this is just math, and so the math that we deal with often times is the burden to to comply with regulatory issues that at times are overlapping and are duplicative.
▶ 1:42:53And so, I would ask you I would ask this committee to consider standardizing the process for plans and providers for requests to transmit clinical information. I would ask you to think about reducing and simplifying the number of quality and efficient and efficiency measures that we have to report on to multiple agencies.
▶ 1:43:13I would ask you to create one claim system for Medicaid as opposed to 50 that are that are different that creates for organizations like mine, and I won't speak for my colleague to the right, but with organizations who who serve patients in multiple states, that's a significant regulatory burden for us administrative burden for us, excuse me.
▶ 1:43:35Um I I would ask this committee to think about stronger coverage for behavioral Um a lot of the costs that we incur in our emergency departments are because individuals do not have adequate coverage. Mr. Ellison, we're out of time, but first of all, would you all submit to us in your highest priority the business model and what we need to do to improve it.
▶ 1:43:57And the other thing, I I got to tell you, we got to get on I don't know in an outfit that puts such a burden on hardworking American taxpayers is when is enough truly enough? And if you got the if you got the government out of the way, how much easier would it be to run your businesses? All right, thank you for being here today. We really appreciate it. Keep up the good work and I know there's a lot of sick people out there and uh look, we're trying to take care of everybody we can. This is not a Republican issue or a Democrat issue. We need to get off that kick, okay?
▶ 1:44:24And I whether it's the one beautiful bill, the one ugly bill, whatever the hell they want to call it. If there's the thing, it's the bill. It's the bill. So, thank you for being here.
▶ 1:44:32Mr. Larson.
▶ 1:44:34Thank you, Mr. Excuse me. Thank you, Mr. Chairman, and thank you for this hearing and uh especially the witnesses I want to thank as well. It's nice when you have CEOs that are before you that uh are compassionate and uh concerned uh about America, about this great country we live in. So, my question to all of you, and I like what the chairman did before, I'll take a show of hands.
▶ 1:44:59You all believe that health care is a fundamental right of every American You do. All of you believe that. Well, and do you believe I from the testimony that so health care isn't a rural or urban issue or a wealthy or poor issue, it's something that impacts every single American. And yet there are what, 28 million Americans?
▶ 1:45:28You know, health care cover is at a the lowest it's ever been in terms of people that don't have insurance. 28 million Americans don't have any insurance. I believe in the health care costs. We've had hearings where everybody's pointing fingers the other way. And there's a lot of blame to go around.
▶ 1:45:51But has Medicare been a an a program that you uh Raise your hands if you dislike Medicare as a a program and a way to make sure that people have coverage. how many would be in favor of Medicare for all?
▶ 1:46:14Something where every single American, rural or urban, is guaranteed by the very government that they're a part of, that they have access. And then all these issues with respect to the coverage and the costs, etc., need to be worked out in conjunction with all the entities that are impacted by this. Mr.
▶ 1:46:42Donnelly, I had a question too that a uh constituent had and I wanted to uh run it by you. Uh the United States Department of Justice recently filed a suit alleging that the New York Presbyterian violated antitrust laws by stifling competition between New York City providers.
▶ 1:47:03New York Presbyterian has publicly commented that the suit is without merit and its policies and are pro-competitive. How are your policies and procedures As you know, uh Congressman, we were recently named in a lawsuit brought by the Department of Justice regarding our contracting practices. And therefore, I can't discuss any of the issues relating to that case.
▶ 1:47:30We do believe that that case is without merit. We do believe that we comply with all federal and state laws. so while this investigation is is going on, would you say that there's a cooperative nature of working towards a solution or this is another example of people just taking sides? We we look to collaborate with all involved people to get to a solution.
▶ 1:48:01Well, I thank you. I also because of the discussion about CEOs that are here, I want to note the CEO of uh Hartford Hospital in my home state, Jeff This is a CEO who goes out in the winter and finds people that are homeless sleeping under bridges, etc. and brings them back to the only place that they will have refuge and care.
▶ 1:48:27in listening to the testimony here today, it it appears clearly that while policy initiatives and the so-called solutions that might appear in future bills are actually right in front of us in a bill that's been in existence but isn't accessible to all Americans.
▶ 1:48:55Is there anyone that disagrees that Medicare for all should be something that every single American has so that they have the access to the very health care facilities to make a better life, to get the kind of nutrition that's been discussed here, to have a path forward.
▶ 1:49:21And why should we be sitting in testimony instead of at odds agreeing that this is what we have to Will all of you pledge to work towards getting all Americans covered under health care and improving Medicare for all so that it accomplishes that goal? Raise your hand if you do.
▶ 1:49:50So, two of you do.
▶ 1:49:54I I strongly support coverage for all. I'm not a policy maker, so I don't know all the specifics of that, but certainly
▶ 1:50:00ask you to make the policy. I asked you if you were for coverage for all.
▶ 1:50:03I'm I'm I'm for coverage for all.
▶ 1:50:05Thank you.
▶ 1:50:07Congressman, I am for coverage for all as well. Yes. and Mr. Hazen?
▶ 1:50:13We we fundamentally believe coverage is the answer.
▶ 1:50:18So, with everyone believing that this is the answer and knowing from your you know, everybody needs this coverage and Mr. Waldron, you were especially articulate in pointing out what the chairman's district goes through, the inequities between rural and urban areas. I could, however, point out in urban areas like the one that I live in where people go without health care as well. I yield back.
▶ 1:50:46All right, thank you. Um Mr. Schweikert.
▶ 1:50:50Thank you, Mr. Chairman. Um as each of you as CEOs is listening to and hopefully you accept the premise, we've turned health care into financial engineering. If you actually listen to us up here, much of the discussion isn't actually about health care inputs, outputs, it's about the financial Um we have to deal with the reality and I'm still just stunned how little I get input from the healthcare community.
▶ 1:51:18Um, 6 and 1/2 years Medicare spending goes from 1 trillion to 2 trillion. In 6 years the trust fund is empty. So in 6 years you're all getting a 12% under the current law. But how much have you heard from that of the actual demographics? Um, look, we have an interesting issue.
▶ 1:51:43Next year the United States functionally has fewer 18-year-olds than we had 20 years ago. Double the number 65 and up. I'll be one of them next year. We have a demographic. I've had only one member of the panel sort of talk about and we're going to have a little discussion about your patient mix, severity mix, and some of the inputs with that.
▶ 1:52:08Um, um, it's one of my intense frustrations we as policy makers often are desperate to find someone to blame because we want to feed simplicity to our voters. What happens when the reality of is a complex problem requires a complex solution? Are we capable of doing complexity? Mr.
▶ 1:52:31Lassiter, um, uh, if you were to actually say, what's the difference in the presentations you have today compared to 20 years ago in health, obesity, complexity, um, multi-chronic issues. How different does your world look in your patient mix today than 20 years ago?
▶ 1:53:01So I would say, um, I will speak in generality, sir, only because um, I wasn't at my current organization 20 years ago and so I can't speak to what what that population
▶ 1:53:10thought experiment. I'm just trying I'm heading towards making a point here.
▶ 1:53:14Yes, absolutely. So I think what what you would find and I believe this would be shared across the panel, you would find that patients that present to hospitals today are sicker and more comorbidities than they did 20 years ago. You would find as you see in general research that the level of obesity in our populations would be higher today than it was 20 years ago.
▶ 1:53:40Those are the things that you would see whether patients are presenting at a primary care physician's office or presenting at a hospital emergency department. That's what you would would
▶ 1:53:49to that point, does the panel substantially agree with this? I mean you can just grunt at me yes, sir or argue with me.
▶ 1:53:59Yes, we are seeing much sicker patients.
▶ 1:54:01So what would happen if one of the most powerful things we could do is actually having to do with Americans health statistics. We have a data set that my Joint Economic Committee published about two, three years ago. Controversial, I thought we were going to get the crap kicked out of us cuz we told the truth about the math. We showed that almost 9.1 trillion over 10 years of health care costs was obesity. That 47% of US health care costs were related to obesity.
▶ 1:54:31And yet somehow we think it's moral to hand someone an EBT card to go buy onion Um we live in a time of technology Maybe part of our fixation is coming up with a much more holistic view of how you run your organizations. I'm I'm enraged how much of a health care hospital bill is the air conditioning, is the parking lot, is the infrastructure, but that's what you're required to do in today's model.
▶ 1:55:04dealing with the reality of I have a population that's getting older very I got what 76 million of my brothers and sisters who are baby boomers. Geriatric health care and the population when 31% of Medicare spend is just We actually know how to attack this and approach this, whether it be a combination of some of the new drugs that are on the market to incentives to actually be healthier.
▶ 1:55:34Maybe my solution, maybe our solution as a society is deal with the reality of our demographics. Try to help our brothers and sisters be healthier and then we're going to have a world of how do I get market technology, whether be wearables, other things to basically make you all compete like crazy. Um because honestly, in 6 years Medicare spending doubles and the trust fund is gone.
▶ 1:56:05And we're not prepared to deal with the scale that's coming at us. With that I yield back.
▶ 1:56:10Ms. Sanchez.
▶ 1:56:15Thank you. I want to welcome all our witnesses and thank you for your testimony today. Mr. Lasseter, um I agree that we should pass the Medicare Advantage Prompt Pay Act and I assure you that Mr. Arrington and I are working to secure a legislative hearing on that piece of legislation. But I want to talk to you about something a little bit different today because I believe you're the only witness on the in our hearing today that has a presence in my district.
▶ 1:56:43I want to ask you about an issue that has impacted my constituents directly and one that has been raised in many of the town halls that I've conducted. Um last summer ICE began terrorizing the communities of Los Angeles. So I want to ask a very simple question. Do you believe that immigration enforcement should be conducted in a healthcare setting?
▶ 1:57:05Councilman, thank you for the question. what I would say to you is this. Um I believe strongly that in a healthcare setting, we should deliver healthcare. And we should do that in an unencumbered way. Um my organization, as I would presume all that are here, are committed to trying to deliver the best possible care um to the patients who who present to us.
▶ 1:57:27And so, what I would simply uh suggest to you is that we should be able to deliver that care um in an unfettered way, as seamlessly as possible, to meet patients' needs.
▶ 1:57:36Thank you. Do you believe that ICE agents or any federal immigration officer should be present in an emergency department when a patient is seeking care there?
▶ 1:57:47Well, Common Spirit works um very closely with law enforcement to ensure that uh there is uh appropriate respect of of um all local, state, or federal officials. Um I won't opine explicitly on the the the issue um around ICE, except to say again that um I would not be in favor of anything that disrupts the ability of caregivers in an emergency department to deliver high-quality care that meets
▶ 1:58:17the patients' needs.
▶ 1:58:18Okay, I appreciate your answer. I'm I'm asking about this because in July of last year, US Immigration and Customs Enforcement agents occupied Dignity Health Glendale Memorial Hospital for 15 And at times, they were waiting for one patient in the emergency room, behind the reception desk, and in the patient's own room where they were getting care. Um do you know if Glendale Memorial Hospital has a written policy and standard operating procedure for interacting with immigration agents? Do you have that policy?
▶ 1:58:49Well, we certainly have a policy for interacting with all law enforcement Um and again we're respectful of boundaries for local, state, and federal law
▶ 1:58:58So, you do have a policy.
▶ 1:59:00That's correct.
▶ 1:59:01Thank you. I appreciate brief answers cuz we have limited time. Um in September, California passed Senate Bill 81 which would require California healthcare facilities to create and designate non-public areas to protect patient privacy. It further directs healthcare providers to establish clear procedures for responding to immigration enforcement in healthcare spaces.
▶ 1:59:24This was a direct response to President Trump's executive order which for the first time in a decade allowed federal immigration agents to conduct enforcement inside healthcare facilities. Um Mr. Lassiter, I understand you've overseen the entire health system since 2022. Um can you speak briefly as to how President Trump's directive impacts routine patient care specifically at Glendale Memorial?
▶ 1:59:54Congresswoman, I don't know that I could speak specifically to what happens on a day-to-day basis at that facility cuz I'm not physically there regularly. Um but what I would say to you is um when we have individuals in the healthcare space that are not delivering healthcare, it can be disruptive. And we work hard to make sure that we that we work collaboratively with law enforcement.
▶ 2:00:19Thank you. I mean, prior to this there was a sensitive locations memo which did not allow ICE enforcement within a healthcare setting. Um in Southern California alone, nearly 30% of patients have reported missing or canceling appointments due to immigration concerns. I understand I just want you all to know that the healthcare industry is in very uncertain times. The Republican tax bill which gave a tax cut to billionaires just cut $1 trillion from health care programs last summer.
▶ 2:00:49I know that tariffs, illegal tariffs, are driving up the cost of medical supply supplies, general hospital and health system costs, and procurement as Immigration enforcement is decimating our caregiving and long-term health care A cruel immigration regime is deterring people from getting to their doctor's appointments.
▶ 2:01:10So, I understand you're facing a lot of headwinds, but I think it's incumbent upon a local hospital, especially one that was founded on caring for our most vulnerable community members, to provide a safe space for parents and their families. And I wanted to talk to about this particular issue today because this week the House is voting to to progress another $70 billion in funding for Trump's ICE and CBP enforcement, and that kind of enforcement isn't stopping anytime soon.
▶ 2:01:41So, I fear that if you do not have policies that put the patient's health above all else, um this could also be a real disaster for our health care industry. And with that, I will yield back.
▶ 2:01:52Mr. LaHood.
▶ 2:01:54Thank you, Mr. Chairman, for having this important hearing today. I want to thank our witnesses for being here today and your valuable testimony. Obviously, the title of today's hearing is the impact of rising health care costs on patients and families. And as we've heard uh this morning already, this is a a top This is a topic that is top of mind for all of us from a public policy standpoint, from a political standpoint. We have to do something on health care.
▶ 2:02:21Uh and so, ideas, suggestions, proposals, comments are important. Um we also are building upon what we uh earlier this year had before the committee, which was the leaders of the major health care companies uh on how to address the challenges of limited access, rising premiums, and growing out-of-pocket costs for patients.
▶ 2:02:43Today's hearing is a continuation of that and that conversation and I believe that rising costs should be addressed comprehensively by the entire healthcare system. Insurers, hospitals, drug manufacturers, and PBMs all share responsibility for improving affordability and access and I would argue we have an obligation and responsibility to move forward with that.
▶ 2:03:07I regularly hear in my own district from families and employers and providers across Illinois who are concerned about hospital consolidation, higher facility fees, and billing practices that are increasingly difficult for patients to navigate or to understand. Those pressures can increase costs without necessarily improving quality or access. In rural communities, and I have a very rural district, these challenges are even more serious.
▶ 2:03:34When a hospital closes a service, loses staff, or reduces access, patients may have to drive hours for care, which is inconvenient and very very difficult. I and many of my colleagues here strongly support market competition. And I also support vital safety net programs like Medicare and Medicaid and the 340B program.
▶ 2:03:59With Illinois having a significant participation in 340B, we must ensure that this lifeline reaches the vulnerable patients in rural hospitals that the program was intended That's why when market power grows significantly or when public programs are used in ways that we do not clearly benefit that do not clearly benefit patients, lawmakers have a responsibility to intervene and assess what's broken within our system and that's what part of
▶ 2:04:29what today is about. So I look forward to discussing on how we can lower costs, strengthen rural healthcare access, and ensure patients are kept at the center of our system. With that, I want to ask a question regarding 340B, which of course is the drug pricing program designed to lower outpatient drug costs for providers. Dr. Donnelly and Dr. Waldrum, can you please share on how you utilize 340B to provide better care for patients?
▶ 2:04:56And what oversight or reporting requirements must be followed to receive the 340B, ensuring that the resources are directed back to patients?
▶ 2:05:04Sure, thank Thank you for your question, and and I agree completely with you that there's many stakeholders, and all of us, including hospitals, have to play a role in finding a solution. In regards to the 340B, we do believe that we use the resources that we obtain from 340B to take care of vulnerable patients as the program was designed. We have a $2.4 billion community benefit. That's over 20% of our operating expenditures. For nonprofit hospitals, the average is around 9 to 14% of operating expenditures for community benefit.
▶ 2:05:34Specifically, we provide a billion dollars shortfall of care to patients who are insured by
▶ 2:05:44Dr. Waldrum.
▶ 2:05:48Congressman LaHood, I appreciate the the question and the importance of affordability. I think that it's important my whole career has been in safety net organizations, as I've mentioned, and using these programs to support our communities, and make sure that they have access to care, and the significant burden that we all face with uncovered lives. And so, this this is a really important program for maintaining access in rural populations.
▶ 2:06:17And I think it's important to point out that this is not a federal The feds don't pay for it. This is a program that's put in place, and I get that pharma doesn't like it. this is really important for us to maintain the programs that we need to maintain to make to have the access and it's not about convenience. It's actually about lives. We need to not increase the administrative burden as we've mentioned.
▶ 2:06:4720% of our healthcare dollar is spent on administrative burden managing the complexity of the insurance markets. Medicare Advantage is overwhelming our staff and our reporting adding to the administrative burden of this important program will only increase the cost and diminish the benefits that it helps for safety net organizations.
▶ 2:07:12I'm out of time. I yield back, Mr.
▶ 2:07:14Thank you. I now recognize Ms. DelBene from Washington for 5 minutes.
▶ 2:07:18Thank you, Mr. Chairman. Thank you all for joining us today. Um Prior authorization is a tool that is used by health plans to manage costs by requiring healthcare providers to obtain pre-approval for medical services. Um theoretically, people may think this sounds reasonable, but in reality it often uh denies beneficiaries access to services even when they meet coverage rules.
▶ 2:07:42In fact, one KFF analysis found that in 2024, more than 80% of the appealed prior authorization denials were overturned. And unfortu- ultimately, these unnecessary denials delayed patient care, added administrative burdens on clinicians, and hurt health outcomes for Um Mr. Lassiter, you represent uh Common Spirit, the parent organization of Virginia Mason Franciscan Health uh in my state of Washington and many clinics also in my district.
