“Using Modern Tools to Counter Human Trafficking”

1[House Hearing, 119 Congress]2[From the U.S. Government Publishing Office]34                    LOWERING THE COST OF HEALTHCARE:5                          TECHNOLOGY'S ROLE IN6                         DRIVING AFFORDABILITY78=======================================================================910                             JOINT HEARING1112                               before the1314 SUBCOMMITTEE ON ECONOMIC GROWTH, ENERGY POLICY, AND REGULATORY AFFAIRS1516                                and the1718           SUBCOMMITTEE ON HEALTH CARE AND FINANCIAL SERVICES1920                                 of the2122              COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM2324                     U.S. HOUSE OF REPRESENTATIVES2526                    ONE HUNDRED NINETEENTH CONGRESS2728                             FIRST SESSION2930                               __________3132                           DECEMBER 10, 20253334                               __________3536                           Serial No. 119-513738                               __________3940Printed for the use of the Committee on Oversight and Government Reform4142    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]4344    Available on: govinfo.gov, oversight.house.gov or docs.house.gov4546                                   _______4748                 U.S. GOVERNMENT PUBLISHING OFFICE495062-183 PDF                   WASHINGTON : 20265152              COMMITTEE ON OVERSIGHT AND GOVERNMENT REFORM5354                    JAMES COMER, Kentucky, Chairman5556Jim Jordan, Ohio                     Robert Garcia, California, Ranking57Mike Turner, Ohio                        Minority Member58Paul Gosar, Arizona                  Eleanor Holmes Norton, District of59Virginia Foxx, North Carolina            Columbia60Glenn Grothman, Wisconsin            Stephen F. Lynch, Massachusetts61Michael Cloud, Texas                 Raja Krishnamoorthi, Illinois62Gary Palmer, Alabama                 Ro Khanna, California63Clay Higgins, Louisiana              Kweisi Mfume, Maryland64Pete Sessions, Texas                 Shontel Brown, Ohio65Andy Biggs, Arizona                  Melanie Stansbury, New Mexico66Nancy Mace, South Carolina           Maxwell Frost, Florida67Pat Fallon, Texas                    Summer Lee, Pennsylvania68Byron Donalds, Florida               Greg Casar, Texas69Scott Perry, Pennsylvania            Jasmine Crockett, Texas70William Timmons, South Carolina      Emily Randall, Washington71Tim Burchett, Tennessee              Suhas Subramanyam, Virginia72Marjorie Taylor Greene, Georgia      Yassamin Ansari, Arizona73Lauren Boebert, Colorado             Wesley Bell, Missouri74Anna Paulina Luna, Florida           Lateefah Simon, California75Nick Langworthy, New York            Dave Min, California76Eric Burlison, Missouri              Ayanna Pressley, Massachusetts77Eli Crane, Arizona                   Rashida Tlaib, Michigan78Brian Jack, Georgia                  James R. Walkinshaw, Virginia79John McGuire, Virginia80Brandon Gill, Texas8182                                 ------8384                       Mark Marin, Staff Director85                   James Rust, Deputy Staff Director86                     Ryan Giachetti, Chief Counsel87                          Jack Furla, Counsel88   Kylie Hinojosa, Professional Staff Member and Administrative Clerk89   Ellie McGowan, Professional Staff Member and Administrative Clerk90         Mallory Cogar, Director of Operations and Chief Clerk9192                      Contact Number: 202-225-50749394                Robert Edmonson, Minority Staff Director95                      Contact Number: 202-225-505196                                 ------9798                             SUBCOMMITTEES99100                              ----------101102 Subcommittee on Economic Growth, Energy Policy, and Regulatory Affairs103104                   Eric Burlison, Missouri, Chairman105106Gary Palmer, Alabama                 Maxwell Frost, Florida, Ranking107Clay Higgins, Louisiana                  Member108Byron Donalds, Florida               Yassamin Ansari, Arizona109Scott Perry, Pennsylvania            Dave Min, California110Lauren Boebert, Colorado             Ro Khanna, California111112                                 ------113114           Subcommittee on Health Care and Financial Services115116                  Glenn Grothman, Wisconsin, Chairman117118Paul Gosar, Arizona                  Raja Krishnamoorthi, Illinois,119Pete Sessions, Texas                     Ranking Member120Anna Paulina Luna, Florida           Emily Randall, Washington121John McGuire, Virginia               Wesley Bell, Missouri122Brandon Gill, Texas                  Lateefah Simon, California123124                         C  O  N  T  E  N  T  S125126                              ----------127128                           OPENING STATEMENTS129130                                                                   Page131132Hon. Eric Burlison, U.S. Representative, Chairman................     1133134Hon. Maxwell Frost, U.S. Representative, Ranking Member..........     3135136Hon. Glenn Grothman, U.S. Representative, Chairman...............     5137138Hon. Raja Krishnamoorthi, U.S. Representative, Ranking Member....     6139140                               WITNESSES141142Mr. Brian Whorley, Chief Executive Officer, Paytient143  Technologies, Inc.144Oral Statement...................................................     8145146Dr. Darius Lakdawalla, Quintiles Chair in Pharmaceutical147  Development and Regulatory Innovation and Chief Scientific148  Officer, Schaeffer Center for Health Policy and Economics,149  University of Southern California150Oral Statement...................................................     9151152Dr. Ziad Obermeyer, Blue Cross of California Distinguished153  Associate Professor, Health Policy and Management, company,154  University of California-Berkeley155Oral Statement...................................................    11156157Mr. Chris Jacobs, Founder, Juniper Research Group158Oral Statement...................................................    13159160Ms. Sophia Tripoli (Minority Witness), Senior Director of Health161  Policy, Families USA162Oral Statement...................................................    