Insurance plan CEOs pressed during joint House hearings
Last week on Jan. 22, five CEOs of the nation’s largest health insurers and pharmacy benefit managers (PBMs) appeared before the full House Ways and Means Committee and the House Energy and Commerce Health Subcommittee in separate, but coordinated, hearings. Throughout the day, the AMA used the hearings to promote its policies and research while responding to the executives’ testimony and representatives’ questions and statements through a series of posts on X.
The issue of prior authorization and delayed care was the most discussed topic. Representatives spoke about their personal experiences with prior authorization as well as those of their constituents. Ways and Means Committee member Rep. Mike Kelly (R-PA) promoted his bipartisan Improving Seniors’ Timely Access to Care Act (H.R. 3514), which was designed to operationalize a consensus statement negotiated by AMA with other providers and the health insurance industry. H.R. 3514 is strongly supported by the AMA.
Members of both committees questioned and pressed the CEOs on the use of AI in prior authorization decisions. Patients and physicians deserve transparency, accountability and real medical oversight—not algorithms making care decisions alone.
Physician members of the committees also voiced the frustration of medical professionals in their statements.
Other topics covered included the impact of consolidation and vertical integration in health care competition, implementation of the No Surprises Act, physician ownership of hospitals, ghost networks, and health care affordability.
The five witnesses for both hearings were:
Stephen Hemsley, CEO of UnitedHealth Group
David Joyner, Chairman and CEO of CVS Health
Gail Boudreaux, President and CEO of Elevance Health
David Joyner, President and CEO of the Cigna Group
Paul Markovich, President and CEO of Ascendiun
Ellen Allen, executive director, West Virginians for Affordable Health Care, was the sixth witness at the Energy and Commerce hearing. ReShonda Young, resident of Waterloo, Iowa, and owner of TnK Health and Nutrition, was the sixth witness at the Ways and Means hearing.
Room block closes today for the AMA National Advocacy Conference: Register now
The AMA National Advocacy Conference is only a few weeks away—Feb. 23-25 at the Grand Hyatt in Washington, D.C. The room block closes today, Jan. 30, so make sure to reserve your hotel room now.
Agenda
Secure your spot to bring the power of organized medicine to our nation’s capital and advocate with hundreds of your fellow physicians on crucial health care issues:
Reforming Medicare payment
Fixing prior authorization
Food is medicine
Protecting access to care in Medicaid
See the preliminary agenda (PDF) for this year’s meeting for more information.
Featured speakers
Mark Cuban, Entrepreneur and Co-Founder, Cost Plus Drugs
Sanjay Gupta, MD, Chief Medical Correspondent, CNN
Please contact [email protected] with any questions.
AMA submits comments on 2027 Medicare Advantage proposed rule
On Jan. 21, the AMA submitted a comment letter (PDF) in response to the Centers for Medicare & Medicaid Services’ (CMS) CY 2027 Medicare Advantage, Medicare Part D, and Medicare Cost Plan proposed rule. The AMA supported CMS’ goals of strengthening program oversight, modernizing utilization management, refining quality measurement, and reducing unnecessary administrative burden as Medicare Advantage (MA) enrollment continues to grow.
The AMA commented that policies governing MA must promote timely access to medically necessary care, preserve physician-led clinical decision making, and hold plans accountable for networks, coverage determinations, utilization management, and payment policies. While recognizing CMS’ recent utilization management reforms, the AMA raised concerns that prior authorization and outdated coverage policies continue to delay care and cause patient harm. These barriers remain especially pronounced in the treatment of opioid use disorder, where access to evidence-based buprenorphine treatment is still routinely restricted.
Regarding quality measurement, the AMA agreed that the MA Star Ratings program has become overly complex and would benefit from meaningful change. However, the AMA cautioned that removing certain operational measures may further shift the program away from its core purpose of helping beneficiaries compare plans based on access to care. For example, the AMA urged CMS not to remove Star Ratings measures that assess plan performance in areas such as appeals, customer service, network oversight, and accuracy of information, as these measures reflect functions within plan control and are central to beneficiary experience and access to care.
The AMA also supported CMS’ focus on marketing oversight, network adequacy, behavioral health access, and supplemental benefit design, while stressing the importance of careful implementation to avoid unintended gaps in access for beneficiaries with complex needs. Finally, the AMA advocated that CMS address persistent problems in MA like step therapy for Part B drugs, deviations from Medicare fee-for-service coverage standards, and inconsistent claims filing deadlines. CMS will review public comments and is expected to issue a final rule later in 2026.