▶ 2:08:12Um I wondered if you could comment on how prior authorization has affected patients um that you serve obviously in Washington, but across the country.
▶ 2:08:22Thank you very much, Congresswoman, for the comment for the question. Um I would just simply say this. Um authorization as you indicate is a tool health systems are experiencing that tool being misapplied at times to procedures that should be quickly that are not or denied authorization for procedures that clearly are within the the coverage plan that patients have we
▶ 2:08:52experience that frustration we hear it our front off our front line teams hear it from patients who experience delays in being able to schedule procedures and that comment is sort of across the system is not specifically to Seattle or or state of Washington but broadly and again we believe that um that some of the administrative oversight and the work and rework that's required there we estimate that for us
▶ 2:09:23it's about a billion dollars worth of additional time and effort spent chasing down authorizations pre-authorizations denials etc.
▶ 2:09:31And not only delaying and denying care for patients but you talked about the burden on clinicians and others the when folks are spending more and more time doing paperwork they're not able to actually see patients and do the work they're there for you know I absolutely believe we should look at innovative solutions to reduce hurdles that stand between Americans and the health services they need so I was definitely alarmed to see this administration do the opposite and leverage AI tools
▶ 2:10:01to deny people care in traditional Medicare two weeks ago we had secretary Kennedy here he came in to testify in front of this committee I asked him about the implementation of the new wasteful and inappropriate service reduction model the wiser model which is actually is happening in Washington State This it's launched in six states including the state of Washington and allows for-profit companies to use kind of black box algorithms to deny Medicare claims.
▶ 2:10:32And even worse, it financially rewards these companies with a share of the cost that they claim to have saved by rejecting physician prescribed care. So Mr. Hassler, if we speak specifically about the wiser model which is in Washington um What is your relationship and communication like with these companies that are actually doing the prior authorization, the for-profit companies that are doing prior authorization in the wiser model
▶ 2:11:03in states like
▶ 2:11:06Congresswoman, thank you for the It's It's a little early for us to to have a bottom line point of view about the wiser model. We have concerns about entities that have incentives to to disallow appropriate claims. We liken this to some extent to the days when we had those Medicare rack audits and you had the audit firms who had a financial incentive to to deny claims. We see it somewhat similar to that.
▶ 2:11:36Again, it is early. As you mentioned, it's in six states. Washington's one of those. Our team is closely monitoring um the the effects positive, negative, or neutral of the wiser model. But I have some concerns about the the misalignment of incentives between the firms that are doing it and what they are the basis of their payment.
▶ 2:11:58Thank you. And we are hearing directly from patients across the state who are being impacted from providers who know their patients are having their their care delayed. It's more expensive. So this idea that somehow this model was supposed to save money is actually make it harder and harder for patients. Um, thank you so much. Um, I yield back, Mr. Chairman.
▶ 2:12:23Well, thank you and I now recognize myself for 5 minutes. Um, I appreciate all the witnesses for being here today and you know, I I want to start off a little bit uh first with just talking about some of the positive aspects that uh impacts on health care systems can have when they actively invest in a communities. In my own dis- in my own district, HCA's Wesley Medical Center is delivers more babies than any hospital in Kansas.
▶ 2:12:47And to address the severe severe workforce shortages, HCA recently opened a Galen Nursing campus in Wichita fully funded by HCA and tuition without public dollars. And they now have over 200 patients and are proactively partnering with nine other local nursing schools to ensure no existing clinical rotations were disrupted. This is a true addition to our state's workforce and not a replacement.
▶ 2:13:13Uh Wesley's hired over half of those graduates and the rest are serving other communities across Kansas. That's the type of local investment we like to see and I appreciate that effort. Um, we do want to look though at as we talk about the broader national landscape. as as been brought up earlier, the rapid commercialization of our medical care is concerning.
▶ 2:13:34Uh we're watching as these the large systems swallow up independent practices creating local monopolies that drive prices for patients without necessarily improving the quality of care. a massive driver for this consolidation is as we've seen and creates a heavy burden for a financial burden for our patients is the broken system around site neutrality.
▶ 2:13:59I mean, right now Medic- Medicare and commercial payers generally pay significant more for care provided at an outpatient facility that's owned by a hospital compared to the exact same facility if it were owned by an independent doctor. Because of this, when large hospital systems buy up independent practices, they routinely add huge facility fees onto the regular outpatient services.
▶ 2:14:22In fact, patients this can end up paying up to four times as much for routine care just because a hospital acquired the clinic even though they see the exact same doctor. And this this payment loophole incentivizes health systems to continually purchase independent practices simply to bill at a higher I want to talk a little bit about that. Obviously recognize that in a hospital setting there are some additional costs.
▶ 2:14:47I mean having an ER, having maybe an on-site pharmacy or other facilities does add some of those costs, but it doesn't necessarily affect the actual services provided at an outpatient facility that that may have been just recently One of the reasons why I want to talk about this is just the impact on seniors who living on fixed income sometimes pay 20% of their out-of-pocket for outpatient services.
▶ 2:15:14For example, a senior may pay $50 copay for a checkup at a doctor-owned at a hospital-owned clinic instead of $20 copay at for an independent doctor. How do you how do you look through that as with your systems? I mean that this is kind of a question for anybody is you know is there is there a $30 value added to that patient because the the facility is bought? Dr. Waldrum.
▶ 2:15:40Yes, Congressman. I appreciate the question the question and I think that the assumption that we are consolidating out of profit motive out of profit motive is is wrong in rural America. In our market, I can only speak to what we face and I've never bought or sold a practice because any of the doctors or hospitals or communities wanted to actually make that happen.
▶ 2:16:09Our system grew because of all nine eight rural hospitals were failing and were were about to be closed when those communities approached us because they had years of deficits in their community and they were losing doctors and in Martin County, a county about 45 miles north of Greenville, North Carolina, 3 years ago that rural closed.
▶ 2:16:37It was a for-profit organization closed because they couldn't make it in that community. It left that community as one of the largest health care deserts in the country and for us to sustain care and pay the overhead and to to provide access in those communities, the provider based reimbursement helps us meet that obligation. So, we're working with the state.
▶ 2:17:02We'd like to work with feds and uh we're working with our community to try to find a solution and this is one of the programs that helps us meet that.
▶ 2:17:11and I think that's a a good use of consolidation practices. I mean, I have a lot of counties in my district where 4,000, 5,000 population entire county and that's not enough to support that either competition or let alone support a standalone hospital and I'm worried more about the standalone clinics that get bought that aren't necessarily a hospital and and the impact there and and so, anyway, I I've got so many other questions, a lot of things that we've talked about
▶ 2:17:41rural classification and and the impact there and we've really got to figure out a different way of doing this and so, I've run out of time, but I want to make sure that we we focus on how do we lower the health care costs for everybody across the country. Now, pursuant to committee practice, we will go to two to one questioning and now I'll call on Mr. Arrington for 5
▶ 2:18:07Thank you, Mr. Chairman. Witnesses, um I want to follow on the line of questions that Chairman Estes articulated. First, I think it's probably been well established. I think everybody understands that the current system is broken, fundamentally broken.
▶ 2:18:26It is not delivering in country as wealthy and as capable technologically, as rich in resources, in personnel, in brick and mortar, we should not be the least efficient system in the developed world.
▶ 2:18:46a third of the budget and a third of which driving us further into uh the tens of trillions in debt hole with a looming debt crisis is health care. It's 20% of the economy. You look at Medicare with 10,000 baby boomers retiring every day. We're going to go from a trillion to two trillion in less than 10 years. One in every four Americans in 2022 were on Medicaid. In '22, Medicaid was almost $600 billion.
▶ 2:19:15That was a 45% increase from 2019. And these are just two programs, the largest health care programs of the federal government. We cannot sustain this. And it's going to end really badly if we don't do something about it.
▶ 2:19:28And I haven't even gotten to the consumer or the patient price But in 2015, Congress passed the Bipartisan Budget Act, established site-neutral payments under Medicare for services received at off-campus HOPDs, basically hospitals, unless the location was already billing as a hospital department prior to the date of enactment. Mr.
▶ 2:19:56Chairman, this grandfathering clause and other exemptions in the law have resulted in a that is driving cost up for patients, premiums for Medicare beneficiaries, and taxpayers that are paying the freight of the system. I'm talking about site neutral. Where in Plainview, Texas, it's real simple.
▶ 2:20:20We're paying hospitals a whole lot more for the same outpatient procedures that physicians uh conduct with the same outcomes, often with the same mid-level uh uh support.
▶ 2:20:36And you've got for example, uh biopsies today on average cost about $150 at a physician's office, it's $800 at a hospital setting, and there's a whole list of things, epidural injection, $250 at a physician's office, 740 because of that HOPD PD payment. Now, there are some things hospitals can do that outpatient physician groups can't.
▶ 2:21:06We want you to be motivated to do that and do that well. There's a cost structure associated with it. We want you to be adequately funded. But if we just did what President Obama suggested in his budget, what Joe Biden included in his budget, and yes, Donald Trump included in his budget in in his first uh administration, we could save $160 that would go to reducing the deferred tax on our children or
▶ 2:21:36the national We could uh among other things, uh save 94 billion to beneficiaries, 672 billion for greater health care uh for the greater health care system, and on and on. It's a simple, straightforward thing, Mr. Chairman.
▶ 2:21:54And to my Democrat colleagues, this was led, I think, uh during the Obama years, and we've carried it over into all of our budgets, but just like we say we want to get rid of waste and fraud, and we put it in the budgets as a saver so we can show that we're getting close to balance. We don't do jack squat about it.
▶ 2:22:14Now, we did, and then we got vilified by our Democrat friends for supposedly cutting benefits, and all we were doing is cleaning up the system so we could sustain these programs, and so that we could also steward tax dollars. But yet, here we have another opportunity, Tom, another opportunity to do something that both sides have said is important, is common-sense, straightforward, save the system money.
▶ 2:22:40Why wouldn't that Raise your hand if you think that's a If you think that that's a straightforward, common-sense idea that we ought to do to help save the system from collapse, if not the entire country from a fiscal or debt-related that could be potentially irreparable? Do you think it's a good idea to have site-neutral, or y'all against it? I That So, no hands, no takers for that. But I Look, I'll give you, Mr. Hazen, give me your the last your your comments.
▶ 2:23:10I know my time's expired, so you'll be the last word on this. But I didn't get any takers on on site-neutral.
▶ 2:23:16I think there are certain aspects of your discussion here that have merit. I think there's also merit to the hospitals receiving a premium in certain circumstance. So, we would be more than willing to work with you on it.
▶ 2:23:30I think that's fair, and I want to be sensitive to those nuances so we don't hurt you while helping the system. So, let's work together and get it done. I yield back.
▶ 2:23:41Thank you. I now recognize Ms. Sewell of Alabama for 5 minutes.
▶ 2:23:44Uh thank you, Mr. Chairman. I want to thank all of our witnesses for being here today. My Alabama district is both urban, Birmingham, uh as well as rural, the Black Belt of Alabama, which is where I grew up in. Um and all what they have in common is that they are they they are areas where underserved people uh live. And so, there are lots of needs in my particular district.
▶ 2:24:09But, if anyone knows what's possible from that district with resources, opportunities, it's me and my staff, and we work hard every day to try to provide those resources and opportunities to the people of the 7th Congressional District. Alabama has a bare-bone minimum Medicaid program.
▶ 2:24:26Uh we have the lowest Medicare wage index, meaning that Medicare reimburses our hospitals at 65% of costs compared to more wealthier uh cities uh and states at of uh of cost. Um we have fewer folks on private insurance, so our hospitals are heavily reliant on Medicaid and Medicare reimbursements.
▶ 2:24:53And most recently, I held a round table with my rural hospital CEOs. And over seven of them attended, as well as uh several executive directors and CEOs of a community health centers. They are exhausted. They are exhausted because they feel like they're getting hit by all sides, and that there's no end in sight. They aren't hopeful about the Rural Health Transformation Fund because they don't think that it will trickle down to their hospitals.
▶ 2:25:22When compared to the impending uh Medicaid cuts as well, they think that they're in a no-win situation. Mr. Waldrum, I Dr. Waldrum, I want to thank you for being here today and for your work at UAB, uh the former CEO of, University of Alabama Hospital in Birmingham.
▶ 2:25:41I also want to thank you for your leadership in the double A M C M C M C I'm proud of your partnership with on my bill to expand medic medical residency slots. I think all of us wanted to make sure that we have as many residents as possible especially for rural parts of our districts.
▶ 2:26:03You're familiar with the state of Alabama's Medicare and I wanted to see if you would give an assessment on how you think that the rural and safety net hospitals will fare under the Medicaid cuts and your thoughts about the rural hospital transformation fund. Dr. Waldrop
▶ 2:26:26It's good to see you. Thank you. Um And as as mentioned I spent 20 years of my career in Alabama running one of the country's largest safety net organizations in downtown Birmingham and have visited every rural hospital in the state of Alabama just as I have in our market of Eastern North Carolina and they're very similar demographically and from a rural context.
▶ 2:26:51So I very much appreciate and understand the issues that your constituents are facing. The fact is is that when we look at the HR1 and what it will do for funding in rural environments we see a fairly large reduction in in reimbursement.
▶ 2:27:13The year after next we realize a $30 million decrease which starts to compound year over year and over the next 10 years conservatively is a billion dollars in cut to our rural delivery system and then we appreciate the fact that the the the rural health transformation fund that underscores that there's really a difference in rural and urban
▶ 2:27:43think we all know that. And I think that the challenge of course in Alabama is that we didn't expand Medicaid. And we also have the lowest wage Medicare wage index. And I know that our whole delegation has been fighting to increase that. But to increase Alabama and other southern states means you have to decrease New York and other uh uh west and east coast. And so it's a win it's a win-loss proposition for so many.
▶ 2:28:11Um your thoughts about what we can do um with the transformation fund uh as well as your thoughts about um you've said that the cuts will be devastating. How devastating will they be for rural and underserved communities?
▶ 2:28:23Well, we are starting to plan and it will if we don't get relief we'll be closing access and and and services. So that's just a a mathematical reality. And so I think that that will play out. The the amount in the rural health transformation program will not offset and is not nearly um and and every state's different. So I don't know exactly how the Alabama program
▶ 2:28:44Well, Alabama's getting 200 million dollars for that first year. But they've also said that that transformation fund I know every state is different and can can develop their own. But our transformation fund will only be for will not be for operational costs or deferred maintenance. Both of which are critically important to those facilities staying open. Again, I want to thank all of our uh witnesses for being here today. And um just wanted to say that um we have a lot of work to do Mr.
▶ 2:29:12Chairman when it comes to really undergirding our rural hospitals. And I look forward to rolling up my sleeves and working in a bipartisan manner to make that happen. Thank you.
▶ 2:29:21Thank you. I now recognize Mr. Smucker from Pennsylvania for 5 minutes.
▶ 2:29:25Thank you Mr. Chairman. Um thank you to each of you for being here. It's an important conversation. We all want to ensure that everyone uh has access to the health care that they deserve and at a price that uh they can afford and to the insurance uh access to insurance they can afford as And there's a lot about the the marketplace in health care that is not an efficient marketplace due to a lot of regulations of rules that have been put in place by, you know, many uh folks here and and uh those that were here before us.
▶ 2:29:56Uh but I do want to uh before I get uh just have a uh want to get to a line of questioning, but um I I I'd like to respond to some of the things that Democrats have been saying and also their witness, Mr. uh Woodhouse. Uh we we heard Mr. Smith debunk one of the claims about a facility that closed um in his district. I also want to say that you the data that he cites about 800 hospitals are at risk risk of closure.
▶ 2:30:21That data was available and the data he's using was from 2019 well before the bill that Republicans passed was even uh being considered or passed into law. He also quoted and Democrats have quoted uh 15 million people who will lose their health health care. I've seen you all nod along. Do you know who's going to be losing their health care, does any of you? No? The 15 million people that will be losing their health care?
▶ 2:30:50Um CBO actually addressed this um and uh I'll tell you who it will be. Uh so 6 million are able-bodied adults without dependents who are working age, who choose not to meet modest Medicaid work requirements that have been put in place with this bill. Or they choose not to fill out common sense Obamacare verification forms.
▶ 2:31:15We want to ensure that taxpayer dollars are being spent on people who truly need it. So that's 6 million of them. 1.4 million are illegal immigrants. Uh state some states allow illegal immigrants to uh benefits. That's 1.4 million. 3 million are people already ineligible for Medicaid, and they simply haven't been removed from the program yet.
▶ 2:31:42Um or have access uh to other subsidized coverage besides Medicaid. Uh and 5 million are potentially due to the expiration of the expanded Obamacare tax credits that Mr. Woodhouse uh talked about. Uh that have increased costs. Those were put in place by Democrats set to expire, and we see in uh we're seeing the cost increase because of that.
▶ 2:32:07That is what CBO has said about the 15 uh million people who uh will no longer be uh eligible. Um I The other thing about Obamacare, which Mr. Woodhouse talked about, uh um the cost of Obamacare premiums has doubled in the last 10 years. Has gone up well above uh business um uh insurance plans.
▶ 2:32:30And in fact is almost double 180% of a of a of a business insurance plan that uh would be Um so there's a lot of work to be done. There's a lot of blame on Republicans, but these are just some of the uh facts. I want to talk a little bit. I noticed one of you is a for-profit, three are not profit. And of course we in the tax code designate uh nonprofit um status for companies that are providing some uh public benefit.
▶ 2:33:00Um and of course the governor the government the federal government gives up uh tax revenue as well as local uh communities. So for instance, in my community like the city, houses a lot of Penn Medicine's facilities and forego or do not receive uh tax benefits as a result of that. When I look at your systems, I don't know that I see a lot of difference between a for-profit and a non-profit. Mr. Hazen, you're the for-profit.