14163164Written opening statements and bios are available on the U.S.165  House of Representatives Document Repository at:166  docs.house.gov.167                           INDEX OF DOCUMENTS168169  * Article, Juniper Research Group, ``No, Obamacare Premiums are170  NOT Doubling in 2026''; submitted by Rep. Burlison.171172  * Article, Center on Budget and Policy Priorities, ``By the173  Numbers Harmful Republican Megabill''; submitted by Rep. Frost.174175  * Article, The Hill, ``Medicaid Cuts Will Harm Rural Republican176  Communities the Most''; submitted by Rep. Frost.177178  * Fact Sheet, Keep Americans Covered, ``Preserve Health Care179  Tax Credits''; submitted by Rep. Frost.180181  * Report, Commonwealth Fund, ``Expiring ACA Premium Tax Credits182  Could Lead to Nearly 340,000 Jobs Lost''; submitted by Rep.183  Frost.184185  * Article, Unleash Prosperity, ``How Much Does That MRI Cost'';186  submitted by Rep. Grothman.187188  * Article, AMA, ``Trends in Health Care Spending''; submitted189  by Rep. Grothman.190191  * Fact Sheet, CMS, ``National Health Expenditures''; submitted192  by Rep. Grothman.193194  * Article, Jaisri Lingappa, ``How WISeR Will Enable Companies195  to Profit From Pain--A Retired Physician's Story''; submitted196  by Rep. Randall.197198The documents listed above are available at: docs.house.gov.199200                    LOWERING THE COST OF HEALTHCARE:201                          TECHNOLOGY'S ROLE IN202                         DRIVING AFFORDABILITY203204                              ----------205206                      WEDNESDAY, DECEMBER 10, 2025207208                     U.S. House of Representatives209210              Committee on Oversight and Government Reform211212 Subcommittee on Economic Growth, Energy Policy, and Regulatory Affairs213214           Subcommittee on Health Care and Financial Services215216                                                   Washington, D.C.217218    The Subcommittees met, pursuant to notice, at 10:04 a.m.,219in room HVC-210, Capitol Visitor Center, Hon. Eric Burlison220[Chairman of the Subcommittee on Economic Growth, Energy221Policy, and Regulatory Affairs] presiding.222    Present: Representatives Burlison, Grothman, Higgins,223Donalds, Perry, McGuire, Gill, Comer, Frost, Krishnamoorthi,224Randall, Bell, and Simon.225    Mr. Burlison. This joint hearing of the Subcommittee on226Economic Growth, Energy Policy, and Regulatory Affairs and the227Subcommittee on Health Care and Financial Services will come to228order.229    Welcome, everybody.230    Without objection, the Chair may declare a recess at any231time.232    I recognize myself for the purpose of making an opening233statement.234235          OPENING STATEMENT OF CHAIRMAN ERIC BURLISON236237                  REPRESENTATIVE FROM MISSOURI238239    Welcome to this joint hearing of the Subcommittee on240Economic Growth, Energy Policy, and Regulatory Affairs and the241Subcommittee on Health Care and Financial Services. Today, we242are here to explore how innovative technology in the healthcare243sector can help lower Americans' healthcare costs.244    Healthcare costs in the United States have long been on the245rise, but recent Democrat policies and the radical Biden246Administration's regulatory agenda have made healthcare costs247in America even worse.248    The Inflation Reduction Act, or the IRA, signed into law by249the Biden Administration in 2022, was passed under the guise of250lowering healthcare costs for working Americans.251    These two Subcommittees recently held a joint hearing on252the ballooning costs and the market-distorting policies253included in the IRA. Today, we have another opportunity to take254a hard look at the consequences of policies that not only255failed to accomplish their intended goals but place an undue256regulatory burden on Americans.257    Business owners in our country put their livelihoods on the258line to develop breakthrough technologies to reinvent the259healthcare industry but are forced constantly to navigate the260regulatory obstacles put in place by Democrat administrations.261    The money spent on legal fees and administrative procedures262could be reinvested to further improve technologies that263doctors and other medical providers can use to improve patient264experiences, save lives, and bring families together.265    Congress must give private sector innovators the space and266the resources that they need to develop these technologies.267    We have already begun to see the tremendous capabilities of268artificial intelligence to help lower costs in our everyday269lives. If that power were harnessed in the healthcare sector,270resources could be more effectively deployed to help patients271get better.272    In addition, lower costs would save the Federal Government273and the taxpayers a lot of money in any of our Federal274healthcare programs.275    For example, patients can use wearable technology to276monitor their health. These devices assist doctors and277researchers with realistic data on their patients day to day in278real time.279    3D printing can create personalized medical devices for280individual patients. Investment in this printing technology has281led to the development of customized prosthetics, implants, and282surgical tools.283    Telehealth improves the efficiency of healthcare by284allowing medical providers to serve patients in a live virtual285call. Telehealth saves time and helps patients connect to their286doctors, especially in rural areas where there are few medical287facilities.288    These kinds of technologies are revolutionary, but if289innovators cannot afford to develop more of them because of the290expensive barriers put in place by the previous administration291and the Inflation Reduction Act, the American people will miss292out on cutting-edge medical care that could improve patient293outcomes.294    Earlier this year, President Trump signed the One Big295Beautiful Bill into law. That bill gives over $50 billion to296rural hospitals to ensure their continued operation and297development of medical technology.298    Since entering office, President Trump has taken decisive299action aimed at reversing innovation-stifling Biden-era300policies in artificial intelligence, promoting transparent drug301pricing, and eliminating the ``Biden Pill Penalty.''302    Our expert panel of witnesses, including a fellow303Missourian and a medical technology business owner, will304provide testimony on this important issue.305    I thank all of the witnesses for being here today, and I306look forward to our discussion.307    And with that, I yield to Ranking Member Frost for his308opening statement.309310               OPENING STATEMENT OF MAXWELL FROST311312                  REPRESENTATIVE FROM FLORIDA313314    Mr. Frost. Thank you, Chairman Burlison and Chairman315Grothman, and thank you to the witnesses for being here this316afternoon.317    I have got to be honest, I was a little shocked to see this318hearing called on healthcare affordability this week as we319continue to see congressional Republicans block extension of320the tax credits that will help people obtain affordable321healthcare.322    We, as in this moment, are in a crisis. In just five weeks,323the Affordable Care Act, ACA, enrollment period ends, and324189,000 people in my district alone will be paying anywhere325between 50 and 300 percent more in premiums, and many will opt326out of coverage altogether.327    So, we can hold a hearing about whether technology for new328software and medical tools can decrease costs. It is very329interesting. I would appreciate that conversation and support330innovation in the way that we deliver healthcare.331    But to hold this hearing now while ignoring the massive332upcoming cliff in front of us right now is, quite frankly, an333insult to the 25 million Americans that will see their334healthcare costs go up if Congress does not do its job.335    Healthcare costs are going to skyrocket for American336families if people cannot afford their premiums, and using337technology to make certain procedures or processes slightly338more efficient will not change that.339    We cannot allow the costs of treating cancer, diabetes,340heart disease, and any other condition to people we know and341people we love that are battling every day to bankrupt342hardworking Americans.343    I cannot imagine trying to convince my constituents who are344about to be paying an additional $2,000 a month in healthcare345premiums that giving