Playing the Blame Game

By: David Ostrowsky

For some Americans, there is a natural tendency to conflate healthcare with health insurance. Perhaps on the surface, they seem one and the same, but in reality, of course, they are entirely different entities: the former involves providing services and treatment while the latter involves paying for services and treatment. Last month on Capitol Hill, when the titans of the health insurance industry testified before Congress, the stark distinction was on full display.

The healthcare industry has long been under mounting public and political scrutiny to answer for escalating costs faced by tens of millions on employer-sponsored plans. This year, the pressure has only intensified after Congress allowed enhanced Affordable Care Act subsidies to vanish, prompting Obamacare premiums to become financially untenable for millions. With the midterm elections looming this January, politicians want to demonstrate to their respective constituencies that they genuinely care about holding industry leaders accountable, and did just that by calling on the chief executives of the nation’s five most prominent health insurers—Stephen Hemsley, CEO of UnitedHealth Group; David Joyner, chairman and CEO of CVS Health; Gail Boudreaux, president and CEO of Elevance Health; David Cordani, president, CEO and chairman of the board of The Cigna Group; and Paul Markovich, president and CEO of Ascendiun—to take the stand on January 22 at two congressional hearings. Perhaps not surprisingly, the sessions were heavy on finger-pointing and light on accountability, much to the dismay of lawmakers.

“The cost of health insurance is driven by the cost of health care. It is a symptom, not a cause,” offered Hemsley in his prepared testimony. “Premium rates are based on two key factors: how much care is used and how much is charged for that care. When the price of care goes up and care activity increases, the cost of health coverage necessarily follows.”

Additionally, Boudreaux pointed out that hospital care, doctor services, and prescription drugs “have been the largest contributors” to rising U.S. healthcare spending, which, according to Politico, mushroomed by 7.2 percent to $5.3 trillion in 2024. Meanwhile, Cordani highlighted data demonstrating how hospital prices have shot up exponentially in recent decades—a situation The Cigna Group CEO believes has been exacerbated by the recent surge in hospital acquisitions and private-equity ownership of provider practices.

The message from the quintet of health insurance execs, while naturally drawing strong rebuke from hospitals and pharmaceutical companies (The American Hospital Association, in a statement submitted prior to the hearing, said “actions by many commercial insurers erect barriers that make it more difficult for patients to receive timely access to needed medical care”) was not well received by Congress, to say the least.

Members of both parties chastised the insurers on several fronts, focusing attention on their excessively high executive-level compensation and their pervasive practice of denials and delays in paying for patients’ care. Even though their opinions may differ over to what extent the Affordable Care Act contributes to higher premiums and out-of-pocket expenses, the panels’ Republicans and Democrats were united in their belief that the aforementioned commercial insurers had failed to contain costs for the American patient.

“There is not one single American I have met that believes health insurers are effective at lowering costs,” opined Representative Jason Smith, the Republican from Missouri who chairs the House Ways and Means Committee.

“Premiums are rising — patients are struggling to afford care,” noted Representative Buddy Carter, the Georgia Republican and pharmacist who is a member of the health panel under the House Energy and Commerce committee. Carter also made note of the yearly salaries of executives at CVS Health, including Joyner, who was paid $17 million in 2024.

“You all have been very delinquent in your duty,” added Representative Greg Murphy, a North Carolina Republican and a physician.

While the back-and-forth bickering continues as we speak, tens of millions of Americans are struggling to access affordable healthcare while confronting daunting heating bills, stubbornly high grocery prices, and an unstable job market. As the blame gets passed around like a wintertime cold, hardworking taxpayers are the ones ultimately shortchanged.

Though it wasn’t a complete mea culpa, Markovich, the chief executive of Ascendiun, the parent of the nonprofit Blue Shield of California, summed up the universal truth that is utterly undeniable by acknowledging, “Our health care system is bankrupting and failing us.”