▶ 2:33:28Do you think there's much difference in the way hospitals that are designated for-profit operate differently than a non-profit?
▶ 2:33:36Thank you, Congressman. Uh I've had this question posed to me many times, and the short answer is no.
▶ 2:33:43Okay, thank you. Um and I'm I'm sorry, I'm running out of time. Um I'd like to go to uh Mr. Lassiter.
▶ 2:33:52Your compensation seems to be maybe on par with a for-profit. I have see your compensation was 21 million last year. Is that correct?
▶ 2:34:01That's not correct.
▶ 2:34:02Okay, what was it?
▶ 2:34:04Uh it was 14.
▶ 2:34:0514 million? Okay. Is that on par with what a for-profit would be receiving, or is it more?
▶ 2:34:13Well, I I I can't answer that explicitly. What I can say to you is my
▶ 2:34:17Do you think that your system is using some of what would have been paid in taxes to compensate you?
▶ 2:34:24Uh do you think that public benefit includes 366 360 million dollars invested by your organization in Central America and
▶ 2:34:38We We don't have We have no operations in Central America.
▶ 2:34:41You You invest in public publicly traded
▶ 2:34:46Is that right? 718 million invested in publicly traded securities, 134 million dollar gain by those securities?
▶ 2:34:54Uh 163,000 spent on board meetings in Europe, Canada, and Mexico.
▶ 2:35:00That's not true.
▶ 2:35:02We We We do not hold board meetings
▶ 2:35:04Can you explain to me uh why you should be granted non-profit status?
▶ 2:35:10Sorry, Mr. Chairman. So, so on an annual basis, Common Spirit delivers about 5.2 billion dollars a year in community benefit. That is approximately 12 times our the value of our taxes foregone. When you think about the community benefit that my organization
▶ 2:35:29I'm and I'm really sorry I'm out of time. I would love to ask Mr. Hazen how much community benefit that benefit they provide just for a comparison because they being a for-profit but I know I'm well out of time. Thank you, Mr.
▶ 2:35:40Thank you very much. Gentlemen's time has expired. Now recognize Dr. Murphy for 5 minutes.
▶ 2:35:46Thank you, Mr. Chairman. I will say I've had an illustrious and very very rewarding career practicing urology in Eastern North Carolina. I also served as chief of staff of the ECU Medical Center, 1,000-bed hospital now 1,000-bed hospital that serves a 29-county referral area and as Dr. Waldron pointed out, one of the poorest referral areas in the country. I know the vocabulary. I know how to speak the language. I know that health care is very complex. Yet we are in a situation now that is untenable and must change.
▶ 2:36:16It must change. I will just before I get started, I want to give a shout-out to ECU Health. I've worked in that system for 35 years. It is the paragon of what Mission Health is supposed to be about, serving a poor, less accessible area, taking care of those who are marginalized, taking care of those who have no access to health care and as Dr. Waldron pointed out, accessing hospitals which would otherwise have failed. It has been my honor to take to work in that health care system and I think they do a fabulous job.
▶ 2:36:43Sadly enough, the beast of our existence, United Health Care, they're now in negotiations with this. United, which earns billions and billions of dollars of profit every year, is now trying to skim pennies off a poor Eastern North Carolina system. I wish you well in your negotiations. I hope someday the FTC breaks up United Health Care and turns them into dust as I asked that they be done before.
▶ 2:37:07It is ridiculous that for-profits insurance companies, and I think all of us can agree on this, are preying on the American patient making partly healthcare unaffordable. Just as as a recognition, I understand hospital costs have gone up. Regulations, government regulations go up. Labor costs have gone up. We saw that with traveling nurses during the pandemic. Medications have gone up, which in some ways is a good thing, we're keeping patients alive. Electronic medical records costs have gone up. Liability costs have gone up.
▶ 2:37:36C-suite they're ridiculous. They're ridiculous, and it's hard to make a justification for some of those sometimes when patients cannot afford Democrats love to feed the beast of increasing healthcare costs. You talked about the ACA extended subsidies. All those did were insurance company benefits and profits during that time. That's what they were doing. And as my friend Mr. Smucker pointed out, what a great correction of the record about who is really getting their quote healthcare removed.
▶ 2:38:06We need to rethink the urban rural classification. We have institutions that are taking advantage of this. That's just wrong. It's just wrong. We need to rethink that completely. If you look at why rural healthcare is having suffering so much, it is because manufacturing has gone in eastern North in all areas, especially in eastern North Carolina. Government subsidies are only a panacea. They don't get to the problem. I'm glad we have a president that's trying to bring manufacturing back to this.
▶ 2:38:33So, I racked my brain because I still see patients, and they come in and talk about the cost of healthcare. How do we do this? There's culpability everywhere, from hospitals to insurance companies to pharmaceutical companies. There's even plenty of culpability for physician associations for instead of teaching how to order one more test, how do we do things more slightly? We have to fix this problem. We have to fix this problem. Medicare for all is a ridiculous initiative.
▶ 2:39:00You want less government, you want less government in the situation cuz that's some of the the worst problems that we have today. So, it brings us back to why is health why is health care so unaffordable these days? In many different institutions, their their for-profit status really, I think we have to question it today. It was fine 10 and 15, maybe 25 years ago, but it's gotten to be out of control.
▶ 2:39:25We're now institutions are more aligned and care more about their dividends and their their shareholders than the patients themselves. I have to stare directly at patients every day when I see patients and explain the system to Mr. Hazen, your institution, I had the honor of going out to Mission in Asheville. Tremendous job they did after Hurricane Helene. Tremendous initiative putting in a drill 48 hours to to get water.
▶ 2:39:51I was really blown away and thought they did a a wonderful job right after the hurricane. But, I need you to help me understand something. In this case of how can you justify a for-profit institution when you guys made 6-7 billion dollars in profit, returned to shareholders, none of whom have anything to do with health care when people cannot afford their health care premiums? Help me understand why we should allow for-profit systems to
▶ 2:40:19Congressman, thank you for acknowledging our team at Mission. That was a Herculean effort. I went through Katrina as well, so I'm really proud of our folks there. I will tell you I think our model is the model. It's the solution in many instances. In addition to um the five billion dollars roughly of uncompensated care costs
▶ 2:40:41Look, I believe me, I get the whole uncompensated uncompensated care thing. I I I get it. I I understand this, but how can we justify in today's market when people cannot afford health care that there are systems that are survived just for-profit? Now, I'll I'll extrapolate this to our wonderful United to our health insurance companies. United is the third largest corporation in the country. How does this extrapolate to patients who cannot afford health care today?
▶ 2:41:08Well, our focus is on our patients. We have 33,000 patients in a bed right now, and we're 100% focused on that.
▶ 2:41:15The the bottom line is we can't justify it in today's market. We cannot justify that billions of dollars are taken out of patients' pockets, not being able to allow them to access health care, and that it goes for for-profit on stock markets. We just can't do that anymore. Now, I don't want to sound like a communist. I'm not. I'm a capitalist at heart. I absolutely believe in this. But if we now have institutions that put profits above patients, and I'll beat more on the insurance industry than anything, we have to rethink this model. Thank you, Mr. Chairman.
▶ 2:41:45I'll yield
▶ 2:41:46Thank you. Gentlemen's time's expired. Chair would like to remind members and witnesses to please limit their comments to 5 minutes allotted. Uh and now recognize Ms. Chu from California for 5 minutes.
▶ 2:41:57Mr. Woodhouse, undermining vaccines drives costs through the entire health care system, including hospitals. Preventable infections lead to more emergency room visits, more inpatient hospitalizations, more ICU admissions, and more uncompensated care. Uh the Trump administration has spent months undermining trust in vaccines.
▶ 2:42:19They've fired independent vaccine experts, empowered vaccine skeptics, and spread serious doubt about vaccines that we know are safe, effective, and One of the clearest examples is hepatitis B. For more than 30 years, the recommendation was simple. Every newborn should receive the hepatitis B vaccine within 24 hours of birth.
▶ 2:42:43That universal birth dose helped drive a nearly 99% decline in hepatitis B infections among children. But after Secretary Kennedy totally reshaped the CDC's vaccine advisory panel, the recommendation was overturned.
▶ 2:43:00So, it's no surprise that just yesterday a new study in JAMA Pediatrics came out warning that even a short delay in the hepatitis B vaccine could mean hundreds of additional infections, more cases of liver cancer, more preventable deaths, and tens of millions of dollars in added health care That does not sound like making America healthy again.
▶ 2:43:26And we are seeing the same dangerous erosion of trust around vaccines for measles, the flu, and COVID. So, Mr. Woodhouse, can you explain how these attacks on vaccines are not only dangerous for public health, but are driving up costs for families, hospitals, and taxpayers?
▶ 2:43:46And what should Congress be doing right now to undo the damage that has been um and um that has been occurring recently and restoring trust in vaccines and stop paying for so that we can stop paying for more preventable crises?
▶ 2:44:00Well, Congresswoman, thank you for that question. I would say the first thing that Congress should do or maybe President Trump should do is show RFK Jr. the door. Uh I mean, this is someone who came into this administration um having spent a dozen years or you know, much of his adult life sowing conspiracy theories uh about about vaccines. It was a grift.
▶ 2:44:22I mean, he had a nonprofit that he was making lots of money off of that was selling disinformation uh about vaccines, selling disinformation about the measles vaccine causing you know, autism. And he has sown more disinformation and discord uh in this regard since uh since he's been Secretary of Health and Human Services. We've called for his resignation. I don't know a Democrat on Capitol Hill that hadn't called for his resignation. Public health is a disaster because of uh of RFK Jr.
▶ 2:44:49We have uh the largest measles outbreak in this country in 20 years. We are very likely this year to lose our measles elimination status. Um, he is, you know, he has undermined confidence in uh, in the COVID vaccine and the measles vaccine. And of course, more people, uh, let's take South Carolina. I mean, the in the the area of Greenville, South Carolina, where in that area where measles has exploded. And you know, RFK Jr.
▶ 2:45:16hadn't stepped foot in South Carolina to address uh, to address the measles epidemic there. He hadn't set foot in South Carolina and said, "Yes, you should get, you know, you should get the vaccine. Yes, you know, there is no uh, link between measles vaccine and, you know, and autism." So, obviously there, that's going to have increased health care costs for people that have to be have to be cared for.
▶ 2:45:37Well, let me ask, uh, just turning, uh, to another topic that is, uh, to me very essential, which is about private equity and how that's affecting hospitals. Um, when hospitals are financially stable, they're may able able to make decisions based on patient care, but Republicans' big ugly bill is pushing hundreds of hospitals to their breaking point. Hospitals are losing Medicaid revenue, facing more uninsured patients, and being forced to cut services just to survive.
▶ 2:46:05And when they become distressed, then private equity comes in. And often times the priority's not patient care, but investor return. And it private equity is often the kiss of death for hospitals. Um, in fact, it's hard to think of a business model less compatible with health care than private equity. So, Mr. Woodhouse, does Republicans' big ugly bill make it more likely that struggling hospitals would be pushed into these kinds of
▶ 2:46:34Well, well, let me say a couple things here. One, we have 889 pins on our map of hospitals that are struggling. I think there's no doubt that that creates a sense of desperation, and that's the very type thing that can happen. I'll say another thing. None of the data on our map is from 2019. None of the data on our map is what Congressman Smucker said it was was from. The very first pin we put on our map was the day this bill passed and it was sent to the president. Hadn't been signed yet.
▶ 2:47:02A hospital in forgive me, I believe it's Oklahoma or Nebraska. But they looked at their financial situation, they looked at what they were likely to get cut from Medicaid in future years and they closed before the bill was signed by the president. They announced their closure. That was the first pin on our map. That was not in
▶ 2:47:20Thank you for clarifying that and I yield back.
▶ 2:47:23Thank you. And now recognize Mr. Fitzpatrick from Pennsylvania for 5
▶ 2:47:28Thank you, Mr. Chairman. Year after year my constituents in Bucks and Montgomery counties are seeing rising health care costs forcing many to make impossible decisions when it comes to necessary care. The consolidation of health care systems over the past several decades, among other factors, raises serious questions regarding the rising cost of care.
▶ 2:47:48I want to focus my questions on workforce challenges that have had a direct impact on rising costs including a specific example from the SEIU in my in my home district. Mr. Donley, many labor unions provide health insurance from for their members and their families including in Pennsylvania's first congressional district.
▶ 2:48:09Unions, like thousands of employers across the country, use price transparency data from the administration's price transparency initiative to garner information on their premiums. They found New York Presbyterian charges much higher than Medicare for their care. To be precise, 358% After this union dropped New York Presbyterian from their network, they reportedly saved substantial resources allowing for more financial flexibility for their members.
▶ 2:48:40Mr. Donley, I assume like most uh private health plans, you have built um you have to build in uh some cost shifting in order to help offset losses um from the Medicare and Medicaid patients that you serve. Um so, I question Dr. Donnelly, does this situation um that I mentioned cause any changes or considerations to the prices that are charged?
▶ 2:49:04You know, as you note, uh pricing is very complex. There's many different variables. Uh I would say at New Presbyterian, as we look at pricing, uh what we look uh for our pricing to be based off based off of is the quality care that we provide. We're very proud to be a five-star CMS hospital, recognized for our quality. Only 10% of hospitals in America are recognized as five-star. The other thing we look at uh when we price is the complexity of the illness of the patients that we're treating.
▶ 2:49:33And the third variable is our underlying cost. Uh and that's what we base uh our uh costs on uh when we price.
▶ 2:49:42I want to move on um to discuss the workforce shortages impacting affordability and access to quality care for patients. The country uh is facing significant uh physician shortages that is impacting access to care for millions of Americans.
▶ 2:49:58And I, amongst many others, am concerned as recent um commentary suggested that Congress should eliminate uh GME funding by formula and replace it with a discretionary grant program, uh problematically stating that the program supports revenues and not residents.
▶ 2:50:16I have partnered with Representative Terri Sewell on this committee to introduce the bipartisan legislation, the Resident Physician Shortage Reduction Act, which would invest uh in additional Medicare funding to train more residents.
▶ 2:50:29Specifically, this bill would add 14,000 residency slots over 7 years, prioritizing distribution uh in rural and underserved areas, health professional shortage areas, states with new or expanding medical schools, as well as hospitals currently training their resident caps or training over their resident caps. Dr. Donnelly, question for you again.
▶ 2:50:52Can you explain how this legislation would benefit patients access to quality affordable care and how shifting GME to a grant program would be harmful to physician training programs at teaching hospitals specifically.
▶ 2:51:06I I strongly appreciate your support of You know, in 10 years time, we're going to be 86,000 physician shortage. And we're not going to solve that problem without increasing the GME spots that are available. And so, I think it's really important what you're doing and what you're leading around that. We train 2,500 residents, 500 over the cap. As you're well aware, that means those 500, we actually bear the cost ourselves. It's a part of our mission, and we're committed to doing
▶ 2:51:37Thank you, sir. I yield back, Mr.
▶ 2:51:40Thank you. I now recognize Mr. Kustoff from Tennessee for 5 minutes.
▶ 2:51:44Thank you, Mr. Chairman. Thank you to the witnesses for appearing today. Uh Dr. Donnelly, if someone presented themselves at your facility for a colonoscopy and they had commercial insurance, would you be able to tell them what the facility fee is within reason? I personally don't know uh the facility but our team would absolutely be able to get that information
▶ 2:52:10In other words, the patient would be able to find out the the facility fee if they had insurance.
▶ 2:52:17I believe so. Yes. Uh I mean
▶ 2:52:20It's an important question because the patient's entitled to know, aren't they?
▶ 2:52:24They're absolutely entitled to know, and our intent is that the patients absolutely know the transparency of the
▶ 2:52:30Would the patient know the facility fee if they were on Medicare?
▶ 2:52:36You don't know.
▶ 2:52:37I believe they they would. That's not a yes, though. I mean, price tran- We we we talk about price transparency a lot. That's important to the president. It's important to every patient. And you're unsure whether they would know what the facility fee is before getting the colonoscopy at your facility.
▶ 2:52:59Price transparency is extremely important to us. It's extremely important that patients know that. I will tell you in my first 12 weeks as it might not be something that I specifically know, but I know our team would know the answer to that. And absolutely, we're committed to make sure patients know the price.
▶ 2:53:16All right. Well, let's see if we can I'm going to show you a some data from CMS about a colonoscopy performed at an ambulatory surgical center and one at a at a hospital.
▶ 2:53:32And I know that when Chairman, I believe it was Chairman Smith asked everybody to raise their hands about the disparity in cost at a procedure performed at a hospital versus a surgery center, you did raise your hand and you said that that that was acceptable.
▶ 2:53:49This shows the cost of a colonoscopy performed at a surgery owned by a physician or group of physicians is That's CMS's fee that they pay. The facility fee at a hospital is almost double that, $1,222.
▶ 2:54:14I'm asking this and showing this to you because you raised your hand you accepted the fact cuz you set the that the facility fee can be higher than the surgical center fee. My question to you is and and I'll uh concede that there are some services that you provide that the surgery center doesn't provide outside of the colonoscopy.
▶ 2:54:44But is a 100% increase in the fee that you charge versus the surgical center, does that seem reasonable to you, to the American taxpayer?
▶ 2:54:55I think there's absolutely opportunities as we look at site neutrality uh to look where things aren't reasonable. I do think it's important though that we recognize when things are done in hospitals that hospitals compared to place of not hospital physician owned, hospitals will take care of sicker patients. That's more risk and that's costlier. Hospitals also will take care of all patients that show up regardless of what their payer is and that's different uh than physician owned uh places.
▶ 2:55:25The other thing is in a hospital place, the third point, there's a higher regulatory burden for a hospital uh a place opposed to a physician owned place. Those are costs that we need to make sure as we look at better options for site neutrality that we remember that.
▶ 2:55:42All right. This isn't private insurance. This is Medicare. CMS. Does all that justify a 100% increase in the fee that the facility charges versus the surgical center?