money to tech companies will knock off a346few dollars here and there and that it is the best their347leaders can do for them.348    It is not just my district. Millions of people across the349country are unsure whether they can afford healthcare coverage350as premiums and deductibles rise.351    One in four Americans who currently rely on the Affordable352Care Act for health insurance are at risk of losing coverage if353congressional Republicans succeed in letting these tax credits354expire.355    Most Americans who are enrolled in the Affordable Care Act356will see their healthcare insurance premiums increase anywhere357from 50 to 300 percent. And at the same time, congressional358Republicans have taken a sledgehammer to our healthcare system359and set us on a path to undo all the gains that made healthcare360more affordable under Democratic leadership.361    President Trump's One Big Beautiful Bill Act takes362healthcare coverage away from a whopping 15 million Americans.363The single biggest legislative achievement of congressional364Republicans and President Trump this year has been to rip365Medicaid away from almost eight million people by 2034.366Congressional Republicans and Donald Trump, seems like, do not367care whether or not you can afford your healthcare or medical368care, and we have got to be clear this issue is fixable.369    The healthcare crisis that congressional Republicans and370Donald Trump have created have real and devastating371consequences for Americans. Patients will go without the372preventative and primary care that they need. One in three373young Americans are at risk of losing their health insurance in374the next few years.375    The number of Americans without health insurance coverage376in every state and every congressional district will rise. And377thanks to the work of Donald Trump and congressional378Republicans' new draconian work requirements for Medicaid379eligibility, 2.1 million American women may no longer have380health insurance when they are pregnant or caring for young381children.382    And many people, like my Governor, Ron DeSantis, come out383and say that young people, quite frankly, might not need health384insurance if they are under the age of 40.385    People who get health insurance through Medicaid or the386Affordable Care Act marketplaces are the same hardworking387Americans that we live and work with every single day. The388Affordable Care Act premium tax credits allow farmers,389ranchers, and small business owners to stay self-employed,390invest in their businesses, and employ others. All these things391strengthen our communities and economy.392    Let us not forget that 77 percent of the Affordable Care393Act Marketplace enrollees live in states that President Trump394won in 2024. How quickly has he abandoned them. congressional395Democrats are fighting to make healthcare more affordable. We396are fighting to lower prescription drug prices, and we are397fighting to make sure that all Americans have access to quality398healthcare.399    We know we have a broken healthcare system. There is a lot400I personally want to talk about as it relates to this401healthcare system. I personally believe in single payer.402    But the fact of the matter is right in front of us we have403a cliff that we are barreling toward, and if we do not do our404job, this whole topic of affordability, I mean, it is something405that 25 million Americans are facing as we speak.406    As we learn about innovations in healthcare technology407today, it is important that my congressional Republican408colleagues face the reality that healthcare innovation is not a409substitute for affordable healthcare coverage, and it is not410enough to reduce cost on its own. Innovation cannot reverse the411damage Donald Trump and congressional Republicans have done412with their devastating healthcare cuts.413    I urge all of us to keep everyday working families in mind414that are struggling to afford healthcare. Let us ensure that we415pass these premium tax credits. Let us ensure that we do not416hike healthcare costs for 25 million Americans from anywhere417from 50 to 300 percent. And then let us get together and figure418out what we can do in terms of innovation to bring down costs419for all Americans.420    Thank you, and I yield back.421    Mr. Burlison. I now recognize Chairman Grothman for the422purpose of making an opening statement.423424          OPENING STATEMENT OF CHAIRMAN GLENN GROTHMAN425426                 REPRESENTATIVE FROM WISCONSIN427428    Mr. Grothman. Yes, thanks. Just to respond to that a little429bit.430    I think it is becoming more and more over time apparent431that the major beneficiary of Obamacare, or the ACA, are the432insurance companies. And we are at a cliff here where we are433going to find out--where we find out what happens when we let434the insurance companies write such a plan.435    We are at a point in which we have got to spend $34 billion436a year or more to prop up a failed plan or come up with some437sort of alternative.438    So, welcome to this joint hearing of the Subcommittee on439Economic Growth, Energy Policy, and Regulatory Affairs and the440Subcommittee on Health Care and Financial Services. This is an441exciting opportunity for us to address one of the most pressing442issues for Americans: the continued rising cost of healthcare.443    Healthcare costs have been steadily increasing since 1970.444The total healthcare spending in the United States was just shy445of $5 trillion a year. That is $14,500 per person. That is446almost 18 percent of GDP. In 1970, healthcare spending447accounted for only seven percent. So, it has increased by 150448percent over the last 50 years.449    The United States spends twice as much per person on450healthcare as other peer nations. I do not have statistics on451how much our insurance companies make compared to other452nations.453    It makes sense that the overall healthcare costs have454increased in the past 50 years. Our country's population has455grown from 200 million to 350 million.456    The problem is not that we are not spending money on457healthcare. The problem is that the money that we are spending458is being wasted and does not improve patient health.459    Recent studies show that nearly one-third of healthcare460spending in the United States is wasteful because it does not461lead to better patient outcomes. In 2023, that would mean $1.6462trillion spent on healthcare was wasted.463    To put $1.6 trillion in perspective, the Federal Government464spent that same amount on total health insurance in 2024,465including Medicare, Medicaid, Children's Health Insurance466Program (CHIP)s, and the Affordable Care Act marketplace467subsidies.468    More than half of this wasteful spending can be directly469attributed to administrative expenses. That is why when you go470into a hospital or a clinic you see a huge number of people471working there who really have nothing directly to do with472healthcare.473    Over the past several decades the growth in administrative474staff has far outpaced the growth in doctors and nurses.475Hospitals, insurance companies, and health systems now employ476layers of administrators focusing on billing, compliance,477reporting, coding, and navigating complex regulations rather478than delivering care.479    In many hospitals today there are multiple administrative480employees for every practicing