Lawmakers look for ways to improve health care affordability, accessibility

In 2026, congressional leaders are taking up legislation that will affect the nation’s public and private health insurance programs.

Americans need health care, and a way to pay for it, but a new year did not appear to bring new agreement among congressional leaders on how to make health care more affordable.

On Jan. 8, the House Energy & Commerce Committee Health Subcommittee held the hearing “Legislative Proposals to Support Patient Access to Medicare Services.”

The Energy & Commerce Committee and Ways and Means Committee also jointly announced Jan. 22 hearings to bring in CEOs of five large health insurers to discuss ways to make health care more accessible and affordable for patients.

It’s clear that the end of 2025 expiration of the enhanced Affordable Care Act subsidies for millions of patients remain a point of contention among lawmakers.

Cleaning up a mess

The CEO hearing will be held with the House Ways and Means Committee. Energy & Commerce Chair Rep. Brett Guthrie (R-Kentucky) and Ways and Means Chair Rep. Jason Smith (R-Missouri) published a joint statement.

“House Republicans are once again left to clean up the mess of Democrats’ flawed policymaking,” they said. “Instead of temporarily bailing out a failing program utilized by a fraction of the country, we have invited five of the top health insurance company CEOs to testify before our committees to have a discussion and answer questions about rising costs, the current state of health care affordability, and the role played by large health insurers.

“This hearing is the first in a series to examine the root causes driving higher health care prices and discuss policies that will lower the cost of care for all Americans,” the lawmakers said.

“Republicans are committed to making health care more affordable by driving solutions that increase patient choice and competition, root out waste, fraud, and abuse, and put patients back at the center of our health care system,” Guthrie and Smith said.

Health insurance: Business is good

There are at least five witnesses invited to the CEO hearing.

• Stephen Hemsley, CEO, UnitedHealth Group
• David Joyner, President and CEO, CVS Health Group
• David Cordani, President, CEO, and Chairman of the Board, Cigna Health Group
• Gail Boudreaux, President and CEO, Elevance Health
• Paul Markovich, President and CEO, Ascendiun

Combined, the companies control health care for millions of people and they make billions of dollars from health care spending, according to published third-quarter financial results, the most recent available.

In Q3 2025, UnitedHealth Group posted quarterly revenues of $113.4 billion, up 12% year-over-year. CVS Health had record high quarterly revenues of $102.9 billion, up 7.8% from Q3 2024. Cigna’s quarterly revenues were up 10% yearly to $69.7 billion. Elevance posted 12% growth year-on-year to generate $50.1 billion in revenues for the quarter.

Ascendiun is the parent company of nonprofit Blue Shield of California and its Promise Health Plan that operates a Medicaid plan, the Stellarus health plans, and Altais health network.

The Energy & Commerce Committee will inquire in a morning session, with Ways and Means members meeting in the afternoon, according to the announcement.

‘Rome is still burning’

In the Jan. 8 hearing on Medicare policy, Health Subcommittee Chair Rep. Morgan Griffith (R-Virginia) recounted a number of bills already introduced on topics ranging from portable ultrasound reimbursement to durable medical equipment to oxygen to home infusions to greater transparency about benefits offered through Medicare Advantage plans.

Some bipartisan agreement will be good, “but I hate to tell you, Rome is still burning,” said Subcommittee Ranking Member Rep. Diana DeGette (D-Colorado).

The expiration of ACA subsidies at the end of 2025 are going to make health insurance premiums skyrocket this year for millions of Americans, DeGette said. She cited her own district, where a family of four making $128,000 a year would see an average increase of $14,000 in silver plans offered through the ACA Marketplace.

DeGette also cited last year’s deliberations and passage of the One Big Beautiful Bill Act that will cut health care for millions while enacting tax cuts for the ultrawealthy. There have been bills to restore or extend the ACA subsidies and the House of Representatives was scheduled to vote on that again Jan. 8.

Guthrie mentioned the scheduled Jan. 22 hearings with the health insurance CEOs as evidence the committee will not shy away from tackling tough issues across health care. Committee Ranking Member Rep. Frank Pallone (D-New Jersey) said Republicans have spent the last year decimating the nation’s health care system, with a cut of $1 trillion from Medicaid. It’s a failure of leadership and affordability so dire that some Republicans have crossed party lines to force another vote on extending the ACA subsidies, he said.