▶ 2:55:55I think there's absolutely opportunities uh in site neutrality uh for us together as we look at solutions for um opportunities for it to be better.
▶ 2:56:06Let me ask you if if you're a physician or a group of physicians and you own a surgery center and you see the disparity in what's reimbursed to them versus what's reimbursed to you, don't you look and say, "How do I compete against the hospitals?"
▶ 2:56:24You know, I think as a physician myself, uh what we see is the less regulatory burden that's in a physician-owned place opposed to a hospital place. We also, I would tell you, I've personally experienced that in a hospital-owned place, you will take care of much sicker patients compared to physician place. They're definitely all
▶ 2:56:44expired. I yield back. Thank you.
▶ 2:56:49Thank you. I now recognize Ms. Moore from Wisconsin for 5 minutes.
▶ 2:56:56Thank you so much, uh Mr. Chair. I want to know on the panel, I like the raising hand thing. How many of you just are really relieved to hear that we didn't cut 1.2 trillion dollars out of Medicaid, that all we did was sort of clean things up? Um and that there's, you know, 6 million able-bodied people, probably young people, are not going to show up in your ERs because they're able-bodied and well. 1.4 illegals that we're going to deport.
▶ 2:57:273 million people who are ineligible and just don't know it yet. And the 5 million ACA Obamacare people who you know, whatever. How many of you agree that we didn't really cut 1. We've heard RFK Jr. say this. We've heard our members on this panel say that that was not a real cut. We just cleaned up. How many of you believe that? None of you.
▶ 2:57:53Let the record reflect that nobody thinks that there was not a 1.2 trillion dollar cut in Medicaid. Um I um I'm going to come back to you, Mr. Woodhouse, to to explain what that is. But I want to ask, how many of you um you heard Mr. um um you heard Mr. Swagger talk about obesity driving being a healthcare cost driver.
▶ 2:58:20How many of you agree that would be very helpful if we if we allowed Medicaid and Medicare both of these systems to pay for GLP-1s for some of our patients. Do you all agree? All right, fantastic. Um I I how many of you that disallowing the provider tax to help draw down more Medicaid.
▶ 2:58:49How many of you see that as a problem with regard to your bottom lines? All right. Wow, that's like most of you all of you except one person. Um Mr.
▶ 2:59:01Lasseter, I have a specific question for I read through your testimony with great interest because you seem really when it comes of being able to navigate um in this current environment because of the the how large your system is. But I'm wondering are you depending on AI and telehealth to navigate these additional costs?
▶ 2:59:28You know, you know, on a bipartisan basis people like telehealth, but I've always been skeptical of it that it may displace care that people need in person.
▶ 2:59:40Congresswoman, thank you for the for the Um and and thank you for acknowledging a a sense of optimism in some of my Yes, I do believe that telehealth is good for the healthcare field. Um and I do believe that technology and AI um has its place. At Common Spirit, we're strongly investing in AI to um support our caregivers in delivering um safer care, higher quality care.
▶ 3:00:07Uh we're using artificial intelligence to support uh reducing costs in in our administrative areas. And we believe strongly that there should always be a human being between AI and the patient, and so we're very focused there. We utilize things like uh virtual integrated care, uh virtual integrated nursing to uh provide support uh in rural communities where there may not be sufficient staffing to ensure that our nurses are relieved from some of the the mundane uh administrative tasks.
▶ 3:00:37But you don't use AI uh in lieu of people coming into your facilities. That's what you're saying,
▶ 3:00:44Not at this Not at this time. That is
▶ 3:00:46Okay, thank you very much. Mr. Woodhouse, there's there's a really a big disagreement about whether or not we cut trillion dollars out of Medicaid, and you've heard all these people, every single one of them say that it's going to disrupt their ability to care for patients.
▶ 3:01:08These people, the 50 million people have been characterized as ne'er-do-wells, lazy people, illegals, uh people who are scamming the system. Can you tell us who these people are?
▶ 3:01:21Well, we we've met with them all over the country. I mean, they're farmers. Uh they're they're small business owners. They're people who are self, you know, self-employed. They're gig They're gig workers. Uh you know, they you know, they they deliver for DoorDash. They deliver for Uber. Like I said, there There are many, many in the rural areas who are you know, who are farmers. So, look, we we we know we've seen in other states. We saw in Arkansas. We've seen in Georgia. We know what a lot of these provisions are about.
▶ 3:01:48They're paperwork provisions that are meant to trip people up, to keep them from accessing care, and reduce that population to create a money that can then be used for tax cuts for the rich. And that's what happened in HR 1.
▶ 3:02:04He's about to drop the gavel on you, so I would yield back Mr. Chairman.
▶ 3:02:09Thank you. Mr. Smucker, I'll recognize you for a point.
▶ 3:02:14Thank you for recognizing. I just like to submit for the record a 990 form from Common Spirit Health relative to questions I had asked in regards to board meetings held outside of the US.
▶ 3:02:32This has a line item Canada and Mexico spent on board meetings there and 78,123 spent on board meetings in Europe. So, I'd like to submit that for the record.
▶ 3:02:46Without objection, so ordered.
▶ 3:02:47Thank you, Mr. Chairman.
▶ 3:02:49Now, I'd like to call on Mr. Steube from Florida for 5 minutes.
▶ 3:02:52Thank you, Mr. Chairman. In Florida, rapid hospital consolidation and vertical integration have expanded the use of off-campus outpatient departments that bill at higher hospital rates, even when care is delivered in settings that look like independent physician offices.
▶ 3:03:05Congress recently took a step towards greater transparency by including provisions from the FAIR Act in the January appropriations package, requiring distinct national provider identifiers or NPIs for on and off-campus facilities, aimed at exposing site of care billing practices that drive up costs for patients and employers. Congress acted on a bipartisan basis to require separate NPIs, so patients and payers can finally see where and how services are billed.
▶ 3:03:31Will your hospital systems fully comply in a timely manner and will you commit to making the data easily accessible to patients? I'll start with Mr. Hazen.
▶ 3:03:46Thank you.
▶ 3:03:47In Florida, patients are often charged significantly more for the same service based solely on hospital ownership of a Um and basically, I'm just going to build on the questions from Mr. Custoff. Um Mr. Donahue, you already answered that, but how can you justify facility fees on outpatient facilities when there is no meaningful meaningful difference in the care delivered or the quality of the care? And I'll start um at the end of the other end of the table, Mr.
▶ 3:04:15I think there are aspects to hospitals that reimbursement covers beyond just the procedure. And that's 24/7 365 readiness. It's hurricanes, as you know, in Florida. It's uncompensated care. And those components, uh I do believe there are opportunities to rationalize some of those differences as I mentioned.
▶ 3:04:36So, give me an example. What would that
▶ 3:04:38Well, I think um in the ambulatory surgery center uh discussion, there could be certain procedures that are the separation between the prices are too significant. And uh they need to be um less because they're not emergency driven or something of that nature. That's just one example.
▶ 3:04:55something that HCA would look at in the next 30 to 60 days and then report back to the committee on on any changes?
▶ 3:05:02on that. We would be glad to work with the committee on that.
▶ 3:05:04Uh Mr. Lassiter, same question.
▶ 3:05:07Um thank you, Congress- Congressman for the question. I would concur with my colleague to the right regarding why some of the uh differences exist between hospital-based activities and physician office activities. I would say to you also, sir, that uh at Common Spirit, we operate 2,300 care sites. Only 158 of those are hospitals.
▶ 3:05:29And so, we work very hard to to operate ambulatory surgery centers that would not have that that um that site neutral um adjustment. Um uh I would agree with the prior the prior comment that we we uh would acknowledge there might be opportunities um for um for uh modifications in the current site neutral process.
▶ 3:05:54We support the fact that with hospitals having 24-hour coverage, emergency departments, etc., that that does drive some of the cost But we also, frankly, we we open more ambulatory non-site neutral facilities every year than we operate than we acquire new hospitals. So we're very focused on having multiple care sites to ensure that patients in the community have access to to affordable services.
▶ 3:06:22Mr. Waldrum.
▶ 3:06:25Thank you. As you know, we have a federal mandate to care for anyone who shows up to the hospital. We have a moral obligation to do this. We're the only participants in the healthcare value chain that have that obligation. Doctors, nurses, insurance companies, drug companies do not share in that obligation. In order to provide rural access to rural care, HOPDs help us recruit physicians and support the workforce to maintain that critical
▶ 3:06:55So you're saying because of that federal requirement it's going to cost more for you to provide the exact same services it would at say an ASC.
▶ 3:07:01We we do not provide the exact same service. We we care for more complex patients, and it's the only service.
▶ 3:07:09Yeah, but just like what Mr. Just like what Mr. Kostoff was showing in
▶ 3:07:12We don't we don't operate in New York City. We operate in rural North Carolina. And so in order to recruit and provide access for cancer care and other services, as mentioned, we're willing to look at it. We would like to work on some some rational reworking of how that works, but these payments are essential in providing access to care for rural
▶ 3:07:35So you're saying in your hospital system if somebody went to a private provider at an ASC for the same surgery, that it would be the same price? Or you're saying that it would be different based on the federal mandate that you have to treat everybody?
▶ 3:07:49I'm saying what we've talked about is that we have a problem with workforce and having doctors in access in rural environments. There is no alternative access points and no one is coming to rural America to set up those practices.
▶ 3:08:04My time is expired. Thank you. I now recognize Miss Tenney from New York for 5 minutes.
▶ 3:08:10Thank you, Mr. Chairman. Thank you for holding the meeting and thank you to the witnesses for being here on this very important topic. I've heard the Democrats on this committee and their witness, Mr. uh Woodhouse, uh absurdly framing the affordability crisis as a result of HR 1.
▶ 3:08:25Well, as a New York resident and a New York business owner, I can tell you this healthcare affordability crisis has existed for years in my state and it lies solely at the feet of Albany bureaucrats, which for decades have saddled working class families and small businesses with exorbitant taxes and private insurance.
▶ 3:08:43The truth is that Kathy Hochul and Albany Democrats, and I served in the state legislature, operate a healthcare financing system that extracts at least 6.6 billion in hidden taxes from working families for their health insurance insurance, maximizes federal cost shifting to cover their own budget failures, and insulates powerful institutions from accountability, all while calling itself a model of progressive governance.
▶ 3:09:10The result is the number one highest employer-sponsored health insurance premiums in the country, not second highest, first. $9,589 for a single coverage, $27,188 for family coverage. And I have a family business and we are now paying in excess of $30,000 for a family in rural upstate New York.
▶ 3:09:32They're are 15 to 20% higher than the national averages and just think of what what our small family business does, founded by my grandfather, who by the way founded a community hospital in the little hamlet of Hamilton, New York. And the state just approved premium increases from 7 to 13% for for this coming year. Now, Mr. Woodhouse, I heard him his a little bit of his testimony, is not a physician. He's not trained in health care.
▶ 3:09:58He's a political operative and worked with President Obama to create what I think is one of the worst things that's happened to our country and our small small business community, and that's the ACA, otherwise known as Obamacare. Mr. Woodhouse, you said in your testimony that there are five hospitals in my district, New York 24, that are risk of closure because of HR 1. I have no idea where you got that idea, and I question the credibility of your source on that.
▶ 3:10:22But, I can tell you every hospital in my district, and probably every hospital across the state, makes up the difference from commercial payers becoming fewer by the year because of the Albany Democrats and their disastrous policies and what's happened since the advent of the Obamacare system. So, Mr. Woodhouse, you came here today to talk about working families being squeezed. So, did those families know they were paying $7 $1,760 a year in hidden Albany taxes on top of their already skyrocketing premiums?
▶ 3:10:52Is your organization advocating to reduce those taxes? That's a rhetorical question. Do you believe that collecting 6.6 billion a year in hidden taxes on health insurance, including a covered lives assessment for the professional education pool, the state-run GME program that hasn't been funded since 2008, preceding Obamacare, lowers premiums for working families and small business owners and employees?
▶ 3:11:19These taxes hit a mechanic in Oswego, my home county, the exact same way they hit a Wall Street executive in Manhattan. So, Albany built a public coverage program that was bankrolled off of exorbitant subsidies for non-citizens, priced private insurance out of competition for nearly 10% of the state's population.
▶ 3:11:39Is it progressive to pull healthy people out of the private risk pool, concentrate the sickest and most expensive patients in what's left, and then call the result the resulting premium an explosion of a federal problem. This is a New York State problem that is on top of a huge federal problem created by Obamacare, not HR 1. Uh Mr. Waldhouse came here to tell this committee that Washington is responsible for America's health care affordability crisis.
▶ 3:12:07But New York stories New York story tells you different and everything you need to know about where that framing breaks down. Albany created a tax in 1996 to fund doctor training aside from the fact that our state is already one already the number one beneficiary of federal GME funding. They killed the program in 2008 and kept the They created a coverage mandate and diverted the revenue.
▶ 3:12:31They built a zero premium public program on federal dollars tied to a 30-year-old eligibility rule with no contingency for that the day that that rule was reasserted and called it sustainable. They layer mandate after mandate on the private insurance every insurers every single session and and and private employers. They run an indigent care program that sends more than more money to well-resourced hospitals than the the safety nets institutions in my communities that actually serve the poor.
▶ 3:12:59And they have been doing all of this for decades while presiding over the highest employer-sponsored health insurance premiums in the country that is bankrupting our employers across New York State. New York is not an outlier. This is a preview of where the Democrats health care policies will lead us and I agree with Dr. Dr. Murphy, the dream of Medicare for all is absurd. We have to stop this nonsense now. Affordability is because of the ACA and because of states like New York.
▶ 3:13:29I yield back my time.
▶ 3:13:32Mr. Byer.
▶ 3:13:33Mr. Chairman, thank you and thank you all very much for being here. Uh I I get to coach here the bipartisan mental health caucus and we're all deeply concerned about it. And just because of your important roles, I'd like to dive deeper. I know we see emergency departments are an increased number of people with mental health. Think the teenagers in ERs waiting days for a bed. We have this challenge with boarding and trying to improve early I represent Innova, large hospital chain here in Northern Virginia.
▶ 3:14:03They established an impact unit recently specifically designed to provide emergency care for adults experiencing mental health crisis. Um, Arlington County, right across the river, established a mobile crisis team. We funded it with special project funding uh, making it a significant difference. But Dr. Donnelly, I'm particularly interested in what New York Presbyterian is doing to on mental health with early intervention, with improved access to care, and with support care coordination. What happens when they get out of the hospital?
▶ 3:14:33Congressman, thank you uh, very much for the question and thanks for your support uh, towards mental health. As you stated, it's a uh, growing problem in America that we must face and it's a big source of the cost of care. At New York Presbyterian, we're proud of our commitment to behavioral health. We have 500 inpatient beds. We're one of the largest providers of behavioral health services in New York. Now, one program that recently we found very beneficial is we work uh, with non-profit government organization to do patient navigation.
▶ 3:15:03And so, when patients come into our emergency rooms, we screen them for housing insecurity, we pair them with our partner, and we're able to find housing for them. This is not only great for the patients themselves, it's obviously great for their families, but it also is great for taking out the cost of care because otherwise these people across across the country are frequently using the emergency room. We've already found uh, we've already been able to help 200 patients uh, like that using that
▶ 3:15:34Very fit Thank you very much. Uh using Mr. Lassiter's statistics, Dr. Waldrum, he talked about 141,000 physicians short, 70,000 primary care physicians, the shortage of psychiatrists, especially child psychiatrists around Um when you look at the cost of college, like a Virginia public school, you know, like James Madison, UVA is going to be pushing $30,000 a year. You talk about medical school, especially with the loan cut off now at $50,000.
▶ 3:16:02how do we address this long-term physician and nurse shortage? Especially with the extraordinary cost it is to to move them through. And let me throw out my favorite thing. Why do we insist on a 4-year college education for physicians here when they don't throughout Europe, where the medicine is very good?
▶ 3:16:18So, thank you for the uh highlighting a very important issue. Uh as we've mentioned and I've mentioned, workforce is a major driver of health care costs, and we have to increase the pipeline and make the pipeline more efficient. So, cut cutting off and we we built pathways to decrease the uh level of uh education, that So, a year of college off, and then we're looking at 3-year programs, uh and then for GME, and specifically for behavioral health, so graduate medical education, and
▶ 3:16:48looking at how we can be more efficient at for the pipeline, because as you mentioned, it takes 10 years to to create a physician, and so the glide path that is long. And importantly, this expansion of GME, as we all cover an extreme amount of that workforce development and graduate medical education. I'm very proud of the school at Brody School of Medicine of ECU. We have one of the lowest debt rates coming out.
▶ 3:17:13We've structured our pipeline to increase the yield for primary care and for rural um environments. We've had investment in rural residency training programs, and we can show a direct return to those communities with over 70% retention. So, that's built into the way we recruit and then train our doctors for the specific environments that we serve.
▶ 3:17:34Great. Great. Thank you very much. Mr. you run a big system. Um we know that administrative costs like NIH administrative costs are 17% of total hospital costs. You got to fight overpayment recovery requests, all kinds of things. What do we do about payment friction? What can we do to reduce the administrative costs in hospitals?
▶ 3:17:57Thank you, Congressman. That is one of the areas where we see opportunities, opportunities for the patient, opportunities for providers, and really for the system as a whole. I think digital integration between payers and providers is a very significant opportunity. We in fact are working with some of the major payers on that very uh effort, and I think we're, as I mentioned in my opening comments, making progress. Uh the idea of regulations and regulation overlap and conflicts also complicates the whole administrative processing of claims.
▶ 3:18:26I think there are opportunities there. We discussed a few of those today. Those are areas, and then I think using um uh best practices, innovation, new technologies like AI to improve uh administrative activities is going to be
▶ 3:18:41Thank you very much. I yield back, sir.
▶ 3:18:43Thank you. Ms. Van Dyne.
