The April 28 Ways & Means hearing made one thing clear: “healthcare is complicated” no longer works as an answer. Here’s what Congress asked, how the industry answered, and what your system should take from it.
How we got here: a cracking down on the corporatization of healthcare.
The hearing wasn’t a one-off. It was the third act in a deliberate sequence:
- January 2026 — Insurers and PBMs testify. CEOs of UnitedHealth, CVS Health, Elevance, Cigna, and Blue Shield of California answered for how vertical integration (owning the insurer, the doctor, and the pharmacy) limits patient choice and raises premiums.
- April 2026 — Medicare fraud. Fraud victims, hospice industry leaders, and healthcare investigators testified on the $60 billion lost annually to criminal networks exploiting loopholes in hospice and home health billing.
- April 28 — Hospital CEOs testify. Leaders of HCA, CommonSpirit, NewYork-Presbyterian, and ECU Health answered for a 300% rise in hospital prices and the use of “legal loopholes” to secure taxpayer-funded subsidies.
The numbers Congress kept returning to.
- 300% — increase in hospital prices over the last 20 years, more than any other sector of the economy.
- 1/3 — share of all U.S. healthcare spending that goes to hospitals, roughly $1.6 trillion annually.
- ~2,000 — hospital consolidations creating concentrated markets, cited as a driver of pricing power.
These numbers don’t care about context. That’s the problem for health systems: both parties agree costs are a crisis, and these three stats are the frame every hospital now testifies inside.
How the industry answered.
- For-profit (HCA): coverage gaps are leaving patients behind, not hospitals, citing a 15% rise in uninsured patients in Q1 2026 tied to ACA subsidy expiration.
- Nonprofit (CommonSpirit): nonprofits absorb the system’s failures, serving the underserved while payors sit on payments: $4.3B in unpaid Medicare Advantage claims and a $225M operating loss on $40B in revenue.
- Academic medical (NewYork-Presbyterian): academic medicine is high complexity and high cost, driven by payor administrative burden, rising drug costs, and sicker patients. The system also faced scrutiny over its “rural referral center” designation despite its Manhattan location.
- Rural safety-net (ECU Health): consolidation is survival, not a growth strategy, with the hearing’s most compelling rural defense: “If we leave, no one else comes.”
Where the defense fell short.
- No solutions on the table. Every CEO explained their own pressures well. None arrived with credible, specific proposals to make care more affordable, and the absence was noticed.
- Industry question, individual answers. Congress asked about hospitals as a category. Each CEO defended their specific system. The disconnect made strong individual arguments read as narrow.
- The payer blame playbook is worn. Pointing at payors and PBMs is legitimate, but it’s been the industry’s go-to for years. Without solutions alongside it, it reads as deflection.
What it means for your system.
The narrative being built in Washington will land in your local market: in your paper, your board room, your next payer negotiation. The lesson of this hearing is that explanation without proposal no longer passes, and the systems that fare best under scrutiny will be the ones that arrive with a specific, honest, solutions-forward story before they’re summoned to tell one.
Three questions for your leadership table:
- The value narrative. If your CEO were in that chair, what would they say your system is doing to make care more affordable, and is it specific enough to survive follow-up?
- The local version. When the DC narrative lands in your market, are government affairs, communications, and the C-suite aligned on one story, or three?
- The scenario prep. Site-neutral payments and consolidation limits are likely coming. Do you know what each means for your revenue model, and is the communications response built before the policy lands?
Where BPD comes in.
BPD Healthcare helps health systems build the solutions-forward value story that holds up under scrutiny, align leadership voice across earned media, advocacy, and local markets, and prepare the communications response before policy arrives. If any of the three questions above is hard to answer, that’s the conversation to have now.
