During two congressional hearings on Thursday, five executives from the country's biggest health insurers suggested ways to improve affordability, expand access, and simplify the patient experience. While lawmakers disagreed over the causes of premium hikes, the CEOs emphasized policy changes and internal reforms they believe can meaningfully reduce costs across the system.
Health insurance CEOs from UnitedHealth Group, CVS Health, Elevance Health, The Cigna Group, and Ascendiun (the parent company of Blue Shield of California) on Thursday appeared before the House Committee on Ways and Means and the Committee on Energy and Commerce Subcommittee on Health to discuss the root causes of skyrocketing health care costs.
The hearings were scheduled in the wake of the failure of Congress to extend the enhanced Affordable Care Act (ACA) premium tax credits, which will result in millions of Americans facing significantly higher premiums this year. The subsidies expired at the end of 2025 and annual premiums are expected to rise an average of 114 percent from $888 to $1,904.
During their opening statements, the executives discussed what their organizations are doing to better control costs and offered suggestions for lawmakers.
Expand preventive care to avoid high-cost illnesses
The United States spends too much treating illness after it develops and too little on preventing it, the executives testified. They urged Congress to support models that reward early intervention and long‑term health maintenance instead of volume‑based care.
UnitedHealth Group CEO Stephen Hemsley said the company is investing heavily in preventive care to help people “get care before a condition worsens or before becoming sick at all,” arguing that healthier patients ultimately need fewer resources, helping control premiums. Insurance, he said, is the only sector in health care that has incentives to keep costs of care as low as possible while striving for high-quality health outcomes for patients.
Cigna CEO David Cordani called for shifting resources “earlier in the care journey,” particularly programs that prevent chronic disease and support long-term health, and eliminating or lowering out‑of‑pocket costs for life‑saving medications to encourage treatment adherence.
Reduce administrative burdens and modernize prior authorization
Several CEOs identified administrative burdens—including paperwork, delays, and outdated systems—as a hidden driver of rising health care costs.
CVS Health CEO David Joyner said reducing administrative tasks will allow clinicians to spend more time with patients, noting the company has already lowered the number of services subject to prior authorization and now approves 77 percent of authorization requests “in near real time” and the number is growing.
Joyner highlighted CVS Health’s bundled prior authorization approach to give providers one approval to cover medical procedures, such as repeat imaging and medications for specific conditions. This allows patients who are undergoing breast cancer treatment to receive a single authorization for the entire series of procedures to prevent delays in care.
Elevance Health CEO Gail Boudreaux said prior authorizations apply to about three percent of the organization’s claims. Since January 2024, Elevance has removed more than 400 services from prior authorization requirements and is expanding electronic prior authorization to speed decisions, reduce paperwork, and cut redundant steps.
Increase competition in the prescription drug market
Prescription drug spending was a major focus, with several CEOs urging policymakers to expand tools that make medications more affordable. Drug prices are a key driver of premiums, they said, and Congress can play a critical role in opening markets to lower-cost alternatives.
Joyner said CVS Health is “aggressively promoting the use of biosimilars,” leading to $1.5 billion in savings for members, and for many, $0 out‑of‑pocket costs for formerly expensive biologics.
Cordani noted that generic and biosimilar competition can significantly reduce costs and pointed to Cigna’s success in offering $25 insulin and $0 biosimilars for many patients.
Blue Shield of California CEO Paul Markovich advocated eliminating pharmaceutical “kickbacks in the form of rebates, fees and spread pricing,” a move he said would make drug pricing more transparent and reduce premiums.
Improve consumer tools and transparency
Making prices and coverage easier to understand was another theme during the hearings. Reforms that expand transparency, particularly in hospitals and drug pricing, would make it easier to control costs long term, the panel said.
Hemsley said UnitedHealth is introducing Medicare Advantage plans with no deductibles or coinsurance, designed to give patients upfront cost information so they can comparison‑shop for care. He said members in these plans pay 50 percent less in out‑of‑pocket costs compared to traditional plans.
Joyner described a “modern consumer health care platform” being built by CVS Health for all plans and providers, allowing patients to schedule visits, manage prescriptions, and access preventive care within a single app.
Boudreaux emphasized simplifying the system with “clear information in plain language,” to reduce patient confusion.
Invest in coordinated, value‑based care models
The insurance executives emphasized replacing fee‑for‑service reimbursement with systems that pay based on patient outcomes. Value‑based models not only lower costs, they said, but reduce patient confusion by making it easier to navigate care.
Hemsley said UnitedHealth Group is expanding value‑based care to “improve outcomes and protect access,” noting that these arrangements can deliver better coordination and lower total costs.
Boudreaux reported that Elevance’s coordinated oncology program has reduced chemotherapy‑related hospitalizations by more than 60 percent by ensuring patients get the right care at the right time.
Markovich called for “breaking the do‑more, get‑paid‑more fee‑for‑service model” and replacing it with payments tied to outcomes to reward efficiency and better health.
Strengthen marketplace stability and risk pools
Finally, Congress must adopt policies that bring younger, healthier people into the insurance risk pool, an approach executives said would reduce premiums for everyone. Joyner highlighted this as a key reform area for stabilizing marketplace plans.