▶ 3:18:46Thank you very much, Mr. Chairman. As we examine health care affordability today, American families are getting squeezed from every direction. Premiums keep rising, but so do the underlying costs, especially hospital prices, which now account for the largest share of health care spending. Just a few months ago, we were having the same conversation when this committee brought in the CEOs of the largest health insurance companies. A lot of commitments were made in that hearing about lowering costs and working with Congress on solutions, and it's been interesting to see what's happened ever since.
▶ 3:19:17Of the five CEOs who testified, only one has continued to actively engage with my office to follow up on these So that gap between what's said in a hearing and what actually happens afterward is part of the problem. And until accountability matters, it's going to you're going to see this problem grow rampant across the entire system. That's why I've been leading legislation to repeal the federal restrictions on physician-owned hospitals.
▶ 3:19:42And right now, Washington is effectively blocking the expansion of facilities that often deliver high-quality care at lower costs. And these restrictions protect incumbent systems and limit patient choice. We should not be protect protecting consolidation. We should be encouraging competition. And physician-owned hospitals can help bring real market pressure into highly concentrated areas, lower costs, and expand access. But today, they're essentially frozen in place by outdated federal policies. That needs to change.
▶ 3:20:11And this issue goes beyond providers. I hear constantly from constituents who are trying to buy coverage on their own that they only have one or two options, all of them are expensive, and no meaningful ability to shop for anything that actually fits their needs and their budget. So affordability is not just about the cost of care, it's also about the people whether or not the people have access to coverage options that work for them. So doctor, um is it Hazan or Hazen? I want to make sure.
▶ 3:20:39Hazen, no doctor.
▶ 3:20:39Hazen, okay. I want to make sure that we're saying your name correctly. Physician-owned hospitals expand access, they lower costs, and they serve a broad patient population. What are your specific concerns with that model?
▶ 3:20:51Uh Congresswoman, I'm glad you raised that. I've had 43 years uh in this industry. I've seen physician-owned hospitals operate. I've seen them close. Uh And so, I think uh we're all for competition. We're all for competition uh with physician-owned hospitals. However, it has to be level playing field. My experiences in the past is that's just not the case. They don't have functioning emergency rooms.
▶ 3:21:18They don't take care of uninsured Medicaid and so forth and so you have a difference in competition in that it's not level and balanced and there are conflicts. And so I think if we can harmonize those factors and make sure that all aspects of the system are competing on a level playing field, that could be productive.
▶ 3:21:39Don't you see that some of the hospitals also cherry pick their patients? I've got you I've got an article here that shows that babies will no longer be delivered at Research Medical Center. This is an HCA Midwest Research Medical Center in Kansas City that you actually stopped seeing labor and delivery patients. Don't don't hospitals do that
▶ 3:21:58Well, Congresswoman, we have 33,000 patients in a day a bed today. 90% of them presented to our emergency room first. So 30,000 of them came through our emergency room. We're not cherry-picking patients when 30,000 of the 33 come to our hospitals.
▶ 3:22:16All right, thank you. Mr. Lasseter and really all of you, this is kind of an open question. There's been a lot of discussion about how the administrative burden is driving up costs. We've all seen that the charts where you see the growth in physicians, the people who actually touch the patients are pretty much level, but the administration has gone up like like multitudes. Um that's contributing to burnout and it's not improving patient care or the patient experience. It's really only increasing costs.
▶ 3:22:41From your perspective, and I want you to be as specific as what federal requirements should we be targeting to targeting to meaningfully reduce that burden?
▶ 3:22:52Thank you for the question, Congresswoman. I'd say a few things. First and foremost, the the quality reporting is one area that I would that I would specifically focus on. There is significant overlap in in the requirements to report, which which creates significant issues. At Common Spirit, um we're working on trying to reduce some of that burnout that you described uh by investing in, for instance, ambient scribing, which
▶ 3:23:23I'm not I'm not asking what the hospitals could do. I'm asking what what federally what what requirements that we should be looking at that we can scrap that would help reduce the costs.
▶ 3:23:33Thank you for the clarification. So, I would say that I do believe that our administrative burden is tied very much to what we have to report on, um what we are regulated on, the agencies that have overlapping jurisdictions that require that kind of multiple reporting on similar issues. Those are the kinds of things that I would that I would point
▶ 3:23:54And I see everyone wants to jump in, but I'm already over my time.
▶ 3:23:57I I would love to see supportive policy to protect uh the safety of health care workers. You mentioned burnout. There's an alarming increase of violence against health care workers. So, policy to protect uh those workers, we spend $120 million on physical and cybersecurity every year.
▶ 3:24:13Excellent. Thank you very much. Now, I
▶ 3:24:15I think it's important to just put this in context. Uh for MA alone, uh our there's 3,700 MA Advantage plans. With uh our beneficiaries can choose 40 diff- 42 different plans. And they all have with nine different carriers. And they all have different reporting rules. They all have different uh prior auth rules. They all will have all these administrative burdens.
▶ 3:24:40So, in the clinics in rural America, that's what we have to train our staff on, and that's what we have to submit the data on. And that is an extreme expense that we have to incur.
▶ 3:24:51Mr. Feenstra.
▶ 3:24:54Thank you Chairman Smith and and Ranking. Thank you uh for holding this hearing. Uh we've talked a lot about Uh I am from rural Iowa. I sat on an board of a small rural hospital and it's different than urban centers. I know I know we all talk about the hub and spoke I get it. You know, I mean we are a spoke to one of the big hubs in in Sioux Falls, South Dakota or Des Moines or Sioux City.
▶ 3:25:22But I want to talk a little bit about how we can maybe look at affordability different. Mr. Hazan, you noted that affordability is a barrier to care. I we all get that and the starting point is insurance So I want to ask you what happens if somebody doesn't have insurance coverage but wants to pay straight cash? What is their discount? And the reason I'm asking, well, let me ask you that question first. What is their discount if they want to pay straight cash?
▶ 3:25:54I I I can't give you a specific percentage because it varies by hospital, it varies by service. 10%? 5%? 20%?
▶ 3:26:02Oh no, it's way more than that.
▶ 3:26:03It Say it again. It's way more than
▶ 3:26:0510 or 20%.
▶ 3:26:06Yeah, it's way more than 20%.
▶ 3:26:08All right. I just want to think about this. So the average hospital charges commercial insurers about 250% of Medicare rates. Okay? So you really have the the the insurance people, all right, people that are carrying the insurance are really covering for those that are using Medicare. Is that a fair statement, Mr.
▶ 3:26:31There is cost shifting that occurs.
▶ 3:26:34Cost shifting. Yes. Yes. Yes. Yes. So this is the problem with just the common common family. All right? They their child breaks a leg. They have an HSA. HSA all of a sudden they got a $10,000 deductible and their broken leg cost $8,000. All right? So they pay $8,000 out of pocket. But here's the problem. They don't get the cash discount because they're going through the insurance company. An HSA still has to go through the insurance company.
▶ 3:27:03So, the insurance uh insurance company has to do all the pre-authorization, all this other stuff. Why can't we get rid of the insurance company and say, "Let's just do cash base and and and create an account for somebody that get get can grow tax-free like an HSA?" And and not having all this other red tape involved. Dr. Donley, what is your thoughts? How how do you handle your your cost accounting when it comes to somebody that wants to private pay and pay cash?
▶ 3:27:32You know, we have a we have a process in finance department for patients that would want to pay uh cash. Um and they do receive a discount uh off the listed uh price.
▶ 3:27:43How much?
▶ 3:27:44I don't know the exact uh amount, but it
▶ 3:27:47But it should be significant, right?
▶ 3:27:50Okay. What I'm trying to get at is the cost of having health insurance and you using health insurance, and you just noted it, Dr. Walbrom, uh about Medicare Advantage plans and all this stuff. I mean, there's bureaucracy that's incredible.
▶ 3:28:04So, when you move the bureaucracy off to the side and say, "Hey, I'm just going to pay cash." uh you can dramatically lower your cost of And I just look at it the government saying, "If this is what we want to do, then you just do it tax-free." And say, "You put this in a tax-free account, not an HSA." Because an HSA is again tied to a health health insurance company. It would work a lot better. All right, I'll get off my high horse. To me, it's so important. I want to talk to you uh uh Mr. Walbrom.
▶ 3:28:34Thank you, by the way, for uh what you wrote in your your testimony. Maternity units are closing at an alarming rate. Um I did my doctorate uh in this very vein uh showing that uh maternity units are closing at this crazy rate, and we're seeing dramatic in uh increase in infant mortality. And the problem is, as you noted is is we have less births and the cost and med mal practice and there's a lot of other things.
▶ 3:29:05So on in the hub and spoke model the hub and spoke model you you noted that we're also seeing you know you can you can give early care but you still need a main hospital to have maternity care. How do we change the system where we get more these these spokes to have maternal care and maternity unit
▶ 3:29:27So I think it's important to understand the hub and spoke model. We operate all of our hospitals as one conglomerate whole and we understand our population and we match the needs of the patient to care locations and keep it as close to home. I have five hospitals five hospitals in very remote rural organizations that we maintain maternity units and AI will not deliver a baby.
▶ 3:29:54And so I pay doctors and nurses and drug companies to catch one baby or maybe two babies a day. They don't come that way. They may come five a day and we know that if we close those units that more moms and babies die in rural America. So we take the profit on the academic medical center that is in a rural community called Greenville, North Carolina and we cross subsidize it because that's what a mission based
▶ 3:30:19I yield back. But you nailed it. You absolutely nailed it that we're having higher infant mortality infant mortality rates and and mom mortality rates. It's sad. Thank you. I yield back.
▶ 3:30:29Mr. Evans.
▶ 3:30:30Thank you Mr. Chairman. Congress is not addressing the right now. Premiums in Philadelphia have drastically risen over the last year. An increase of 116% calling severe financial stress on many of the residents of the city. One of my constituent is a musician and an independent contractor.
▶ 3:30:56He says when the ACA subsidy went away, his monthly premium went up by over $600. He is now paying over $180 a month. That's 1/5 of the income on the health insurance. He's He's not counting on co-payment and prescription.
▶ 3:31:20The ACA is not perfect system, but making people who are financially struggling to bear the burden of health cost is unfair. Mr. Woodlawn, what would you say the people experience what my constituents describe, especially when they have to choose between health care, food, and housing?
▶ 3:31:46Well, I think it's something that in the stories that we've been collecting that we're that we're seeing. Um and and there there lots of really tough choices. We have a um a a a a a a woman who uh Teresa Costa in Georgia who uh had her had her own business um and then had these exorbitant uh health care premium increases as a result of the ACA ACA tax credits going away. And it's similar to another story that I recounted earlier where she's now got to go find a job that has insurance.
▶ 3:32:16She cannot afford the her own premiums on you know, on the marketplace. And we're seeing this We're seeing this with farmers. We're seeing the small business owners. We're seeing a lot of really tough decisions with the Medicaid cuts coming with caregivers who were thinking about what is the access that they're going to have uh going to have the nursing homes. And by the way, these people are not just facing affordability crisis in in health care. Let's talk about, you know, let's talk about eating.
▶ 3:32:42You know, let's talk about the cuts that were made in HR 1 uh to snap and that were made to to food assistance. And then we talk about a healthy diet. Vegetables are more expensive today because of tariffs and because of all the all of the inflation that we've seen since Donald Trump came into office. And so you can't they can't eat healthy. They're having a hard time accessing health care, having a hard time accessing the premiums.
▶ 3:33:06It is a It is a lot of things on an affordability crisis on Americans all at once.
▶ 3:33:15Dr. Julie, how is your hospital committed to offering low-cost health insurance plans for consumers and employees? Dr. Pickett.
▶ 3:33:34You know, we're com- I'm sorry.
▶ 3:33:36Yeah. Yeah, how is your your your hospital committed to offering low-cost health insurance plans for consumers and employees?
▶ 3:33:47You know, we we have a strong focus on our employees. Um, we have 45,000 employees who are dedicated to taking care of our patients every single day. And in order for them to be great for our patients, we realize our priority is that make sure that we put a priority on And so it's around their insurance. It's around healthy food. It's around mental health. We have a lot of support programs for them.
▶ 3:34:15Let me go back to Mr. Woodson Rule with South Bend. How does a growing number of uninsured and underinsured patients impact our strained health care system?
▶ 3:34:28Well, I think these gentlemen might be more qualified to answer that than than I am. But I think one of the things you've heard here is about un- you know, uncompensated care. I mean, we you know, I think there's member over here blowing off 15 million people losing access to health care. But as those people lose access to health care, I think what you've heard is there there a lot of emergency room visits. Those emergency room visits not paid for.
▶ 3:34:52That you know, those those costs are borne by other by other people on employer insurance, by other parts of you know, the system. Not to mention the fact that we are seeing states and localities that are really struggling with what are they going to Are they going to allow this calamity to happen? Uh we've seen you know, people are raising property taxes. I mean, I don't think the I don't think the people in those counties I don't think those county commissioners want to raise property taxes, but they don't want to see their their hospitals close. So, it does cascade.
▶ 3:35:25Give me my like give it back.
▶ 3:35:27That's my time.
▶ 3:35:28Thank you, Mr. Hearn.
▶ 3:35:29Thank you, Mr. Chairman, for holding this in very important meeting. Thank you all for being here today. It's obviously a very hot topic among all of our constituents, no matter what side of the side of the aisle you're on. I just a yes or no question. Just so we have you guys on the record. As we go across starting with you, Mr. Hassan, are you you for Medicare for all? Just so all of our colleagues here know that. Mr. Lasher?
▶ 3:35:55Uh no, sir.
▶ 3:36:02It's not a yes or no question.
▶ 3:36:04Nice answer. you know, everyone of us here today I've heard from our constituents expressing the concern of a rising health care cost. Um Since 2000, hospital prices have grown nearly 300%. Vastly out patient out pacing inflation and wages. In fact, hospital prices have grown more than any other part of our economy and no one really knows how these prices are calculated.
▶ 3:36:30Um while most individuals are not directly exposed to true hospital prices, these are not just abstract costs in the after ether. These costs are passed directly on to patients whether it's in the form of cash prices or higher premiums or out-of-pocket cost. I would like to follow up on some of my colleagues comments regarding site neutrality or the lack thereof.
▶ 3:36:51The reality is that federal payment policies and billing practices such as site of service pricing have been able wide variation variation prices that often bear little relationship to the actual cost or quality of care. Hospital systems being allowed to charge more for the same services has led to consolidation in the system.
▶ 3:37:09With hospital systems steadily acquiring more independent physician offices and outpatient facilities reducing Data has shown that when hospitals acquire physician offices patients pay up to four times more than the same exact service done in the same exact place by the same exact doctor. I have one CEO said I can't explain why that is allowed, but that's just the way the system work. And again, this is not just a data game. I've heard from patients directly in my district that seen this happen and want answers.
▶ 3:37:38Their doctor hasn't changed, their health status hasn't changed, the building hasn't changed, just the ownership changed and the price. For all of the witnesses here today, if you all won't commit to supporting site neutral payment policies, how will you ensure patients will not be subject to price increases at their physician offices after they are brought up bought up by your by your hospital systems. thought Mr. Donley, Dr. Donley?
▶ 3:38:03I just think say as a strategy we do not purchase physician practices and turn them into hospital sites. That's not a part of our strategy.
▶ 3:38:11I would say the same thing.
▶ 3:38:13I would concur with that Congressman that we do not buy practices to to convert them to site neutral.
▶ 3:38:19Mr. Osan?
▶ 3:38:21We don't do that at all. Um so continue on the disparities between independent physician offices and hospital systems. I want to talk about tax status. Many large health systems operate as tax-exempt entities and are subject to the same requirements to maintain their tax-exempt status as independent Given the differences between these large corporate health systems and smaller independent providers, I imagine that the IRS reporting varies as well. Dr.
▶ 3:38:50Donley, solo providers report their community benefit spending based on its individual facility. Do large systems like New York Presbyterian report community benefit spending on a facility-by-facility basis, or does the hospital report all of the community benefit spending across all the facilities on one Form 990?
▶ 3:39:08We we report uh following the federal guidelines as one facility. so how can the IRS determine if an individual facility is satisfying the community benefit standard if no information is reported about the community benefit spending by the individual facility?
▶ 3:39:27You know, I think that would be a discussion we'd be happy to have. Uh as I said, right now the federal guidelines uh have us reported as one facility.
▶ 3:39:35So you would have no problem then being able to very large system if you're in a rural community or outlying community, you would have no problem reporting a different 990 for that particular area as you're looking at how your community benefits compare to some other independent provider.
▶ 3:39:50You know, I I think it would take a lot of work. Uh we'd have to work through that uh to see what the process is.
▶ 3:39:56But it's probably well worth it for a tax-exempt status, right?
▶ 3:39:58I think tax-exempt status is very important. You know, we have a $2.4 billion community benefit. Our tax-exempt status is uh a benefit of $622 million. So our community benefit right now is four times what the tax-exempt status is for us.
▶ 3:40:13Yeah, you would I I obviously haven't looked at your financials, and I I'll take you at your word since you're you're testifying here, but that's not the case for all uh when you look at the tax-exempt benefit for many hospitals across the country where their tax benefit, whether it's local, state, or federal, doesn't meet that same community standard, which is by and large one of the reasons the tax-exempt status is questioned from time to time, or quite often, actually.
▶ 3:40:37So, again, maybe you're the model for the rest of the country, or for maybe everybody else that's up here, but it's certainly a real problem for many communities across America, and that's why they get questioned. And, you know, so I I think that as we go through this process, we appreciate you being here. We appreciate all of you all in bringing forth your information, and it'll help us make better policies in the future. Thank you, Mr. Chairman. I yield back.
▶ 3:41:02Thank you, Ms. Miller.
▶ 3:41:03Thank you, Mr. Chairman, and thank you all for being here today. It's been quite an interesting discussion. Mr. Woodhouse, in your written testimony, you mentioned my district and the decision of Greenbrier Valley Medical Center to close their labor and delivery unit. You specifically cite this closure as being caused by HR 1, which you make it sound like it's the but that is false. It is a false statement.