Dated policy for diagnostic testing

The hearing included statements and dialogue with four witnesses who addressed elements working well and areas that need improvement under Medicare.

Medicare is using outdated and incomplete data from 2016 to determine its payment system for diagnostic testing, with more cuts scheduled to take effect at the end of the month, said Susan Van Meter, president of the American Clinical Laboratory Association. There are problems rooted in the Protecting Access to Medicare Act of 2014, she said.

“Laboratory tests screen for disease, prevent diagnostic or provide diagnostic information that informs clinical care, support increasingly personalized medicine, contribute to the discovery of new therapies and help identify emerging pathogens,

From routine tests used to diagnose and monitor a wide range of diseases to biomarker testing that enables clinicians to better target treatments, particularly in cancer care, laboratory testing helps patients avoid ineffective therapies while improving outcomes and reducing unnecessary costs. Laboratory test results serve as the GPS for healthcare decision making, informing roughly 70% of medical decisions, while payments to the clinical laboratory fee schedule account for less than 1% of total Medicare spending, or approximately $8 billion annually. Despite this value, the clinical laboratory fee schedule lacks the stability and predictability laboratories need to maintain access to testing services that are relied upon by millions of patients and clinicians and continue investing in innovation.

Innovation needed for infusions

More than a million patients a year rely on home infusions to treat infections, immune disorders, cancer, heart failure and other complex conditions, said Connie Sullivan, president and CEO of the National Home Infusion Association. The organization represents pharmacies that coordinate and deliver home infusions, said Sullivan, who also is a pharmacist.

Medicare beneficiaries are underserved because traditional Medicare covers a limited number of drugs and professional services around infusions, Sullivan said. That creates real-life access problems for seniors, people with disabilities and patients in rural areas, she said.

“Without home infusion access, seniors must travel back and forth to facilities or extend their hospital stay to receive these necessary and often life-saving treatments,” Sullivan said.

The Medicare policy was analyzed in a 2010 study by the Government Accountability office and its comparison of Medicare and commercial insurance coverage remain true today, Sullivan said. There is legislation that would update and improve Medicare’s infusion coverage and congressional approval would help patients, she said.

“With these changes, more home infusion providers will be encouraged to participate in the benefit, which will then expand access across the country for patients with a variety of needs,” Sullivan said.

Medical equipment needed

There are three bipartisan bills that would protect access to medical equipment for Medicare beneficiaries, said Tom Ryan, president and CEO of the American Association for Home Care.

“Home medical equipment is critical part of the care continuum,” Ryan said. “It keeps people healthier, more independent and in the setting that they overwhelmingly prefer their homes, while reducing costly hospitalizations and emergency room visits.”

In his introductory statement, Ryan discussed bills that would effect items including continuous glucose monitoring, lightweight wheelchairs and liquid oxygen. The legislation has “practical, targeted solutions that will protect access to care for millions of Medicare beneficiaries,” he said.

Same old problems with new prior auths?

It appeared there is a split over a new payment model proposed by the U.S. Center for Medicare & Medicaid Services and its Innovation Center.

The Center for Medicare Advocacy supports legislation that would block CMS’ new Wasteful and Inappropriate Service Reduction model, shorted to WISeR, said center Co-Director David Lipschutz.

Per CMS’ official description: “The WISeR Model focuses on a specific subset of items and services that may have little to no clinical benefit for certain patients and that historically have had a higher risk of waste, fraud and abuse. This includes skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for knee osteoarthritis.”

WISeR started this year in six states. Health care sector analysts have noted it introduces a new level of prior authorizations into traditional Medicare.

Medicare Advantage plans require prior authorizations for virtually all expensive services, Lipschutz said.

“Extensive research and studies and our own experience have found that prior authorization requirements can result in inappropriate denials and delays in obtaining medically necessary care,” he said. “When appealed, over 80% of MA denials are partially or fully overturned, but too few people appeal, meaning millions of beneficiaries are foregoing their right to appeal and going without necessary care.

“The WISeR Model borrows some of the worst elements of Medicare advantage with respect to accessing care, and injects them into traditional Medicare,” Lipschutz said, and lawmakers should rethink it.