physician. These costs are481passed directly to patients through higher prices, higher482premiums, and reduced access to care.483    At the same time, patients are left completely in the dark484about prices. Someone scheduling a routine procedure frequently485has no idea what it will cost or how prices compare across486hospitals, clinics, or providers.487    In almost no other sector of our economy do consumers face488this level of price secretiveness.489    Just imagine how much different our entire healthcare490system would be if more dollars were directed toward patient491care and less toward administration.492    This is where technology has the potential to make a real493difference, which is why we felt it was timely to bring in494experts in technology in the healthcare sector and see what495they had to say.496    Empowering patients with price transparency can drive497competition, lower costs, and improve access to affordable498care.499    Today's expert panel of witnesses will provide their500perspective on how the current healthcare system costs too501much, the leading cause of those rising costs, and how502innovative technology in the healthcare sector will make503healthcare more affordable. We look forward to this testimony.504    And with that, I yield to Ranking Member Krishnamoorthi for505his opening statement.506507            OPENING STATEMENT OF RAJA KRISHNAMOORTHI508509                  REPRESENTATIVE FROM ILLINOIS510511    Mr. Krishnamoorthi. Thank you, Chair Grothman.512    Thank you, Chair Burlison, Ranking Member Frost.513    I associate myself with the comments of Ranking Member514Frost, and I just want to point a few things out.515    If we do not extend these tax credits that are going to516expire at the end of the year, in Illinois alone half a million517people who receive these tax credits will see, on average,518their premiums go from $260 a month to $464 a month, almost an51980 percent increase.520    Looking closer at these numbers, those living in urban521areas will see an almost 90 percent increase in premiums;522whereas, people in rural areas would see premiums rise by a523stunning 107 percent on average. So, doubling their premiums.524    Let us be clear. People will not stop needing medical care.525Safety net and rural hospitals will pay the price. Patients526will still show up in emergency rooms but only after manageable527conditions have become catastrophic, driving the cost of care528through the roof for everyone no matter their insurance status.529    Listen, this is not theoretical. In safety net hospitals530across Illinois, frontline providers have warned me directly:531The Republicans' Big Beautiful Bill--or what I call the Large532Lousy Law--includes Medicaid and ACA cuts that will drive up533costs, slash essential services, and put struggling communities534into healthcare deserts.535    At Loretto Hospital in the Austin neighborhood of Chicago,53683 percent of patients rely on Medicaid. In the face of537Republican cuts, hospital officials told me they may have to538close programs to ensure they do not have to fully shutter the539hospital.540    In Benton, Illinois, which is in southern Illinois, I541visited Franklin Hospital where a fifth of the hospital's542budget comes from Medicaid reimbursements. Republican Medicaid543cuts will require them to provide care ``on a smaller scale''544so they can continue serving their rural community.545    On top of that, leadership at Franklin Hospital told me546that if the Medicaid cuts are significant enough, they would547have to reduce staffing and reevaluate the services they can548provide, and this will affect the entire rural economy.549    Republican healthcare cuts are going to close essential550hospitals, and this is a map of 11 hospitals in Illinois that551are set to shutter.552    It is going to hurt everyone because it does not matter553what healthcare status you belong to, health insurance status554you belong to, if you use any of these hospitals and if they555close, you will be negatively impacted.556    And so, that is why we need to be concerned about this557expiration of tax credits at the end of the year, but also the558implementation of the Large Lousy Law, because it will lead to559a crisis in healthcare that is eminently preventable today.560    If we can just marshal our energies and collective561resources, we can pass an extension of the ACA tax credits and562prevent what would otherwise be a catastrophic situation for563millions of Americans.564    Thank you, and I yield back.565    Mr. Burlison. Thank you, Chairman Grothman, Ranking Member566Frost, and Ranking Member Krishnamoorthi.567    I am pleased to welcome our expert panel of witnesses.568    First, we have Brian Whorley, who is the Chief Executive569Officer of Paytient Technologies, Inc.570    Next to him, we have Dr. Darius Lakdawalla, Quintiles Chair571in Pharmaceutical Development and Regulatory Innovation and572Chief Scientific Officer, Schaeffer Center for Health Policy573and Economics at the University of Southern California.574    Next, we have Dr. Ziad Obermeyer, who is with Blue Cross of575California, Distinguished Associate Professor, Health Policy576and Management, at the University of California-Berkeley.577    And next we have Mr. Chris Jacobs, who is the Founder of578the Juniper Research Group.579    And finally, we have Ms. Sophia Tripoli, Senior Director of580Health Policy at Families USA.581    Thank you to each and every one of you for being here582today. I am looking forward to your testimony.583    Pursuant to Committee Rule 9(g), the witnesses will please584stand and raise their right hand.585    Do you solemnly swear or affirm that the testimony that you586are about to give is the truth, the whole truth, and nothing587but the truth, so help you God?588    Let the record show that the witnesses answered in the589affirmative.590    Thank you, and you may take your seats.591    We appreciate you being here.592    And let me remind the witnesses that we have read your593written statements, and they will appear in full in the hearing594record. So, please limit your comments to 5 minutes.595    The light system is pretty self-evident. Green is go,596yellow is wrap it up, and red is stop.597    I now recognize Brian Whorley for his opening statement.598599                 STATEMENT OF MR. BRIAN WHORLEY600601      CHIEF EXECUTIVE OFFICER, PAYTIENT TECHNOLOGIES, INC.602603    Mr. Whorley. Thank you. My name is Brian Whorley. I am the604CEO and founder of Paytient.605    I founded Paytient because I believe the most powerful way606to remake the healthcare market and lower the prices we pay is607by increasing and returning purchasing power to the one608stakeholder in the system most sensitive to and capable of609discerning value, and that is the patient.610    Our goal is to improve the ability of employers and611patients to simply purchase and pay for care. Ideally, paying612not just transparent but transactable cash prices directly to613providers whenever possible. We do that with help from pioneers614like HealthEquity and Mark Cuban Cost Plus Drugs today.615    Today, we serve 6,000 employers who want the capital616efficiency of lower-cost health plans while ensuring that the61796 percent of their employees who never reach their out-of-618pocket maximum have an easier way to pay for care.619    We do not do this work alone. We are grateful