▶ 3:41:31Vandalia Health, the owner of the hospital, has said themselves that the closure is a recruitment issue, and that the hospital had tried for over 2 years to unsuccessfully to recruit a physician for their delivery room. How can this possibly be an issue caused by HR 1 when the hospital's been unable to recruit physicians to staff its labor and delivery unit for over 2 years, well before this legislation was ever under consideration?
▶ 3:42:00Recruiting and maintaining physicians is only one of the many challenges of rural hospitals. I'm from West Virginia. I understand this issue. Another issue impacting tax-exempt health systems involves the classification of the hospital itself. I'm disturbed at the trend of rural hospitals getting taken advantage of.
▶ 3:42:22As we know, hospitals classified as urban receive higher Medicare payments, whereas hospitals classified as rural benefit from other things like easier access to 340B program and 30% more graduate medical education funding.
▶ 3:42:38That said, an increasing issue in recent years has been the dual classification of some tax-exempt hospitals as both rural and urban, seemingly taking advantage of a Medicare loophole in order to receive lucrative financial That's why I joined with my colleague Congressman Taylor in introducing the Defend Rural Health Act.
▶ 3:43:03My bill safeguards federal resources intended for rural hospitals and the communities that they serve. It closes the long-standing loophole that has allowed large urban hospitals to simultaneously classify as both urban and rural, enabling them to improperly access benefits reserved for rural providers. Dr.
▶ 3:43:24Donnelly, I understand that eight of New York-Presbyterian Hospital campuses are classified as rural despite the proximity to two New York City. Can you explain this to me? I mean, do you think New York-Presbyterian is a rural hospital?
▶ 3:43:41First of all, thank you very much for your advocacy of rural health care. As a physician myself, rural health care is critical to the health care of this country and we all need to focus on making sure that rural health care remains strong. At At New York-Presbyterian, we do not consider ourselves a geographic uh geographically rural hospital.
▶ 3:44:01But under CMS, we are designated as a rural referral center and we are proud of the thousands of patients from rural America that come to us when there's nowhere to turn for a problem that they have. We're also proud of the 2,500 residents that we train, 65% of which leave after their training to go across America, including uh rural
▶ 3:44:23I'd love to know that percentage of how many of them really do go to rural America after being in a big city. I understand that reports have also surfaced that New York Presbyterian provides Chanel gift bags as its maternity hospital. Is New York Presbyterian using the lucrative financial benefits received due to its dual classification to buy luxury handbags instead of lowering cost for their patient care?
▶ 3:44:51We absolutely are not. Those Those are donated and they're uh donated by the company's foundation in addition to philanthropic support that that company and their foundation gives to us to support a fourth trimester program to take care of mother all mothers and all children in the first 12 weeks uh after being born, which is we all know is a critical time.
▶ 3:45:15That is really good news. I thank you. You want any more time? I yield back my time. Thank you.
▶ 3:45:22Mr. Panetta.
▶ 3:45:24Thank you, Mr. Chairman. Uh gentlemen, thank you for being here. Appreciate your time to discuss obviously the many issues in our health care system uh that are deeply important not just to all of us up here but to our constituents back home and I think uh the main point as to why we're here and these issues that we're talking about. Look, for me in the 19th Congressional District, I got a lot of senior citizens and the number one health care issue for them is not coverage, it's access.
▶ 3:45:53It's the delay they constantly face when accessing care through their Medicare benefits. When I talk to doctors as well, I hear similar concerns. Medicare Part B is not keeping up with the cost of providing care. When I talk to these physicians, they tell me they are are to hire and retain staff as demand grows.
▶ 3:46:13And they tell me that they spend as much time in one in five working days fighting Medicare Advantage prior authorization denials, time that should be spent caring for their patients. That's why when it comes to healthcare, there are a number of issues, but in California's 19th Congressional District, fixing the payment system is a priority. Reimbursements have to reflect inflation and the real cost of keeping a practice open.
▶ 3:46:42That's why I've introduced legislation with my colleagues on this committee to address this shortfall. More recently, I partnered with some of you to pass legislation which cracks down on Medicare Advantage ghost networks.
▶ 3:46:56Last week, we built on that success by introducing the Medicare Advantage Improvement Act, a common-sense bill that directly addresses the challenges that my constituents face by speeding up Medicare Advantage approvals, bringing transparency to the prior authorization process, requiring timely payment to providers, and it and it's and limits post-authorization denials that lead to surprise coverage losses.
▶ 3:47:23As you've heard today, there's a lot to discuss about the healthcare system overall, but selfishly, as a representative of the 19th Congressional District, I want to focus squarely on issues that affect my constituents, that they live with every single day, and what together we can possibly do to fix them.
▶ 3:47:42I represent the the Central Coast of California, 19th Congressional District, San Jose, Santa Cruz, Monterey, down the northern San Luis Obispo, a pretty big, diverse, dynamic district. We got a lot of beauty and bounty, and as I said, we got a lot of senior citizens who like to retire In Santa Cruz, though, we got one hospital, Dominican, part of Common Spirit, which Mr. Lauster, you know well.
▶ 3:48:06It's a lifeline for that community with an aging population, more than Medicare beneficiaries. Mr. Lassiter, I'm going to tell you and gentlemen, I'm going to focus mainly on him and not going to ask you any questions, especially in my limited time. You can kind of zone out after the hours that you've been here. Uh, but Mr. Lassiter, you're up. Government payer rates, how do they impact Dominican in particular?
▶ 3:48:33Congressman Panetta, thank you for for the question and also thank you for representing the district where we um uh, offer um, one of our facilities. Um, generally speaking, the answer the answer to your question is this. Um, Medicare reimburses us below our costs to provide care to patients in your Um, on average, it's about 80% of our Uh, the Medicaid program also reimburses us below our costs.
▶ 3:49:02Um, and as a result, that challenges the sustainability and profitability of organizations like Dominican in your in your district.
▶ 3:49:11And what are your contingencies, if any?
▶ 3:49:15Well, uh, I think we've talked a bit today about the issue of um, cost shifting, frankly, and that um for Common Spirit, um, more than two-thirds of our patients are Medicare and Medicaid. And so we rely on reimbursement from commercial insurance to make up for the lack of reimbursement that we receive from governmental payers.
▶ 3:49:36Now, the bill I'm working on to reform Medicare reimbursements, including indexing Medicare Part B to inflation and requiring Medicare Advantage plans to pay 100% of previously authorized services, speed up authorization approvals, and ban retroactive denials, can you give us a sense of how uh, those policies would impact um, seniors' access to bene services via
▶ 3:50:05Thank you for the question, sir. I would say a couple things. Um for senior citizens, one of the bigger challenges are senior citizens who are uh the recipients of Medicare Advantage coverage.
▶ 3:50:20Um when you talk about issues related to um pre-authorization, um denials, um after after positive authorization, and then frankly payment by by hospitals and systems like Common Spirit for services we've delivered to your Um we don't get paid regularly or Uh I mentioned earlier today, sir, before you came in that we have about 4.3 billion dollars of unpaid Medicare Advantage claims um that we are fighting to
▶ 3:50:50receive for care that we've delivered to constituents like yours. I I shared with the committee that um uh more than a billion dollars of those unpaid claims are more than 150 days
▶ 3:51:01Great. Thank you, and I ran out of time. We have more to talk about. We can do that later. Thanks to all you gentlemen for being here. Thank you, Mr. Chairman.
▶ 3:51:08Mr. Carey.
▶ 3:51:09Um thank you, Mr. Chairman, for bringing this um very um the attention to this very important issue, and I want to thank all of you for being here today. I'm going to start my remarks today talking about the ACA. Um in January 1, I with my colleagues, uh many of my colleagues, voted to extend the enhanced ACA subsidies to help keep more Ohioans insured.
▶ 3:51:34Now, while I wish that our Congress would have been able to reach a bipartisan agreement on this issue, ultimately we were unable to do that. Now, I support President Trump's great healthcare plan to reduce insurance premiums and to price transparency. Mr. Hazen. Uh yesterday HCA Healthcare released its Q1 financial reports.
▶ 3:52:05Now, within that, and I may need to put on my glasses cuz we we we're looking at this today. I read that the expiration of the ACA enhanced subsidies cost HCA about $150 HCA still brought in a net income of 1.6 or 8.5% of the revenue. So, I'm going to ask you this question.
▶ 3:52:33Can you speak to the impact of the expiration of the enhanced ACA subsidies on the prices that HCA facilities charge or negotiate with payers? Have they increased as a result? You're up.
▶ 3:52:49Thank you, Congress, for Congressman for bringing up the idea of coverage. I think coverage is fundamental, as we've indicated here today. For us in the first quarter, speaking to that, we did see a decline in covered lives in our facilities. Overall, we saw a 15% increase in uninsured patients across our system as a whole. As it relates to pricing, I would submit that there has been no effect on pricing as a result of that change in
▶ 3:53:20Okay. So, no effect on the pricing. So, I'm going to continue with you. in your written testimony, you referenced that HCA Healthcare provided approximately 4.5 billion in uncompensated care. Okay, including charity care and financial assistance for uninsured patients, and this is just last year. A topic that I'm also interested is the chargemaster pricing.
▶ 3:53:46So, although these are not the prices, obviously, the patients tend to see, uninsured patients or those whose lost coverage after the ACA enhanced subsidies expired and those to whom you are providing this uncompensated care are the patients most likely to see these prices.
▶ 3:54:08Do uninsured patients, the most financially vulnerable, receive these charge master prices, the highest possible, and then receive financial assistance to bring down their costs? Congressman, the 4.5 billion that we refer to is actually the cost that we incur to take care of those patients who are uninsured or charity.
▶ 3:54:32We have a very financial assistance program including our charity policies for patients who don't have insurance and for those who um are completely uninsured, we have a very significant discount uninsured discount for those patients.
▶ 3:54:49Okay, and and the next question is going to be a yes and no. So, when I make the statement you can think about this. These charge master prices are not directly connected to the cost of care. They are inflated to raise the bottom line. Am I correct? Yes or no?
▶ 3:55:06So, how do you calculate the charge master price in total then? the the charge master connected to the point I made in my opening comments about regulatory modernization is an artifact from 50 years ago. And so, the requirements that we have as hospitals is to maintain a listing of charges. So, that listing is not entirely connected to the reimbursement.
▶ 3:55:35So, 80% of our patients are determined by either Medicare, Medicaid or some other government programs in our our company and the balance is largely commercial contracts with large payers. Uh there are
▶ 3:55:49real quick. So then so so if the answer is no, so what really is the point in having these inflated prices if the patients don't even see them? And you got 13 seconds.
▶ 3:56:01As I said, it's a it's an artifact from uh 50-year-old regulation.
▶ 3:56:05Okay, I want to thank the chairman and I want to thank the witnesses again. With that, I yield back.
▶ 3:56:10Miss Malliotakis.
▶ 3:56:12Uh thank you, Mr. Chairman. I want to thank you all for being here today. Um look, this is obviously a very important issue because we're talking about the affordability of health care and making sure that our hospitals stay viable, that they're able to provide the care is necessary in our communities. Over the past two decades, the cost of health care premiums, prescription drugs, and hospital services has risen significantly.
▶ 3:56:33And these increases are driven by a range of factors, including reduced competition, growing consolidation across the health care market, misaligned or overly burdensome government policies such as the unaffordable Care Act, and bad actors who exploit the system to maximize payments from these federal programs.
▶ 3:56:51Since 2000, hospital prices have increased by more than 280% and today roughly 1/3 of US health care spending goes to hospital care, totaling approximately 1.6 trillion in 2024. And as leaders in some of the largest hospital systems in our country, you all play an important role in helping uh shape the health care costs, and we must work together to identify the solutions that can make things more affordable for patients while also ensuring that taxpayer dollars are spent responsibly.
▶ 3:57:21Hospitals are essential institutions. They provide life-saving care. They serve as major drivers of economic activity and employment in communities across the country, including in my own Uh my district, which is Staten Island and Brooklyn in in New York City, has three hospitals in very different circumstances. One is an independently owned safety net hospital. It serves a large low-income population and often faces financial challenges.
▶ 3:57:48Another is part of a larger New York-based health system and operates a robust medical educational program. And then there's a third hospital that serves my district and it's in the process of being acquired by New York City's public hospital system.
▶ 3:58:04So, each of these facilities provides quality care to my constituents and all are top of mind as we consider legislative reforms as we work to bring more affordable services, it's critical that our policy decisions do not create unintended consequences that could undermine the ability uh your ability to serve patients. Uh so, first I want to start off with tax-exempt status reforms. Uh nonprofit hospitals receive a significant tax benefit and in return we expect them to meet certain obligations.
▶ 3:58:34However, those uh requirements are relatively broad and fall under the community benefits standard, which includes operating an emergency department, maintaining a governing board, and investing in facilities or private care among among other standards. But, Dr. Donnelly, first of all, I want to say uh you you're a top-tier uh hospital. We appreciate the work that you do in New York City. Uh you've been recognized by many publications and and and and credited organizations.
▶ 3:59:02Um and you know, when we're examining ways to strengthen these nonprofit requirements such as setting minimum levels of charity care or patient care investments, can you explain how your hospital system meets the community benefit standard, particularly in improving patient care and helping lower costs for patients?
▶ 3:59:19Yeah. Thank you, Congresswoman. Thank you actually for your thoughtful support of hospitals in balancing the different issues to make sure hospitals uh continue to be strong uh for your constituents and certainly for our uh patients. You know, for a community benefit, we have a $2.4 billion uh community benefit. The tax-exempt status uh, benefit that we receive is 622 million is what we estimate. Uh, a bulk of that community benefit is our commitment to take care of patients who are insured by Medicaid.
▶ 3:59:50We are the largest provider of Medicaid services in the state of New York for transplant services and pediatric services and we're the second largest provider in the entire state for emergency room uh, services. In order to provide that care, it's at a shortfall of nearly a billion dollars uh, over the year and that's a big part of our community benefit. It's core to who we are as an organization and it's been core for 250 years that we've been in
▶ 4:00:17committee was going to establish a minimum for charity care or patient investment, how could we uh, design those policies so we avoid unintended consequences, especially for safety net hospitals that we represent that are already struggling financially?
▶ 4:00:29I certainly can speak for New York where Medicaid was expanded uh, in New York uh, there's only 5% of people that don't have insurance. So, I think as we look at making sure hospitals do live up to the community benefit that they should, it's important to look at not just the charity care but also uh, the care provided to patients who are insured by
▶ 4:00:51Okay. And then um, when we look at site neutrality policy, uh, you you your your hospital as well as some in my district, they operate outpatient facilities. is there a way to tailor site neutrality payments so that patients benefit from lower costs while still preserving access to specialized care close to
▶ 4:01:10I think it's important uh, to look at what the options are around site neutrality but we must always recognize that a hospital place to take care of a higher acuity of patients, you also take care of all patients regardless of what their insurer is at hospital sites compared to physician owned sites and there's also a higher regulatory burden for hospital sites.
▶ 4:01:29So, with those things that all be considered as we move forward in deciding what type of facilities have the site neutrality payment.
▶ 4:01:36Okay, and I want to just say you've only been the president and CEO for 3 months. You've already become before a congressional hearing and you've done a good job today. So, thank you and Mr. Gomez.
▶ 4:01:48Thank you, Mr. Chairman. If you talk to any family or American in this country, they know that health care costs are out of control because they see it every single month when they pay their medical bills or their premiums. Um they've seen it for years, but they also know that the system doesn't work and so do a lot of uh elected officials.
▶ 4:02:11Um for far too long you've had a system that was trying to pass the cost, minimize coverage, and passing it from each fighting amongst themselves. PBMs versus uh farm uh uh big pharma uh health health insurance companies, hospitals, physicians, everybody kind of jockeying to pass the uh or the buck or the cost to somebody else and at the same
▶ 4:02:41time making that fall onto the American taxpayer and to the consumer. We recognize that. In my district in the in urban Los Angeles, I had 11 hospitals when I first started in Two of them closed for a variety of reasons. And then we have other ones that are teetering, but I also have LA County General Hospital. I also have Good Samaritan.
▶ 4:03:06I have a lot of hospitals and hospitals that do good work that are trying to take care of their patients. So, I recognize that But I recognize that things weren't perfect. The system The costs were still increasing um and we didn't have a peop Congress didn't necessarily have a plan to deal with it. So, when the Republicans take over, what's their plan? What's the first thing they do?
▶ 4:03:30Is they pass the one big beautiful bill that cuts almost a trillion dollars out of Medicaid that really impacts every individual in this country if they know it or not. It also hurts hospitals that have a lot of patients that are on Medicaid. Um and then they let the ACA subsidies if we look at it, who's getting hurt?
▶ 4:03:57Seniors when it comes to accessing home care, children with disabilities, women who won't get reproductive health care coverage that they need. And in this country, 40% of all births cover are covered by Medicare.
▶ 4:04:12And the highest maternal mortality rates are nine nine out of the 10 top states are Republican who never expanded And then they go and they cut the ACA or let the ACA expire. So you have a situation where the health care crisis in this country is getting worse. But what did the Republicans do?
▶ 4:04:38They their first priority was not to take care of the cost the affordability cost. Their first was to pass the one big beautiful bill that would jack up the deficit and debt by $4 trillion, cut $1 trillion from Medicaid, 200 billion from SNAP, and they made it worse.
▶ 4:05:01So if they now they have a priority, their priority is now trying to make excuses on what kind of plan that they have to address the crisis that they made worse. There was a if there was a fire when it came to the health care affordability in this country, they put gasoline on it. And now they're saying that they're the the firefighters to help deal with the And I think that is completely wrong.
▶ 4:05:26We know that um because the ACA subsidies expire, 24 million Americans are paying higher premiums. 15 million people are going to lose their health care. People are seeing premium increases as high as And here's the thing. It's also on top of every other affordability issue. Housing, energy, uh child care.
