“Excessive.” “Criminal.” “It’s just wrong.”
Those are some of the words members of Congress used to describe health insurance companies during two hearings Thursday, hearings that often turned contentious as lawmakers ridiculed the CEOs of some of America’s largest taxpayers for making profits in the at the expense of the average American.
The CEOs of UnitedHealth, CVS, Cigna, Elevance and Ascendiun were bombarded with questions and criticism about denial of care, market concentration and their multimillion-dollar pay packages at a time when millions of Americans are losing their health insurance.
“Profits have been put above patients. And profits have been put above those who care for patients,” Rep. Greg Murphy, R.N.C., said during the hearing before the House Ways and Means Committee. “He has openly abused his position of authority to provide medical care to patients in this country.”
Payer executives: Stephen Hemsley, CEO of UnitedHealth; David Joyner, CEO of CVS; David Cordani, CEO of Cigna; and Gail Boudreaux, CEO of Elevance, admitted they could do more to improve affordability and access.
However, CEOs attempted to deflect blame, arguing that other players in the health system, especially hospitals and pharmaceutical companies, are responsible for the higher costs.
The notable outlier was Paul Markovich, CEO of Ascendiun, the nonprofit parent company of the larger California Blues plan.
Health insurers focus on profits as much as everyone else, Markovich said in his prepared testimony.
“Our health system is bankrupt and failing us,” Markovich said, adding that participants in the system – including health plans – have put profits before patients or have become complacent about the complexity they have created.
“YOI have come to the conclusion that the system will not fix itself. “The healthcare system needs some tough love and clear direction, and the American government is best positioned to provide both,” he said.
‘The patient is screwed’
The insurance CEOs found few allies during their marathon testimony, in front of the Energy and Commerce health subcommittee in the morning and before the entire Ways and Means committee in the afternoon.
Executives agreed that health care is confusing and inefficient and that prices are too high. But they have already fixed or are working on some of the biggest consumer complaints, such as onerous prior authorization policies, and are generally not to blame for the higher costs, they said.
“The cost of health insurance fundamentally reflects the cost of health care itself. It is more of an effect than a cause,” Hemsley said in prepared testimony. “YOIf insurance costs increase even as we compete aggressively against other companies, this indicates increasing costs of health services, medications and increasing volumes of care activity.”
Premiums reflect the cost of care, which has increased significantly due to the United States’ older and sicker population, strong supplier consolidation, the entry of high-cost drugs into the market, and other factors.
Still, CEOs’ arguments that they keep costs down by negotiating with suppliers and drugmakers largely fell on deaf ears.
“I have not met any American who believes that health insurers are effective in reducing costs,” said Ways and Means Chairman J.Jason Smith, R-Mo.
Legislators from both parties were particularly concerned about rampant vertical integration. The for-profit insurance giants aren’t just insurers: The companies also own physician groups, pharmacies, pharmacy benefit managers and other subsidiaries that give them enormous control over multiple markets in the American healthcare system.
That control may be driving higher spending. For example, data shows that doctors and pharmacies affiliated with a plan typically receive higher rates than non-affiliated providers.
UnitedHealth and CVS, which run vertically integrated healthcare empires, took the brunt of criticism for their consolidation on Thursday. In a testy exchange, Rep. Alexandria Ocasio-Cortez, D-N.Y., cited a CVS investor conference in which the company touted how a consumer could get health insurance, health care, fill prescriptions and even have their medications manufactured, all at CVS subsidiaries.
Joyner denied that this amounted to market concentration. “I suggest that it is a model that works very well for the consumer,” the CEO said during the Energy and Commerce hearing.
“Yes, I think it works very well for CVS,” Ocasio-Cortez responded. “Health insurance gets a cut, the pharmacy benefit manager gets a cut, the drug manufacturer gets a cut. And the patient is screwed.”
Rep. Ocasio-Cortez points to a CVS chart during the House Energy and Commerce committee on health affordability on January 22, 2026.
Rebecca Pifer Parduhn/Healthcare Diving
Executives also attempted to defend their care review practices, arguing that stories of delays and denials of inappropriate care are unfortunate outliers and that they approve the bulk of claims.
But that doesn’t jibe with the investigation, lawmakers said. Data on industry-wide denials is scarce and often disputed by insurers. But 19% of in-network claims were denied in Affordable Care Act markets in 2023, according to a recent KFF study, and providers say denials are increasing.
The high rates of denials are especially concerning given that other research has found that the vast majority of denials are overturned if appealed.
“This sounds like their business model. It seems like they’re betting on wearing patients down and making them unattractive and then they decide to just bear the cost or die before getting the care they need,” Rep. Kim Schrier, D-Wash., said during the Energy and Commerce hearing.
Lawmakers also attacked CEOs over their pay packages, questioning the ethics of receiving millions of dollars in annual compensation when American families struggle to pay for health care.
Executives were also asked about negotiations with clients, the transparency of their plans and the steps they are taking to improve medical access in rural areas.
The insurance CEOs largely remained calm under fire during questioning, although their measured responses were at times at odds with the lawmakers’ intensity.
Hemsley even came under fire after thanking several representatives for their questions, when Rep. Buddy Carter, R-Ga., asked Hemsley if he ever had to explain to a patient why they were denied care.
“Don’t thank me for asking,” Carter said emphatically during the Energy and Commerce hearing. “I was in pharmacy for 40 years. I’m the one who had to look the patient in the eye. I’m the one who had to tell them that. On their behalf. It’s not fun.”
Hemsley’s deferential tone also irritated other members.
“The way you’re talking about this is not understanding. It’s not compassionate. ‘I appreciate the issue.’ These are people’s lives,” said Rep. Nanette Díaz. barragtonorthDemocrat from California.
Health policy disputes
During the hearings, lawmakers attacked their counterparts on the other side of the aisle almost as much as they attacked the CEOs.
Democrats Blast Republicans for Deep Health Care Cuts in Taxes and GOP Policies megabill passed last summer and said it was not too late for Congress to extend higher subsidies for ACA plans that expired at the end of 2025.
Meanwhile, Republicans raised concerns about fraud and waste in the exchanges established by the ACA, and argued that much of the country’s affordability crisis is due to the 2010 law.
Members of Congress sometimes used executives as proxies, asking them to raise their hands if they agreed with one policy point or another.
CEOs generally avoided supporting specific reforms and instead said they supported broad issues such as price transparency, fighting fraud and reducing complexity in the healthcare industry.
Congress faces intense public pressure to improve health care affordability after the expiration of more generous subsidies for ACA plans. As a result, about 20 million Americans on the exchanges will see their monthly coverage premiums double on average this year. About 4 million are expected to drop coverage entirely.
However, while price increases on the ACA exchanges are particularly sharp this year, 2026 is not an outlier.
The country’s health spending reached $5.3 trillion in 2024, more than 7% more than the previous year and outpacing the growth of the overall economy, an unsustainable situation, according to economists and health policy experts.
With costs rising, lawmakers have turned their attention to insurers, including Republicans. It is a radical change for the party, which normally defends big business and privatized insurance. However, President Donald Trump has said he wants to meet with insurance CEOs to negotiate lower prices and issued a basic health care plan earlier this month that would change some of their practices.
Wall Street has been largely indifferent, despite Congress and the Trump administration’s increasing focus on insurers.
Shares of UnitedHealth, Cigna, Elevance and CVS trended higher on Thursday and were basically flat in post-market trading, suggesting investors aren’t worried about the potential for a seismic shift from Washington.