for partners620such as Elevance, Blue Cross Blue Shield of Arkansas, Cigna,621Centene, Gravie, Sidecar Health, Humana, and many others who622have been investing with us for years to improve the623affordability of the out-of-pocket experience for ACA,624governmental, and employer health plan members and providers.625    I am proud to say that Paytient also provides the software626that powers the Medicare Prescription Payment Plan for nearly62722 million Medicaid beneficiaries.628    The Medicare Prescription Payment Plan is a bipartisan629healthcare payment innovation that gives 54 million seniors the630option for their insurer to pay their out-of-pocket costs up631front at the pharmacy counter.632    Seniors receive a statement at month's end to review for633accuracy and then pay in full, like most do, or simply smooth634their payment plan over the plan year to better fit their635household budget.636    This innovation gives 54 million American seniors financial637security and the ability to personalize payment in a way that638works for their budget. It is a pragmatic approach to make639healthcare more accessible and affordable and recognizes the640ability to pay a $600 out-of-pocket expense is not the same for641every senior.642    Importantly, this concept of cost smoothing, it improves643affordability without removing responsibility.644    This bipartisan idea is catalyzing change in the employer645insurance market where brokers, employers, and insurers are646realizing that health plans that include cost smoothing create647the ability to have lower-cost health plans coupled with better648financial experiences for patients and providers.649    The market is moving toward these hybrid healthcare plans650that have the efficiency of simply paying cash in full or over651time for low-cost routine care, coupled with the security and652peace of mind of insurance coverage and payment rails for rare653care.654    Please consider four suggestions to expand the use of this655existing in-market technology to immediately improve healthcare656affordability.657    One, ensure seniors are automatically protected from658unaffordable out-of-pocket costs by auto-enrolling them in the659Medicare Prescription Payment Plan.660    Every insurer in the country has successfully launched and661operationalized M3P. Seniors like the financial protection,662convenience, and ability to review their monthly statements for663accuracy before they send in a check and pay for care. Plans664can and should automatically enroll seniors in 2027 in M3P665instead of laboriously requiring sick seniors to call, opt in,666and potentially delay care.667    Two, encourage insurers to expand payments to include668medical costs. Why should seniors only be able to smooth their669pharmacy claims over time? Why not their larger, more costly,670and unpredictable medical expenses?671    Second, expand payment smoothing into ACA and employer672plans, providing real relief to 180 million people today. To673help this innovation, uncompensated care from payment smoothing674should be clearly characterized as the equivalent to a medical675loss encountered below the line.676    Three, allow seniors to access the benefit in real time.677Seniors should be able to opt in in real time when they need678help the most, when they are standing in a moment of679uncertainty at a pharmacy counter, instead of waiting 24 hours680and making a return trip to the pharmacy--or not.681    The technology exists to allow seniors to opt in in real682time or near time, allowing them to simply get their meds when683they need to.684    And last, return the economic power to the people by685allowing employees to receive and control more of their own686healthcare dollars. Give employers and employees the voluntary687option to receive the full cash value of what their employer688would have spent on their health plan into a Health Savings689Account (HSA) or a Roth version of an HSA that they could use690to invest in their health, purchase insurance, or simply and691directly pay transparent, transactable cash prices directly to692providers.693    Thank you for the opportunity to share my testimony.694    Mr. Burlison. Thank you, Mr. Whorley.695    I now recognize Dr. Lakdawalla for his opening statement.696697               STATEMENT OF DR. DARIUS LAKDAWALLA698699         QUINTILES CHAIR IN PHARMACEUTICAL DEVELOPMENT700701         AND REGULATORY INNOVATION AND CHIEF SCIENTIFIC702703          OFFICER, SCHAEFFER CENTER FOR HEALTH POLICY704705        AND ECONOMICS, UNIVERSITY OF SOUTHERN CALIFORNIA706707    Dr. Lakdawalla. Chairman Burlison, Chairman Grothman,708Ranking Member Frost, Ranking Member Krishnamoorthi, and709honorable Members of the Subcommittees, thank you for the710opportunity to testify today about accelerating medical711innovation through regulatory reform. The opinions I offer712today are my own and do not represent the views of USC or the713Schaeffer Center.714    In 1965, the world's first beta-blocker drug, propranolol,715was readily available to patients in Europe. Unfortunately,716American patients would have to wait 11 years to fully benefit717from this revolutionary treatment for cardiovascular disease.718    We now know that delay was deadly. Clinical trials show719propranolol reduced stroke risk by 25 percent and cut heart720attack mortality by nearly 30 percent.721    Later, USC Schaeffer research discovered this delay hurt722the least-educated households the most because they lacked the723means for the complex diet and exercise regimens that serve as724the key alternative treatment option.725    Propranolol was not an isolated case. From 1972 to 1987,726new drugs were twice as likely to launch overseas first.727    Then, in response to growing calls for timelier approvals728driven by the AIDS crisis, the FDA pioneered a series of729reforms, including the fast-track approval of HIV drug AZT in7301987.731    Thanks to these and other forward-thinking regulatory732reforms, America is now the preferred launch market for733breakthrough medicines.734    What is needed today is the next generation of forward-735thinking regulatory reforms that would encourage critical736innovation and improve the health of American patients.737    First, Medicare's Coverage With Evidence Development738program needs urgent reform. Despite its name, CED limits both739coverage and evidence development.740    USC Schaeffer analysis reveals how it creates stark741disparities. CED-qualified hospitals are half as likely to742treat patients that reside in rural areas. Similarly, they743treat fewer low-income, subsidy-enrolled patients and fewer744patients residing in socioeconomically disadvantaged745neighborhoods.746    Not only do these kinds of constraints reduce equitable747access, but they also undermine a key goal of CED: to generate748evidence on a nationally representative sample of clinically749eligible patients.750    Several steps could move CED in the right direction:751developing a clear definition of Centers for Medicare &752Medicaid Services (CMS)' ``reasonable and necessary'' standard,753limiting coverage constraints only to those circumstances where754clinical risks matter to patients, and providing transparent755milestones that would end CED restrictions.756    Second, the current approach to Medicare Advantage risk757adjustment weakens or sometimes even eliminates incentives for758long-term