▶ 4:05:49And as somebody who grew up without health insurance, I know what parents do when their kid gets sick or injured. They want to wait to see if that their child or their family member gets worse or they get When I was about 7 years old, because my parents wanted to see if I got better, I ended up getting the uh getting pneumonia so severe I had to spend a week in the hospital.
▶ 4:06:13When I broke my leg in ninth grade or my ankle in ninth grade, my parents had me ice it for not for 4 to 5 hours, for 4 to 5 days before I had to go and get it checked out because it was not getting So, that delayed care is going to only make people go to the emergency room where it's the uncompensated cost. So, this is a we are in a crisis.
▶ 4:06:40But, the priorities for my Republican colleagues were never to address this crisis. And even now, it's really as a political stunt to have something to show for the midterms that they actually And they're the way they're talking is a little confusing because they have no concept of plan, no plan, and they don't even know if they believe in private care, public care, if they believe in nonprofits.
▶ 4:07:05Yeah, they're all over the place because they're not being truthful on what they actually believe. And they believe that the American taxpayer should not be involved in the delivery of care or involved in health care at all and that every American should be on their own. And if the when they say that, they will have more credibility in the eyes of the American public. With that, I yield back.
▶ 4:07:30Mr. Yakim.
▶ 4:07:32Thank you, Mr. Chairman, for holding this important hearing and thank you to our witnesses for being here and testifying today. Cost, quality, and access to health care is constantly top of mind for the Hoosiers that I serve. My district faces regulations and health care services, provider shortages. Uh in addition to that, we also face a constantly rising health care costs. Hospitals account for about a third of health care costs, and hospital prices have risen faster than any other part of the economy over the past two decades.
▶ 4:08:00Hospital prices are not exclusively responsible for the high cost of health care in the Hoosier state and across the country, but they definitely play a significant role. High hospital prices lead to higher health insurance premiums, placing financial stress on patients and employers that provide those benefits. Dr. Donnelly, New York Presbyterian health system is a tax-exempt system with 11 hospitals located across the New York metropolitan area, including multiple facilities in Manhattan, Brooklyn, and Westchester.
▶ 4:08:30Despite operating in a densely urban area, New York Presbyterian um meaning your urban hospitals are counted as being rural under federal health care programs. Being reclassified allows you to take advantage of programs designed to support our vulnerable rural Do you think it's justified that hospitals in New York City are reclassifying as rural providers in order to to utilize programs designed to support vulnerable rural providers?
▶ 4:08:57Yeah. Thank you, Congressman, for your question and thank you for your advocacy of rural hospitals. Uh rural hospitals are critical to the health in this country. Uh and it's critical all of us focus on making sure they remain strong. We do not in New York consider ourselves geographically a rural hospital, but under CMS, we are designated as a rural referral center. We are proud of the role we play uh in supporting rural health care as a rural referral center.
▶ 4:09:25We treat thousands of patients from rural America each year when there's nowhere to turn for that patient or for the doctor that's taking care of that patient. We also train 2,500 residents each year. 65% of those leave MYP and go across the country in places such as rural health care and help support rural health care.
▶ 4:09:45Would you support Congress closing the rural designation loophole?
▶ 4:09:48I I'd be happy to work with you and have our team talk to you. I want I think it's important that we also, as we look at strengthening rural hospitals, we also maintain strengthen urban There's a shortage of 86,000 physicians uh that we will see over the next 10 years, and I think in regards to GME slots, the answer isn't urban versus rural, the answer is more GME slots.
▶ 4:10:11Yeah, thank you. Uh and large parts of uh my district are are heavily rural, and our rural providers certainly do work tirelessly. They work every day to serve their communities and ensure access uh to Hoosiers uh that live in rural communities. Um estimates show that administrative costs in our health care system account for between 15 and 25% of health care spending. Uh Mr. Hazen, are there specific federal regulations that you see as drivers behind the high administrative costs facing hospitals
▶ 4:10:42Thank you for uh referring to administrative costs, a very important issue and one uh that we believe uh there's opportunity to lower the cost of the system, which should translate downstream to lowering cost of purchasing health care. So, regulation modernization, as we spoke to earlier, is an opportunity. There are uh huge numbers of regulations that get layered upon layers of uh regulation.
▶ 4:11:08We have conflicting regulations across different states, which produce administrative difficulties as well. And then I think in the commercial market, there are opportunities administratively as well that may be enhanced by certain regulation standards that the federal government imposes. So, yes. Thank you.
▶ 4:11:26And Mr. Hazen, just as a follow-up, in your opening statement, you talked about how there are conflicting federal regulations for hospitals. Can you give some examples and maybe expound a little bit on the conflicting federal regulations you see?
▶ 4:11:41If I understood your question correctly, Congressman, the the conflicts exist between certain state requirements and federal requirements. And so, we we have to balance both. There could be opportunities to harmonize some of those. We understand that states have the rights to do regulatory things, but nonetheless, there are opportunities we think in common areas to consolidate certain regulations and create a little bit more efficiency for the system.
▶ 4:12:08Right. And do you have any specific sets of regulations that you'd like to see us roll back or modernize?
▶ 4:12:13Well, these are state-based, and we mentioned this. Uh
▶ 4:12:15Are there any Are there any federal regulations And And for many of you, are there any federal regulations that you think that we should modernize or do some work on that would help lower your cost of health care delivery?
▶ 4:12:25We would be glad to bring some ideas forward. Thank you.
▶ 4:12:28Thank you. Mr. Donnelly.
▶ 4:12:30We spend $120 million on physical and cyber security. I think regulations helping uh to keep our workforce safe uh would be go a long way. These These people, as has been mentioned many times uh by the people committee members here, are critical to provide care across this country. I'd appreciate support of helping keep our workforce safe.
▶ 4:12:52Great. Thank you. And Mr. Chairman, I yield back. Thank you. Mr. Bean.
▶ 4:12:56Thank you very much, Mr. Chairman. Good afternoon to you, and good afternoon, Ways and Means, to our all-star panelists. Welcome. We can all agree that housing prices have risen significantly. We can agree that child care costs a lot more than it used to, and I think everybody knows that college tuition is has risen so much. It's just unfathomable how much it's risen. But wait, hold the phone, shut the front door.
▶ 4:13:24There is a new heavyweight champion of rising prices. It's the hospital industry. And I got the the tape right now. Let's show the the screen. It's not from being. This is from the Bureau of Labor Statistics. That has charted all How have you risen your prices? And this top line is not the outline of Mount Everest. It's the outline of the price curve for hospitals. How much you've risen.
▶ 4:13:52In fact, I think the person that invented the phrase, this is off the charts, probably was looking at the prices that hospitals charge. Now, all that said all that being said, we need you healthy. We want your industry to be healthy. There's 330 million plus Americans that depend on you to provide the quality care that they expect. The federal government, we pay most of the bills. And so we want you healthy. So we've tried to work with you.
▶ 4:14:20And you said, give us tax-exempt status. Give us rural designation. And what did you do? We got less charity care, and you raised your prices. We said you said, pay us more money because when we do procedures in the hospital, because you said we have to support an ER, an emergency room that loses money. So we helped to support that. What did you do?
▶ 4:14:45You now build freestanding ERs on every street corner, at least in the free state of Florida, and you raised your prices. You said, let us consolidate. Let us uh share overhead, and uh we can be a healthy industry. What did you do? You invented something called a facility fee that uh when you buy a physician practice, you charge more and you raise uh prices. So, what did we do? What What do we Where do we go? How do we believe anything you said?
▶ 4:15:13How do we restore trust in an industry that we've given you every chance there there is, yet this Mount Everest is where we're headed. Any thoughts? How do we build trust? As you're thinking about it, uh maybe you'll say, and I've heard it here today a couple of times, the ACA. We want everybody to have coverage. Uh funny you mention that because right around here, right around here, 2010, we passed the ACA.
▶ 4:15:44Everybody gets coverage and uh that surely would make the difference. That's when rocket fuel was added to that price line of where everything shot up. It seems the more money we put into hospitals and in that industry, the uh the more you raise prices. Um where did we go wrong? Where did we go wrong with the ACA and why didn't that honor the promise of bending the cost curve down? Uh we thought this thing would would peak right there, yet it still goes up and there's no stopping it.
▶ 4:16:14Anybody want to jump in with what did we do wrong with ACA and why didn't it bend the uh price curve? Uh Dr. Waldron, welcome. Jump in, my
▶ 4:16:27Well, I think that we do have a math problem and I wouldn't say that anybody did anything wrong. I think we've heard from us that we need to have people have so we can not cross-subsidize and have
▶ 4:16:41And and the hospital is is is not what it was last year or the year before. It's full of sicker, more costly people
▶ 4:16:50Uh Dr. Waldron, hold on one second because it's funny, there are sicker people. Uh, we fell for that already, because built into Medicare, we pay you extra when you see sick people. We've already figured that out. And again, that also is read to everything else. Uh, last year, you're not going to believe this, I got my knee done. I had a new knee put in. And uh, show uh, show our next slide, our knee done, and uh, I still don't really know what it cost.
▶ 4:17:15But if there was a way that uh, you could walk into the hospital and know what things cost, maybe it would look like this. At the Chick-fil-A, you know exactly what everything costs. Here's what uh, I kind of mocked up of of what it should look like. The only thing that I think is going to save us, and if you look at other industries, it's competition. Uh, and I want to salute Mr. Hazen, he understands competition.
▶ 4:17:39He says, get out of the way, we'll we'll compete, but how do we have a competitive marketplace when the public doesn't know? How do we get you guys to be transparent? We've passed bills in the state of Florida, we passed bills here. How do we get hospitals to be more transparent? And uh, I am out of time. I just There's lots of questions. So, here's our homework, how do we restore trust with the American people? And trust me, I am open. I would love to solve I and I think everybody does.
▶ 4:18:09I look at my colleagues on the left and the right, we want to solve the problem, we have to solve the problem. But it it can't be the answer, Mr. Chairman, thank you for my extra time. It can't be we need more money, we need more subsidies. We we're out. The American taxpayer is out. We can't do it anymore. So, what can we do? I look forward to meeting with you later. And Mr. Chairman, thank you. I yield back.
▶ 4:18:30Thank you, Mr. Schneider.
▶ 4:18:32Uh, thank you, Mr. Chairman. I want to thank the witnesses uh, for appearing before us today in your uh, and patient patience and endurance uh, for a long hearing, but we appreciate your Across the community and communities large and small, rural towns and major metropolitan centers, healthcare, and in particular hospitals, are fundamental to the vibrancy and prosperity of our communities.
▶ 4:18:54Local hospitals are often the largest employer in their community, and everyone everyone at some point in their lives are going to depend on quality hospital care. Just reflecting on my own lifetime, I know how blessed I am to live in a city, Chicago area, with many wonderful hospitals. Our children were born in Northwestern's Prentice Women's Hospital. I can't tell you how grateful we were for the quality of care when my wife had a serious medical complication during her delivery of our oldest son.
▶ 4:19:2225 years ago, I had surgery to address severe spinal stenosis threatening to leave me paralyzed at Lutheran General Hospital, now part of Advocate. 17 years ago, I had life-saving surgery at Highland Park Hospital, now part of Endeavor Health, to address a staff infection that had driven risen to critical levels.
▶ 4:19:39Last year, my wife had successful hip replacement surgery at Endeavor Health Skokie Hospital, and just 4 weeks ago, as you saw me limping in, I had major foot reconstruction surgery at Rush I have to recognize how lucky I am to live in a community with so many wonderful hospital and hospital choices, including several safety net hospitals. Having access to these facilities during such crucial times is a privilege I do not take for granted. But here's the thing.
▶ 4:20:09Everyone in this country should have access to quality, affordable care from providers they know and trust when and where they need it. And I know our witnesses, and I'm sure all my colleagues on both sides of the dais can agree with that.
▶ 4:20:24What troubles me most, however, is that my Republican colleagues have had no problem accelerating the administration's attempt at weakening the American healthcare system while hospitals are already under severe It's also noteworthy that the hospitals I mentioned have the names Advocate, Endeavor, and Northwestern, all examples of the consolidation we are seeing across the country. As the witnesses noted, consolidation is driven in part by necessity, necessity to survive.
▶ 4:20:51Access to quality hospital care is becoming more difficult and more expensive irrespective of where we live. And again, as the witnesses have said, in rural parts of the country, hospitals are closing, but also in urban centers as well. That means too many expecting mothers are having to travel more than 30 minutes or even an hour to deliver their Too many patients are waiting an average of 31 days to see a specialist, nearly a 20% increase from just 4 years ago.
▶ 4:21:22Too many ER departments have turned into overrun triage units with patients waiting for hours on end to receive care and be discharged. For example, Northwestern's Lake Forest Hospital in my district opened a brand new facility in 2018 with a beautiful ER. It was immediately overwhelmed. Last year, Northwestern doubled the ER capacity, and already demand exceeds that new capacity.
▶ 4:21:48So, I appreciate the witnesses that the witnesses have emphasized three things we need to be focusing on. Stable and affordable health insurance for all fair competition, and reduced administrative complexity. So, with the little bit of time I have left, I want to ask a few quick questions. Uh for everyone on the panel, when a patient comes to your hospital, do you ever discriminate based on the type of insurance a patient has or doesn't have? Mr. Naser.
▶ 4:22:13We do not.
▶ 4:22:17Absolute absolutely not.
▶ 4:22:18Absolutely not.
▶ 4:22:20That's what I expected. Next question, when an uninsured patient comes to your does that uninsured patient put a burden on the hospital? Yes or no.
▶ 4:22:31They don't put a human burden, they put a cost burden.
▶ 4:22:33Cost burden. I meant cost burden, so thank you. Does it put a cost burden on your hospital?
▶ 4:22:39A cost burden, yes.
▶ 4:22:42All right. So, Mr. Hazen, I'll ask you, have you seen an increase in the uninsured population showing up at your hospital? And at the same time, have you seen a decrease of the population that was previously covered by ACA insurance?
▶ 4:22:58Uh, Congressman, we we just recently reported our first quarter earnings, and yes, we did see an increase in uninsured patients, 15%, and we saw an equal decline in patients who were insured in the health insurance exchanges, yes.
▶ 4:23:14And and there's a difference in coincidence and causality, but it is fair to assume that the fact that so few so many people are are losing their insurance, whether it's because the Republicans took away Medicaid or because the ACA subsidies uh, were allowed to expire, a 15% decline in those who have insurance and a 15% increase of those without insurance seems to be consistent. And, um, I I'll ask the last question. Um, well, I'm out of time, so I'm going to skip that. Let me just again say thank you. I know this is a hard challenge.
▶ 4:23:44We need to work together, both sides of the aisle, Democrats and Republicans, to make sure that Americans in the richest country in the world, everyone in this country, no matter where they live, no matter what income they have, have the greatest health care in the world. And with that, I yield back.
▶ 4:23:58Mr. Moore.
▶ 4:24:00Thank you, Chairman. I appreciate everybody, the witnesses, um, questions from across the dais up here. want to reiterate, I think something that our our chairman was was pointing out that um, you know, we've had, this committee in particular, but across Congress, across the country, and the administration as well, this having several discussions on health care affordability.
▶ 4:24:26I think it's front and center to every American, and particularly over the last year. We've looked at it from an insurance angle, different providers, today hospital systems, pharmaceuticals are always in Um what's clear to me is that if we're actually going to reduce health care for it's going to take some give and take from all sides of the equation. And um everyone here has a role to play in that.
▶ 4:24:58The constant, as the chairman said earlier, it's your fault, it's our fault, it's their fault. Like the American people are getting sick and tired of it. They're sick and tired of the blame game and they want to see results. one of the things that we like to talk about is competitiveness.
▶ 4:25:18This is a unique world because when you're obviously uh in the back of an ambulance and you've had a major, you know, accident happen, you're not in the ability to to make a decision on, "Oh, take me to here, here, or here." You're You're going to go where that ambulance is going to take you, right? The call is made and everything. We get that. There's a There's a different element to health care that that doesn't exist in other markets. it's still a very uncompetitive market.
▶ 4:25:45Even the the dichotomy of New York Presbyterian, right? You're talking about In New York, we have a extremely competitive health care market, but also now under you know, there's an investigation from the DOJ on New York Presbyterian for for anti-competitive practices. There's no question there. I'm just highlighting there is this like well, we do have some competition, but then there's there's accusations of of of it being completely anti-competitive, and we've got to figure out a way outside of that.
▶ 4:26:12It is one fundamental aspect to making sure that our health care can be affordable for for for our for the citizens of this Uh Mr. Hazen, Mr. Lassiter, your companies operate a number of hospitals in competitive and non-competitive markets. I've had a chance to visit many and and and know the system well.
▶ 4:26:34Speaking broadly, would you say that hospitals in smaller markets um maybe your competitors who have fewer hospital systems use insurance contracts to lock patients into one provider system preventing them from shopping around? Is that a tactic that's often used, Mr. Hazen?
▶ 4:26:51Thank you, Congressman. We uh do promote a competitive marketplace. Most of the states we operate in are non-certificate of need. We do have some certificate of need. Uh within our contracting uh strategies, we do not use that tactic.
▶ 4:27:07I would say it's the same answer, sir. Thank you for the question. Um we operate in in uh varied environments across across the country, 24 states. Again, some states have certificate of need, some do not. Uh we operate in states where there is great competition. Um and we operate in states where there are organizations that have uh market market power. Uh we do not use uh the practice that you indicated as part of our contracting strategy.
▶ 4:27:38Would you admit that that use insurance contracts are used to lock in patients to a one provider system? I mean That that is anti-competitive. How much worse is this going to get? I mean, that practice is happening. Maybe you're claiming that there isn't among your systems, but how do we get out ahead of that? How do we stop that from getting worse?
▶ 4:28:03Congressman, I would say more competition creates opportunities to deal with that. Uh supply, if supply's constrained in a particular market, creates opportunities for choice. It creates opportunities for lower cost, convenience, all those factors can contribute to uh dealing with that particular issue. Thank you.
