The CEOs of most of the nation’s largest health insurers plan to lay blame for rising healthcare costs on hospitals, pharmaceutical companies and specialty providers during testimony before Congress on Jan. 22.
In written testimonies submitted ahead of back-to-back hearings before the House Energy and Commerce Subcommittee on Health and the House Ways and Means Committee, the top executives from UnitedHealth Group, CVS Health, Elevance Health, The Cigna Group and Ascendiun (parent of Blue Shield of California) said they would defend the insurance industry’s role within the healthcare system and argue that rising premiums directly reflect underlying medical costs that have grown faster than inflation.
“The cost of health insurance is driven by the cost of healthcare. It is a symptom, not a cause,” UnitedHealth Chairman and CEO Stephen Hemsley wrote. “When the price of care goes up and care activity increases, the cost of health coverage necessarily follows.”
All five CEOs cited hospital pricing and consolidation, prescription drug prices, and the cost of specialty services and diagnostic testing as the reason for rising premiums.
In 2026, employers are experiencing the steepest rise in costs for health benefits in more than a decade, with some estimates putting average increases near 10% nationally. Multiple surveys of thousands of employers have largely attributed rising costs to the coverage of chronic and high-cost conditions, more stop-loss claims, and greater care utilization and drug spending, particularly on GLP-1 medications.
“The American health care system is bankrupting and failing us. It is way too expensive, too impersonal, doesn’t cover everyone, achieves inferior outcomes relative to other countries, is often described as a ‘sick care system,’ and is mistrusted by too many Americans,” Ascendiun president and CEO Paul Markovich wrote.
In his planned testimony, Cigna Chairman and CEO David Cordani pointed to a large health system recently requesting a 30% rate increase over two years, ultimately settling at 20% “to preserve patient access and limit disruption.” He also noted that the median price of a new prescription drug reached $370,000 in 2024, up from about $2,000 less than 20 years ago.
Ahead of the hearings, UnitedHealth also said that it will voluntarily eliminate and rebate all profits from its ACA exchange plans in 2026 as lawmakers work on a long-term solution to extend the enhanced premium subsidies that expired at the end of 2025.
This week, lawmakers unveiled a bipartisan healthcare deal tied to a broader government funding package, though an extension of the subsidies is not included. An extension has been waffled over since late last year, leading to the longest government shutdown in U.S. history and millions of marketplace enrollees facing higher premiums nationwide.
House lawmakers voted in early January to extend the subsidies for three years. Though the extension is not expected to pass in the Senate, a bipartisan group of senators are working on their own draft legislation that could extend the subsidies for two years. President Donald Trump released a sparsely detailed healthcare policy framework Jan. 15 that calls on Congress to codify voluntary drug pricing agreements with major pharmaceutical companies, direct payments to Americans over extending ACA subsidies, and expand price transparency requirements for insurers and providers.
The insurance CEOs plan to propose several legislative actions of their own during the hearings, including patent reform to prevent pharmaceutical companies from delaying generic and biosimilar competition, site-neutral payment policies, restrictions on direct-to-consumer pharmaceutical advertising, expanded HSA flexibilities, and a fix to alleged “abuse” of the No Surprises Act’s arbitration process, where providers are winning the majority of disputes.
In their testimonies, Elevance President and CEO Gail Boudreaux and CVS President and CEO David Joyner also plan to discuss their companies recent prior authorization electronic reform and reduction efforts.
All five executives plan to emphasize that federal medical loss ratio requirements cap insurer administrative costs and profits, mandating that 80-85% of premium dollars be spent directly on medical care and quality improvement, with any excess returned to consumers. The executives testifying lead large vertically integrated companies that generate substantial revenues from care delivery- and pharmacy-focused subsidiaries not subject to MLR caps, including Optum, Evernorth, Carelon and CVS Caremark.
“In 2025, despite premium growth, insurer profit margins declined to approximately 1.8%,” Mr. Cordani wrote. “By contrast, profit margins for pharmaceutical manufacturers and medical technology companies remain significantly higher: drug companies consistently report margins between 20-40% and medical technology companies average margins near 30%.”