prevention.759    For instance, academic research shows that including760pneumonia in risk adjustment coincided with reductions in the761influenza vaccinations that help prevent pneumonia. That is762because risk adjustment insulates insurers from the cost of763long-term illness and eliminates their financial rewards from764preventing such illness.765    On the provider side, alternative payment models also766encourage short-term thinking by limiting shared savings from767prevention to just 12-month horizons.768    Treatment and prevention of obesity is a good example of769long-term thinking. Our research proves investing in obesity770treatments for the Medicare population generates at least a 13771percent annual rate of return--greater than the stock market.772    This recent Medicare coverage expansion for obesity773treatments can help unlock this value, especially if coupled774with a framework that encourages broader preventive775investments.776    As USC Schaeffer research has suggested, CMS could allow777multiyear enrollment in MA plans with premiums fixed over the778enrollment period and set to reflect average growth in cost.779    Lengthening the payback period would align insurers'780incentives with the health of beneficiaries, especially because781beneficiaries tend to stay with the same MA plan for about six782years.783    Third, we must tackle healthcare's pricing opacity. USC784Schaeffer research demonstrates that opaque pricing systems785profit from complexity.786    Imagine grocery shopping where price tags are removed, and787you receive one aggregated bill at checkout. You would have no788idea if milk costs $5 or $50. That is American healthcare789today.790    The economic logic is clear: when buyers cannot see prices,791sellers exploit that blindness.792    In healthcare, aggregated payments and complex billing hide793true costs. This is not just inefficient. It is a transfer of794wealth from American families to healthcare intermediaries who795profit from confusion.796    American patients deserve a healthcare system that delivers797breakthrough innovations efficiently, equitably, and798transparently. These reforms can deliver that system but only799if we act decisively.800    Thank you.801    Mr. Burlison. Thank you.802    I now recognize Dr. Obermeyer for his opening statement.803804                STATEMENT OF DR. ZIAD OBERMEYER805806             BLUE CROSS OF CALIFORNIA DISTINGUISHED807808             ASSOCIATE PROFESSOR, HEALTH POLICY AND809810         MANAGEMENT, UNIVERSITY OF CALIFORNIA-BERKELEY811812    Dr. Obermeyer. Thank you for this invitation to testify. I813am a physician and a researcher at Berkeley where my focus is814on artificial intelligence applied to health. I am also the815Cofounder of a company called Dandelion and a nonprofit called816Nightingale Open Science, both of which are dedicated to817accelerating the development of health AI.818    Every time a new technology comes around somebody says this819time is different, but when it comes to healthcare costs, new820technology always seems to increase them. That is because the821technology is expensive, but also because the more choices we822have of technology, the harder it is to make good decisions,823and that leads to waste and poor quality.824    So, I am going to tell you that artificial intelligence is825different, and you should be suspicious, but let me try to826convince you.827    The reason is because AI is a tool for making better828decisions, and that is how it can give us a rare two-for-one829opportunity to reduce the cost of care and improve the quality830at the same time.831    Let me give you an example. Every year 300,000 Americans832drop dead suddenly because of cardiac arrhythmias. As an833emergency doctor, I have seen too many of those patients, and I834would guess some of you in this room also know somebody.835    What makes these deaths so tragic is that we have a cure. A836defibrillator implanted into the heart could save those lives,837but doctors have trouble deciding which patients should get a838defibrillator, and that means a lot of people die without a839defibrillator.840    But it means something else, too. Two-thirds of the841defibrillators that doctors actually put in never fire, never842deliver a lifesaving shock, because the patients we thought843were at high risk are not at high risk and never go on to844develop those arrhythmias. That is a $50,000 procedure with845real risks, but in this case zero benefit.846    My colleagues and I have built an AI system to help solve847that problem. It looks at a patient's electrocardiogram and848estimates their risk of sudden cardiac death, and our early849testing shows it does so far more accurately than what doctors850are currently using to decide.851    We are already starting to test that system, working with852an incredible team at Providence St. Patrick Hospital in853Missoula, Montana, and rural hospitals around there to get854defibrillators to people who need them and spare the hearts and855the pocketbooks of those who do not.856    If saving lives and cutting wasteful spending sounds good857to you, there are a few ways that the Federal Government can858help.859    First, data access.860    When I started this work, it was so difficult to get the861data that we needed here in the United States that I ended up862doing this research in Sweden. That process took ten years, but863it was still faster than doing it here despite European data864regulations.865    That is a real problem for patients who do not know that866they are at high risk and a problem if we want the United867States to lead in health AI.868    The major culprit here is the many layers of permissions869and approvals required to touch health data. Most of that870burdensome paperwork does not actually keep patients or their871data safe, and it also opens the door to ideological bias. The872paperwork is used to decide which questions get asked and which873do not, instead of assuring that any question can be asked in a874safe and ethical way.875    Concretely, Federal agencies that hold health data should876set clear targets for delivering it. Health and Human Services877(HHS) should also green-light modern technical tools for rapid878de-identification of AI-ready data, like images and notes, and879ONC should prevent vendors from locking up those data with fees880and delays.881    None of this means compromising privacy or safety. In fact,882just the opposite. Adopting modern data management methods can883increase speed and access while improving safeguards.884    Second, FDA evaluation.885    Today we regulate artificial intelligence under statutes886written in 1938, which treat it as a medical device, but AI is887quite different from a thermometer.888    AI makes predictions about measurable outcomes, and that889gives us a simple and rigorous way to evaluate it: does AI890predict what it is supposed to predict in populations that look891like all of America?892    The FDA should put that question at the center of its893approach to AI and build or partner on data infrastructure for894a rigorous, independent evaluation. That transparency is895essential for rapid progress and for catching problems like896algorithmic racial bias, as I have shown in my prior work.897    Third, CMS should pay for AI that does good.898    The private sector is currently underinvesting in AI tools899because of deep uncertainty