▶ 4:28:23Uh Mr. Lassiter, I'll just finish with one last question. Health systems invested over $1.3 billion last year in AI tools um for clinical documentation and coding. Tools that often don't change the care that a patient receives, but instead increases coding intensity and reimbursement. Um when you evaluate ROI on those AI investments, are you measuring success based on improvements in patient outcomes and efficiency or an increase in revenues?
▶ 4:28:47When we evaluate investments in in AI, we're evaluating it based upon a number of factors. I would first and foremost looking at does it help us increase the quality and safety of the care we deliver to our patients. That's That's That's first. The second thing we look at is does it does it improve the working environment for our caregivers um who are burned out and are and we're focusing on helping them increase their Um we do not look at we do not look at AI tools specifically to drive um
▶ 4:29:17I think you didn't use this term, but I would say upcoding and things of that that's not our that's not our explicit uh goal. Our goal is always to code the clinical the clinical record accurately and appropriately.
▶ 4:29:29Thank you. Thank you, Chairman.
▶ 4:29:33Uh Mr. Horsford.
▶ 4:29:35Thank you, Mr. Chairman. I think it's important for us to how we ended up here and how we've arrived at this moment. It was a choice. It was a choice to pass uh a bill last July uh that some call the one big beautiful bill. I call it a betrayal of a bill. It was a choice to give tax breaks to billionaires and to big at the expense of hard-working Americans.
▶ 4:30:03It was a choice to cut $168 billion from nutrition assistance programs uh for people all across this country. And yes, access to food is healthcare. It was a choice to take a trillion dollars out of the health care system. It was a choice, and now there are consequences to that choice.
▶ 4:30:28The consequence is evident in the lives of patients all across this country and in in communities that we serve. It's the consequences in emergency rooms happening right now where someone's life is at risk. It's consequences that are showing up in hospital budgets. And Nevada leaders have warned that residents will, quote, feel the ultimate pinch, and that the fallout from these cuts will be pretty horrific.
▶ 4:30:59And Las Vegas University Medical Center is bracing for a $45.4 million in annual losses. While MountainView Hospital, owned by HCA Healthcare, is projecting an $18 million shortfall. Boulder City Hospital has already begun laying off about 70 workers, ending inpatient care, and transferring patients elsewhere due to changes in the provider fee program.
▶ 4:31:25Make no mistake, these are likely just the first reported hospital job losses in my state alone tied to this one big, beautiful bill. Nationwide Public Citizen recently found that 446 hospitals are at a heightened risk of closure or service reductions.
▶ 4:31:46That represents 69,000 beds, 6.6 million and 275,000 health care workers that we depend on to provide this essential care. In Nevada alone, four hospitals have been identified as at risk, including Saint Rose Dominican de Lima in Henderson, part of the Common Spirit Health System. Mr.
▶ 4:32:11Lassiter, I understand you may not be able to speak to the specific projections, but can you broadly speak to how the one big beautiful bill impacts services that your hospitals provide briefly, please?
▶ 4:32:26Thank you, Congressman Horsford. I would just say simply the impact of the bill for CommonSpirit uh is approximately $5 billion in lost reimbursement over the next 10 Um at its highest point beginning about um CommonSpirit will lose $1 billion in reimbursement that we currently receive.
▶ 4:32:51Thank you, Mr. Woodhouse. Will $50 billion in temporary rural funding make up for nearly a trillion dollars in permanent health care cuts, yes or no?
▶ 4:33:01Well, I no.
▶ 4:33:03Thank you. Investing in the health and vitality of rural America is necessary and long overdue. I agree with the chairman and his passion passionate plea at the beginning of the hearing, but the reality is this. This fund this rural health transformation fund was not designed to replace or meaningfully offset the lost health care funding.
▶ 4:33:26If it were, we would see far greater flexibility to invest in workforce and direct patient care. Instead, much of the funding is geared towards building digital infrastructure, and while that has value, I've yet to see any technology that can replace doctors, nurses, and frontline providers, especially in rural communities like the ones I represent. And while rural hospitals are grateful for any support, they're also deeply concerned.
▶ 4:33:53They worry that program restrictions combined with limited state capacity will only make it more So, Mr. Woodhouse, will the rural health transformation program meaningfully help rural hospitals in my state and how should families in these rural communities react when there are comparable or even greater resources being directed to high-profile presidential pet projects, international ventures abroad,
▶ 4:34:23and now a vanity project to to build a ballroom at the White House.
▶ 4:34:29Well, I I I think your constituents and constituents in rural America should be should be concerned. I mean, that this the I I was not a math major, but a trillion dollars in cuts to Medicaid and a 50 billion-dollar rural transformation fund, the two are not comparable to one to one another. Uh the Kaiser Family Foundation said they didn't believe a single state would gain more from the rural transport rural transformation fund than they will lose from the Medicaid cuts.
▶ 4:34:58Just in closing, Mr. Hazen, I know you work closely with SEIU 1107, which represents nearly 20,000 health care workers and public service workers across Nevada. They recently, after 13 months of negotiation, more than 300 employees secured their first contract, one that strengthens recruitment and retention and delivers average raises of more than 12%.
▶ 4:35:22So, I want to ask you, can you commit to engaging in fair, good-faith contract negotiations negotiations in Nevada, and can can you commit to ensuring that equitable wage growth for your staff across the health care system, including at Sunrise?
▶ 4:35:38We Thank you, Congressman. Sunrise is a great hospital. We do approach our contracting with that
▶ 4:35:47Thank you.
▶ 4:35:48Mr. Marion.
▶ 4:35:49Thank you, Mr. Chairman. Before I get into my questions, I want to play a little bit of a cleanup here on a couple of issues. First, Mr. Woodhouse, I want to come to you because I was concerned, Mr. Bean, when he was giving his statements and using his 5 minutes. I was watching you closely Uh and I was shocked and surprised by the fact that you were rolling your eyes during his commentary and I clearly viewed you doing that and I have to say I was disturbed by that.
▶ 4:36:13He was talking about rebuilding trust in the healthcare industry and here one of our five witnesses were here rolling his eyes at the very things he was trying to engage in on a on a bonafide reasonable dispute on differences between your position and ours and I would just say I don't think that's helpful to your position to the things you're trying to advocate for here today.
▶ 4:36:34We want to have an honest discussion and I certainly don't think that Protect Our Care hired you to come to Congress to roll your eyes at a colleague of mine when he is giving you statistics from the Bureau Bureau of Labor Statistics that are honest statistics engaged in an honest conversation. So I'd say next time watch your behavior when you show up in front of Congress.
▶ 4:36:53I don't think I was rolling my eyes at I was not rolling my eyes at that. You're you're you're way more perceptive than I am if that's what if that's what you think. He was talking about increasing hospital prices. That's not my
▶ 4:37:04I'm talking about your reaction.
▶ 4:37:06and so I would so I would beg to differ with your perception. Maybe you should be the one to watch your behavior.
▶ 4:37:11Pardon me, sir, but you're here to answer questions from the United States Congress about how to fix the very problem that you continue to advocate for. You want us to double down on the failed policies of the ACA and I'm amazed that my my colleague over here I'm not asking you questions. You can just hold your tongue for a second. I'm amazed that my colleague would talk about the difference between the $1 trillion and the $50 billion when the $1 trillion is waste, fraud, and abuse. We're talking about people that were not even supposed to be on Medicaid.
▶ 4:37:39And you're saying we want to keep them on the rolls. We want to put more people on the rolls. We want to throw more money at it when only what we're seeing is the prices going up as my colleague so aptly pointed out. I came here with a set of questions and now I'm going to have a hard time getting to because I can't believe that you're wanting to double down on the very failed policies that the that the Democrats have been leaning into for years. That even Hakeem Jeffries said a few months ago was a broken healthcare system.
▶ 4:38:07And that's what I used with the with the health insurance companies when they came here to a few months ago as well. Because it's amazing to me that we want to keep doubling down on the failed policies. I also want to clarify this because before I get into my questions, I noticed that whenever members of the committee have asked the witnesses here today about why they deserve to be paid more than independent doctors for the exact same service. You all keep saying, "Quote, it's because we care for sicker patients." But let's make the record clear and accurate.
▶ 4:38:36Medicare already adjust payments based on how sick a patient is, whether they are sick in a hospital or sick in a doctor's office. So, that argument does not hold any water. And we're talking about why hospitals get paid more for the same service for the same sick patients just because their name is on the door, and that's what this committee will work to fix to lower cost for all patients across the country. I can tell you I can attest to this in particular. And again, I probably won't even get to my questions today. It's amazing to me. I understand that the the the issue of site neutrality.
▶ 4:39:07I'm from a rural district. I get that there's there's uh there are uh out outlining entities that need to be supported, and a lot of those those payments go to help support that at the end of the day. But I also understand that from one year to the next, I went to the same pulmonologist, got the same service in the same location, and from one year to the next they were acquired by a hospital system, and all of a sudden I had a enhanced patient fee, a facility fee that I had to pay. Now, I can afford it, but many others cannot.
▶ 4:39:34And there's no reason there's no added expense for that except the law provides for that. And so, that does need to be fixed. And I will also say in my remaining time in the in the last minute here that this this uh this pain point is not just on you guys. We get it. It's PBMs. It's Medicare Advantage. It's health insurance companies. It's hospitals. It is the whole system. And it's working against the patient. In every instance. And I don't get that. Actually, I do get that.
▶ 4:40:04Because it's all about profitability, not just for the hospital systems, but also for the insurance companies, which we hit a few months ago as well. That has to end. The self-serving nature of what we're doing in this industry absolutely must end.
▶ 4:40:19You have to do what's right by the patient and not try to exercise uh strict uh construction of a statute to go against the spirit of the statute, like we're seeing in non-rural medical facilities in the middle of New York City that are claimed to be rural It might meet the letter of the law, but it's not the spirit of the law. And the person that loses on that is the And our patience is waning on that. And Mr.
▶ 4:40:45Chairman, I would suggest that this committee take a holistic view and rewrite this entire scenario, so that we can let the free market determine what's going to happen. We can let patients have more access, more quality care, lower prices. And all of you and all the insurance companies and all the PBMs and all the other entities out there that are gorging profits to the to the detriment of the patients, you begin to And the patients begin to win. With that, I yield back.
▶ 4:41:11Mr. Schweikert.
▶ 4:41:14Okay, thank you, Mr. Chairman. I appreciated your remarks earlier today when you talked about we need to work together, Democrats and Republicans. I think we need to do a lot more of that to try and find answers to these very complicated problems. Uh this is a really complicated topic. I mean, there's just so many different factor I hate the blame game stuff. I really I really think it's so inappropriate because it's so many different factors that are involved here from urban versus rural. I looked it up just a few minutes ago.
▶ 4:41:41There are 1,800 rural hospitals, 3,300 urban hospitals, according to the the Hospital Association. There are 3,000 not for profits, 1,200 for profits, 900 state and local, 200 federal, and 656 psychiatric hospitals. So, it's a very complex, diverse environment that we're living in. I had some friends here from They're kind of act like insurance companies cuz they're self-insured. So, they're upset about increased prices that they have to pay as a union because of self-insured.
▶ 4:42:10But, affordability is a problem for everybody. It's the number one issue in America right now. Affordability is the biggest issue in the country. And hospital cost and health insurance costs are a big part of that affordability crisis in our country. Increasing costs cuz a bunch of people got whacked when they lost their premium tax credits in January of this year. When people lose Medicaid, it's going to hurt a lot of people. It's going to hurt your hospitals. It's going to hurt the health care system. And there's going to be less people insured. When there's less people insured, less people in the risk pool, then everybody's insurance rates go up. Okay.
▶ 4:42:41So, I want to ask a couple I want to just ask some basic questions. And I want to offer to meet with you and bring in experts from insurance companies, from pharmaceutical companies, from PBMs, from doctors. I want to get We got to get We got to get come up with some real answers here. Not these one-off things. We need something comprehensive and not finger-pointing. So, quick questions. Uh Mr. Hazen, you represent a hospital, for-profit hospital. Do you make money or lose money on Medicaid?
▶ 4:43:09Uh Congressman, did did you say Medicaid? I didn't hear you.
▶ 4:43:12On Medicaid, do you make money or lose
▶ 4:43:14Uh we lose money.
▶ 4:43:15Mr. Lassiter, do you make money or lose money on Medicaid?
▶ 4:43:18We lose money, Congressman.
▶ 4:43:19Mr. Downey, do you make money or lose money on Medicaid?
▶ 4:43:21Medicaid does not cover the cost of
▶ 4:43:23Dr. Waldman, make money or lose money on
▶ 4:43:26Lose money.
▶ 4:43:27Okay, so you have three not for profits, you're one for profit. What about Medicare? You make or lose? We're We like to refer to ourselves, Congressman, as tax-paying, but uh nonetheless, we make a little bit.
▶ 4:43:38Okay, how about you, Mr. Lassiter? Do you You money or lose money on Medicare?
▶ 4:43:41Medicare generally does not cover the full cost of care provided to Common
▶ 4:43:45Dr. Donnelly, you make money or lose money on Medicare?
▶ 4:43:48Medicare does not cover the cost of full cost of care.
▶ 4:43:50Dr. Waldrum?
▶ 4:43:52We're price takers and we lose money on
▶ 4:43:55So, when people show up and they have no insurance at all, do you lose money on that or you make money on that?
▶ 4:44:00Lose money.
▶ 4:44:01Dr. Donnelly?
▶ 4:44:02We lose money.
▶ 4:44:03Dr. Lassiter?
▶ 4:44:04We lose money.
▶ 4:44:05Mr. Lassiter, Mr. Hazen?
▶ 4:44:06Lose money.
▶ 4:44:07Okay, so you're going to lose a lot of money from Medicare, Medicaid, and people coming in with no insurance. So, how do you make up for the money that you lose from Medicare, Medicaid, and people not having insurance? You make it up by getting more money from the private insurers, which upsets the insurance companies, so they go after you. It upsets the unions that are self-insured and other self-insured businesses cuz they've got to pay it. But that's understandable that that You also make up it by doing philanthropy. Do you have like charity dinners and things like that, Dr. Waldrum?
▶ 4:44:38Yes, we do. 75% of our uh uh uh patients are Medicare, Medicaid, or And so, the only way that we can make it is through
▶ 4:44:49Do you do philanthropy though?
▶ 4:44:52You get philanthropy, Dr. Donnelly?
▶ 4:44:53Yes, Congressman.
▶ 4:44:54Mr. Lassiter, do you do philanthropy?
▶ 4:44:56Yes, we do.
▶ 4:44:57How about you, Hazen? Do you get philanthropy in the tax-paying hospital?
▶ 4:45:00We provide charity care, yes.
▶ 4:45:02But do you get philanthropy from the private sector?
▶ 4:45:05no, no, Congressman, we do not.
▶ 4:45:07I Do you have an endowment, Mr.
▶ 4:45:11Uh we have reserves, so I guess the answer would be yes.
▶ 4:45:14You can invest that money and make some money off of that?
▶ 4:45:17Dr. Donnelly?
▶ 4:45:18We do.
▶ 4:45:19Dr. Waldrum?
▶ 4:45:21Okay, so you have to figure out how to make up for the losses you have in the other area by doing these other things. And some of the things that you do, I would suspect, are what has been referred to as gaming the system. It's all perfectly legal, but you're trying to use the existing laws that are incredibly complicated. You do something over here and it pops out over there. And you do something over here and it pops out over there.
▶ 4:45:41And so you're trying to figure out how can I use the law in order to bring more revenues into my my hospital, either for-profit or not-for-profit, to make up for the losses I have from my Medicare, Medicaid, and uh non-insurance uh patients. So, it's very complicated.
▶ 4:46:00So, I want to ask each of you if you'll commit to work with me, and I'm going to ask the chairman to feel help me with this as well and get me some Republicans, and sit down and let's figure out let's bring in a bunch of experts and talk instead of like yelling at each other and say, "What can we do to make the world a better place to live in by improving our health care for the people that are suffering from these burdensome costs and have better health for them." Would you help with that, Dr. Waldron?
▶ 4:46:24Yes, we look forward to that.
▶ 4:46:25Dr. Donley, would you help with that?
▶ 4:46:27Yes, I would.
▶ 4:46:28Mr. Lassiter, would you help with that?
▶ 4:46:29We look forward to it, sir.
▶ 4:46:31Mr. Hazen?
▶ 4:46:32And Mr. Woodhouse, I need your help on this, too. I didn't ask you questions cuz you don't run a hospital, but I know you're an expert in this area.
▶ 4:46:38to have your help.
▶ 4:46:40Mr. Chairman, thank you very much and I yield back.
▶ 4:46:43Thank you, sir. Um before I adjourn the hearing, I want to enter into the record um some information. We've heard We've heard a lot of um comments and testimony in regards to 15 million people that was thrown off of health care because of the big beautiful bill. We've also heard the trillion dollars that is being cut to health care. And so, I I just want to give the exact facts from CBO, the Congressional Budget Office, which is being cited.
▶ 4:47:136 million of the people of the 15 million are able-bodied adults without dependents who choose not to meet the modest Medicaid work requirement. So, they just choose not to work for Medicaid. So, that's 6 million people, which adds up to 325 billion. 1.4 million are illegal immigrants and 3 million are people already ineligible for Medicaid and simply haven't been removed from the program.
▶ 4:47:41That adds up to 200 billion dollars. And then there's 350 billion dollars worth of provider tax loopholes that states were using that was cleaned up. And then the remaining 5 million people are supposedly due to the expiration of the expanded Obamacare tax credits, which the Democrats set the expiration date.
▶ 4:48:04Um with that, I'd like to thank our witnesses for being here today um for 4 and 1/2 hours. So, we appreciate that. Please be advised that members have 2 weeks to submit written questions to be answered later in writing. Those questions and your answers will be made part of the formal hearing record. With that, the committee stands adjourned.