Health care finance leaders call for truce in affordability blame game

No one in health care is winning the blame game happening as prices keep going up while patient access becomes more difficult.

Instead, it is time for physicians, hospitals, insurers, employers and technology companies to work together on solutions, according to the Healthcare Financial Management Association (HFMA).

The association hopes sector leaders will join with its new “Declaration on Healthcare Affordability and Sustainability.” The pledge is part of Vitalic Health, an initiative HFMA launched earlier this year to bring new partners together, test solutions and measure whether care actually becomes more affordable.

“For too long, health care stakeholders have accepted a health care system that is unsustainable and no longer provides adequate financial security for patients, while burdening employers and taxpayers with exorbitant health care costs,” HFMA President and CEO C. Ann Jordan, J.D., said in a news release.

“The affordability problem is already well defined. What matters now is action, accountability and results.”

HFMA did not mention physician practices by name. But the proposal courts doctors and other clinicians, payers, financial technology executives, employers and purchasers with hope that “real solutions are within reach.”

The pledge to “end cost shifting in the guise of cost reduction” alludes to a long-running concern for independent primary care physicians: payment rules that pay more for the same service when a hospital-owned site bills for it.

What the declaration says

The declaration calls affordability and sustainability “inseparable” and says no stakeholder can solve the problem alone. Signers commit to:

• Move beyond blame
• Facilitate thoughtful dialogue
• End cost shifting in the guise of cost reduction
• Reduce health care costs, not health care

“Through new partners, ideas, innovations, and ultimately with accountability to patients, employers and taxpayers, our efforts will be squarely aimed at real progress on affordability,” said HFMA national board chair Matthew E. Cox, FHFMA, CPA, executive vice president and chief financial officer of Corewell Health.

Voters are watching. A Morning Consult poll commissioned by HFMA in September found 54% of voters said health care has become less affordable this year, and 57% were concerned about hospitals closing. A separate KFF poll found 60% of registered voters worried about affording care ahead of the Nov. 3 midterm elections, Medical Economics reported.

Coverage isn’t protection

Nearly half (46%) of working-age adults said their families had trouble affording health care in 2025, according to a June brief from the Urban Institute, funded by the Robert Wood Johnson Foundation. Families reported difficulty affording care among:

• 39% of adults with employer coverage
• 53.8% of adults with Marketplace or other individual coverage
• 57% of adults with Medicaid
• 60.4% of uninsured adults

Patients with chronic disease were hit hardest. More than 60% of adults ever diagnosed with cancer, heart disease or diabetes reported affordability problems, as did more than 70% of those with stroke or chronic obstructive pulmonary disease (COPD).

The authors concluded that “insurance often does not provide sufficient financial protection from the costs of obtaining health care.”

Other data point the same way. Just 49% of U.S. adults could consistently afford needed care and medications in 2025, the lowest share since the West Health-Gallup Healthcare Affordability Index began tracking in 2021, Medical Economics reported in August.

The visits patients skip

Cost is shaping whether patients come back to the exam room. Among patients who skipped or postponed care because of cost, 52% skipped follow-up or specialist visits, 43% skipped prescription drugs and 34% skipped preventive visits, according to the 2026 PayZen Patient Affordability Survey.

PayZen, a company that sells affordability and payment technology to health systems, surveyed 1,000 adults in July who had a hospital visit or surgery in the past two years. More than one in four skipped or postponed care because of cost. Among other findings:

• 43% have used an artificial intelligence (AI) chatbot instead of seeing a doctor because of cost concerns.
• 42% received no cost estimate, payment plan offer, financial assistance information or financial counselor conversation.
• Nearly 9 in 10 said they would lose trust in a provider that does not proactively communicate about payment plans or financial assistance.

“Health care affordability is breaking in the middle among patients who have insurance coverage, work, and are often financially stable on paper, yet still face medical costs they cannot easily absorb,” PayZen CEO Itzik Cohen wrote in the report.

Physicians feel it

Access to affordable care became physicians’ top policy concern in athenahealth’s Physician Sentiment Survey, named by 52% of respondents, up from 38% two years earlier, Medical Economics reported in March.

“This trend indicates that access to health care is no longer solely a patient issue but also a critical challenge for the physicians responsible for delivering care,” an athenahealth news release said.

The survey also found 90% of small practices fear for their ability to remain independent.

Practices have little room to absorb rising costs because they don’t set their own prices, Nele Jessel, M.D., chief medical officer at athenahealth, told Medical Economics in March.

“Health care is probably the only industry where prices aren’t actually controlled by the vendor offering the services, but prices are controlled by third parties,” Jessel said.

Same drug, different bill

The HFMA declaration does not take a position on specific policies, such as site-neutral payment.

But other sector analysts and advocates have pointed to various factors that affect health care prices for patients and reimbursement for physicians. For example, costs can shift depending on where care is delivered and billed. Hospital outpatient departments were paid an average of 102% more per unit than physician offices for the same physician-administered drugs, according to a Sept. 24 issue brief from the Employee Benefit Research Institute (EBRI). The median markup was 64%.

The analysis of 2023-2024 commercial claims for 106 high-spending infused and injected drugs estimated that employers and workers would save about $12.7 billion a year if hospital departments were paid physician office rates, Medical Economics reported. EBRI’s earlier research found similar gaps for laboratory tests and imaging.

The consistency of those findings suggests the differences “reflect broader structural characteristics of commercial health care markets rather than differences in the services themselves,” wrote authors Paul Fronstin, Ph.D., EBRI’s director of health benefits research, and M. Christopher Roebuck, Ph.D., president and CEO of RxEconomics.

Funders of the study included the Blue Cross Blue Shield Association, several employers and drug manufacturers. EBRI does not lobby or take positions on specific policy proposals.

The gap is narrowing, slowly. The median hospital markup for drugs EBRI has tracked since 2019 fell from 98% to 70% by 2024, mainly because physician office payments rose, not because hospital payments fell.

The ownership question

Payment gaps also shape who owns practices. When a hospital acquires a physician practice, services once billed as physician office care may be reclassified and billed as hospital outpatient services, sometimes without any change in where patients are treated, the EBRI brief noted.

Hospitals and corporate entities employed 82% of U.S. physicians and owned 63.9% of practices as of Jan. 1, 2026, according to a report by Avalere Health for the Physicians Advocacy Institute (PAI), Medical Economics reported in May.

“The corporate takeover of physician practices continues unabated, causing fundamental changes in how physicians practice medicine in this country,” PAI CEO Kelly Kenney, J.D., said in a news release.

What comes next

HFMA is inviting leaders to endorse the declaration, which does not set a timeline for results.

Lowering prices would require tackling hospital and insurer consolidation, “sometimes excessive provider payment rates,” prescription drug costs and workforce shortages, the Urban Institute authors wrote. They added that the longstanding problem of unaffordable care “requires more systemic reform.”

“HFMA’s Vitalic Health initiative will ensure that collaboration helps solve health care problems long deemed unsolvable,” Cox said.