about what payers will pay. CMS has900the power to shape that, and the new Advancing Chronic Care901with Effective, Scalable Solutions (ACCESS) model is a902promising new step in that direction, but CMS should go further903by creating payment codes for AI tools that are shown to904improve outcomes, reduce cost, and detect fraud and abuse.905    As my 5 minutes draw to a close, three Americans have906experienced sudden cardiac death since I started to speak. They907might still be alive if my data access had taken nine years908instead of ten. Speed is important for patients. It is also909important for the fiscal health of the United States--and it is910important because we are in a race.911    We have a head start in that race with great data, world912class universities, and purchasing power, and if we make it913easier to use data, regulate well, and pay for high-value914tools, we can reduce cost, save lives, and secure American915leadership in AI.916    Mr. Burlison. On the dot, Dr. Obermeyer.917    I now recognize Mr. Jacobs for his opening statement.918919                 STATEMENT OF MR. CHRIS JACOBS920921                FOUNDER, JUNIPER RESEARCH GROUP922923    Mr. Jacobs. Thank you, Chairmen Burlison and Grothman,924Ranking Members Frost and Krishnamoorthi, and Members of the925Subcommittee.926    Good morning. Thank you for inviting me to testify. My927entire written statement is before you, so I will not repeat928it, but instead make three main points regarding healthcare929costs and insurance coverage.930    First, Obamacare has not met its stated objectives. The law931singularly failed to achieve candidate Obama's 2008 promise932that his healthcare plan would, ``bring premiums down by $2,500933for the typical family.''934    Individual health insurance premiums more than doubled in935the law's first four years of full implementation and continue936to rise faster than premiums for employer-sponsored coverage.937Meanwhile, the law encourages insurers to avoid the sickest938patients, often harming those it most intended to help.939    Second, despite what some may believe, there is a940surprising amount of bipartisan consensus about the law's941failure to control healthcare costs.942    Two years ago, Senator Elizabeth Warren coauthored a letter943noting that Obamacare's medical loss ratio provisions have944encouraged insurance companies to acquire other businesses,945like pharmaceutical benefit managers, and to overcharge946patients through PBMs to shift profits from their insurance947business, where Obamacare caps their profits, to pharmacies and948other businesses without such restrictions.949    Indeed, healthcare has only become more consolidated since950Obamacare's passage with hospitals and health insurers buying951up physician practices--and each other--to gain additional952market clout.953    Provisions like the medical loss ratio (MLR) have led954progressives to write analyses discussing, ``How Obamacare955Created Big Medicine.''956    A separate academic study concluded that the 340B957prescription drug discount program, which Obamacare greatly958expanded, raised exchange benchmark premiums by 1.8 percent in9592024, resulting in $2.2 billion in additional Federal spending960on insurance subsidies.961    Third, as to the enhanced premium subsidies expiring on962December 31, this Republican Congress should follow the example963Democrats set regarding the child tax credit in 2021 and allow964this temporary COVID-era policy to expire.965    The myriad studies regarding fraud on the exchanges,966including last week's Government Accountability Office report,967demonstrate why Washington should not spend 350 billion968taxpayer dollars, plus interest, to mask flaws in a law that969has made healthcare less affordable.970    Thus far, during open enrollment, 400,000 more people have971signed up for exchange plans than did so at the same time last972year, notwithstanding the impending expiration of the enhanced973subsidies.974    These preliminary data suggest that the worst-case scenario975cited by enhanced subsidy supporters have not come to pass,976reinforcing why Congress should let them expire.977    Instead, lawmakers should pursue alternative policies that978will enhance insurance portability, realign incentives, and979promote price and quality transparency.980    Thank you very much for the opportunity to testify, and I981look forward to your questions.982    Mr. Burlison. Thank you, Mr. Jacobs.983    I now recognize Ms. Tripoli for her opening statement.984985       STATEMENT OF MS. SOPHIA TRIPOLI (MINORITY WITNESS)986987         SENIOR DIRECTOR OF HEALTH POLICY, FAMILIES USA988989    Ms. Tripoli. Chairs Comer, Grothman, and Burlison, Ranking990Members Garcia, Frost, and Krishnamoorthi, and Members of the991Committee, thank you for the opportunity to testify today.992    On behalf of Families USA, a leading national nonpartisan993voice for healthcare consumers, I want to thank you for this994critical discussion.995    The United States is in a full-on healthcare affordability996crisis, and our Nation's families are breaking under the weight997of it.998    We all see it. Parents who cannot afford the treatment999their kids were prescribed. Families delaying care because1000their deductibles wipe out their savings. Workers who1001technically have insurance but cannot actually afford to use1002it. Employers who want to offer good insurance but are being1003crushed by rising premiums. And Federal and State lawmakers in1004gridlock over how to balance budgets and which services to1005prioritize.1006    Today's focus on technology is important given the rapid1007advancements in technology over the last century, which has1008revolutionized healthcare delivery on everything from reducing1009medical errors to strengthening diagnostics and treatment1010protocols to streamlining eligibility and enrollment1011determinations for coverage.1012    But it is important to note that while technology is a1013critical tool that can drive innovation and increase efficiency1014with appropriate patient protections in place, it is not a1015replacement for comprehensive, affordable health insurance.1016    People without insurance are in no position to benefit from1017healthcare technology, and technology itself does not address1018the core drivers of unaffordable care.1019    The trajectory of healthcare costs in this country is1020unsustainable for consumers, for the public sector, and for the1021private sector alike. But this is not caused by people using1022too much care or because immigrant families need healthcare.1023    Our affordability crisis is caused by corporate health1024systems, whether it is big insurance giants, drug companies, or1025corporate hospital chains charging excessive prices that have1026absolutely no relationship to healthcare quality or outcomes1027and with no accountability from lawmakers.1028    These excessive prices generate record profits for these1029corporate health systems all on the backs of the millions of1030Americans who cannot afford to buy groceries or pay rent1031because of rising healthcare costs.1032    But instead of taking on the corporate price gouging at the1033core of our Nation's affordability crisis, this Congress cut a1034trillion dollars from the very programs built to provide a1035safety net and ensure access to affordable care and has so far1036failed to extend the enhanced