Lawmakers Question Health Insurers on Rising Premiums and Affordability

U.S. lawmakers pressed executives from major health insurance companies on affordability during a congressional hearing Thursday, as millions of Americans face higher insurance costs tied to changes in federal subsidies.

Executives from CVS Health, Cigna, UnitedHealth, and Elevance Health testified before Congress amid sharp criticism from lawmakers who argued that insurer practices have reduced competition and contributed to rising premiums. The hearing came as special COVID-era tax credits for Affordable Care Act plans expired, resulting in significant premium increases for many enrollees.

Lawmakers from both parties offered competing explanations for the rising costs. Some focused on industry structure, while others pointed to federal policy decisions.

Concerns Over Market Concentration

Several lawmakers highlighted vertical integration within the health insurance industry as a factor keeping prices elevated. In these arrangements, a single company manages multiple parts of the health care supply chain.

CVS Health was cited as an example because it operates a health insurer, a pharmacy benefit manager, and a national retail pharmacy chain. Lawmakers argued that this concentration of services weakens competition and limits options for independent providers.

“Market power is concentrated, competition is weakened, independent providers are squeezed out, and families are forced to pay more,” said Rep. Lori Trahan, a Democrat from Massachusetts.

These concerns centered on whether integrated business models give large insurers pricing advantages that smaller competitors cannot match.

Insurers Respond to Cost Criticism

Insurance executives pushed back on the idea that company practices are the primary driver of rising premiums. UnitedHealth CEO Steve Hemsley told lawmakers that insurance costs reflect broader health care expenses.

“The cost of healthcare insurance fundamentally reflects the cost of healthcare itself,” Hemsley said. He added that understanding rising costs requires transparency about the underlying drivers of medical spending.

Executives emphasized their stated goals of maintaining affordability while managing overall health care costs, though lawmakers continued to question how those goals align with current pricing trends.

Political Divide Over Subsidies and the ACA

The hearing also exposed sharp partisan disagreements over who was responsible for premium increases. Republican lawmakers blamed insurers and the Affordable Care Act for higher costs, while Democrats pointed to the expiration of federal subsidies.

“You have people whose premiums have doubled, tripled because of the Republicans’ inaction on premium tax credits,” said Rep. Frank Pallone, a Democrat from New Jersey and ranking member of the House Committee on Energy and Commerce.

The special tax credits, introduced during the COVID-19 pandemic, lowered out-of-pocket premiums for many Americans enrolled in Obamacare plans. Their expiration has led to higher costs for millions of policyholders.

Rising Costs Across Coverage Types

Data presented during the hearing underscored broader cost pressures across the health insurance market. Annual premiums for U.S. families with employer-sponsored health insurance rose 6 percent in 2025 to nearly $27,000, according to a survey by health policy organization KFF.

Meanwhile, U.S. government data shows that medical costs have increased by more than 7 percent in recent years, adding to pressure on insurers and employers alike.

These trends have fueled renewed scrutiny of pricing, competition and the role of federal policy in shaping insurance affordability.

Administration Position and Industry Actions

President Donald Trump has said he does not support reinstating the Affordable Care Act subsidies. Instead, he has proposed direct payments to consumers shopping for health insurance, which could be deposited into health savings accounts.

Affordability remains a central issue as the upcoming elections approach, with control of Congress at stake.

In written testimony submitted Wednesday to the House Ways and Means Committee and the House Energy and Commerce Committee’s Subcommittee on Health, UnitedHealth said it plans to provide rebates to customers enrolled in its Affordable Care Act plans for 2026.

The testimony marked one of the few concrete steps discussed during the hearing related to near-term consumer costs, as lawmakers continued to debate the broader causes of rising premiums.