Paul Markovich, president and CEO of Ascendiun, the parent company of Blue Shield of California, is not one to sugarcoat the state of the healthcare system.
“I don’t see how you can look at it and say there isn’t a fundamental problem. It’s systemic in nature,” Mr. Markovich said on the Becker’s Healthcare podcast.
Mr. Markovich was one of five health insurance CEOs who testified before House lawmakers in January over the broad topic of rising healthcare costs. The hearings lasted more than nine hours and covered industry consolidation, prior authorization and executive compensation. Most people would be nervous to be summoned before Congress in general, much less to speak to lawmakers about controversial topics — but not Mr. Markovich.
“We’re passionate about trying to transform the healthcare system. We think it’s dysfunctional and broken and bankrupting us, and we need structural, systemic change,” he said. “Frankly, we need help from the government.”
Mr. Markovich pointed to a central tension facing payers, providers and patients: The average American cannot afford the average healthcare premium without a subsidy, and the entities providing those subsidies, primarily employers and the federal government, are signaling they can no longer keep pace with the growth in costs.
Enhanced ACA premium subsidies expired at the start of 2026, employers are facing some of the steepest increases in health benefit costs in a decade, the Medicare Advantage market has undergone major upheaval over the past two years, and H.R. 1, signed into law last summer, includes deep Medicaid cuts that have yet to hit the system.
“One of the things I tell industry leaders all the time is you cannot have a sustainable business in an industry that is not sustainable, and this industry is just not sustainable,” Mr. Markovich said.
His message to the industry is blunt: Stop asking for more money.
“This is our new normal. We have to, as many other industries have, figure out how to make an impact and do better with fewer resources and be more productive. That has not been the mindset of the industry for most of my career,” he said.
“We have to get into a different mindset: How do we make healthcare affordable? We all have to be financially viable, but how do we make healthcare affordable and worthy of our family and friends? That means we have a cost problem that we need to address,” he added. “I’m hopeful that creating that kind of budgetary, top-down pressure helps create that mindset and gets us into a much more innovative phase in healthcare, one where we really are focused on how to make things better for the patient and more efficiently.”
To listen to the full conversation with Mr. Markovich about PBM reform, the company’s efforts to unbundle pharmacy benefits and keep Blue Cross Blue Shield plans competitive, plus his scathing rebuke of fax machines, you can tune in here.
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