premium tax credits that keep1037coverage affordable for 22 million Americans.1038    Poll after poll confirms that heading into 2026, voters1039want lawmakers to address healthcare costs above all other1040priorities--jobs and unemployment, immigration, crime, and the1041budget deficit. Ninety-one percent of the American people, from1042conservative Republicans to progressive Democrats, are begging1043this Congress and the President to lower their healthcare1044costs, not strip away their only lifelines to more affordable1045coverage.1046    Voters want Congress to rein in the corporate profiteering1047making healthcare unaffordable, and your decisions have real-1048life consequences for everyday Americans.1049    For people like Tony Gonzales in Pennsylvania who is1050fighting cancer and can only afford the treatment keeping him1051alive because of premium tax credits.1052    And Brick Williams, a small business owner in Utah who1053needs regular infusions to stay alive, costing $150,000 a year1054without insurance. Enhanced premium tax credits are the only1055reason he can afford his lifesaving care.1056    And Cassandra Nelson in rural Georgia who cares for her1057daughter with Type 1 diabetes and seizures and has been crushed1058by the weight of medical debt and the dread of wondering1059whether she can afford the care her child needs.1060    These families and millions more across the country are1061doing everything right and playing by the rules, yet stand to1062lose everything in a system that is rigged against ordinary1063Americans and built to fuel corporate greed.1064    As challenging as this moment appears in our Nation's1065history, there is good news. We already know the solutions that1066will lower healthcare costs and hold corporate health systems1067accountable for charging the excessive prices driving our1068Nation's healthcare affordability crisis.1069    The solutions are to immediately pass a clean extension of1070the enhanced premium tax credits; to enact site-neutral1071payments to stop big hospital systems from charging Medicare1072more for the same procedure if it is performed at a hospital1073instead of a doctor's office; to allow Medicare to negotiate1074prices on more drugs and closing legal loopholes that allow1075drug companies to block lower-cost drugs from coming into the1076market; to stop Medicare Advantage companies from exaggerating1077patients' health risks just to get paid more; and to scrutinize1078the growth of private equity and the monopoly power of big1079corporate healthcare chains that drive up healthcare prices for1080all of us.1081    These policy solutions are wildly popular and garner almost1082no opposition from voters across political parties. The1083American people are fed up with the broken healthcare system,1084and they are frustrated with politicians who choose to play1085politics with their health and financial security instead of1086delivering meaningful reforms.1087    We appreciate today's discussion on technology and its role1088in potentially reducing cost and the opportunity to draw1089attention to the healthcare affordability crisis.1090    Congress has the power to advance policies that will lower1091healthcare costs and hold corporate health systems accountable1092for our Nation's affordability crisis. We urge you to take1093action.1094    I thank the Committee for your time, and I look forward to1095answering your questions.1096    Mr. Burlison. I am very thankful for the opportunity to co-1097chair this Subcommittee hearing along with my colleague,1098Chairman Grothman, and I want to thank again the witnesses for1099being here today on this important issue.1100    Unnecessary government regulation is an obstacle to1101developing innovation in healthcare technology. This is1102technology that will not only--I am sorry. I am supposed to1103recognize myself for 5 minutes. I am yielding to myself for 51104minutes.1105    Unnecessary government regulation is an obstacle to1106developing innovation in healthcare technology, something that1107I worked in for almost 22 years. This is technology that will,1108if left alone, lower costs but improve patient outcomes and1109save lives.1110    But bureaucrats often step in the way, just like the Biden1111Administration did when they attempted to force a one-size-1112fits-all approach to the healthcare sector while failing to1113consider what is happening at the local level.1114    While I served in the Missouri Legislature, I introduced a1115plan that was called the Health Care Compact, trying to wrestle1116that one-size-fits-all authority back to the states. And I am1117pleased today that I have another fellow Missourian who is1118thinking outside of the box, Mr. Whorley, on how to address the1119healthcare costs for patients.1120    Mr. Whorley, what have you found to be the greatest1121obstacle in your business to develop this new kind of way in1122which people can pay?1123    Mr. Whorley. Every single day we are motivated by one1124single goal, and that is to help people better access and1125afford care.1126    We employ a team of incredibly talented people to make the1127unsure, uncertain moment that is facing Americans all across1128the country something of the past. And so, we want to give1129people the confidence, the ability, and the dignity to easily1130and effortlessly access and pay for care.1131    I think our biggest barrier to that is just the inertia of1132the status quo, and moving that uphill requires the best1133efforts from all of us.1134    Mr. Burlison. Would you say that the status quo is propped1135up by the regulations that this town has created that really1136kind of--that stop innovation like yourself, like what your1137company has provided?1138    Mr. Whorley. I think the degree, to the extent that we1139can--the best regulation is probably no regulate--the ability1140for us to innovate and have degrees of freedom to respond to1141the market and respond to the customers and partners that we1142serve, that is what we are attuned to.1143    Mr. Burlison. And how would you say that your business1144under the previous administration, now that you have had ten1145months under this administration, have you recognized any kind1146of change?1147    Mr. Whorley. 2025 has been a transformational watershed1148year in that we have enabled nearly 20 million people to more1149easily access and afford care. We are providing people with the1150peace of mind and certainty and ensuring that that unsure,1151uncertain moment that they are standing in a pharmacy is1152something of the past. We are giving them the ability to take1153care of themselves and their loved ones, and that is with the1154launch of the bipartisan Medicare Prescription Payment Plan.1155    Mr. Burlison. Thank you.1156    Mr. Jacobs, how has the Affordable Care Act caused1157healthcare to actually be unaffordable?1158    Mr. Jacobs. Thank you, Mr. Chairman.1159    It has really encouraged consolidation within the1160healthcare sector. I talked in both my prepared testimony and1161my written comments about how the medical loss ratio encourages1162consolidations, that we essentially have healthcare oligopolies1163now, that it encouraged insurers to buy pharmaceutical benefit1164managers and other forms of businesses where they could offload1165and shift their profits.1166    Mr. Burlison. Vertical integration.1167    Mr. Jacobs. Correct.1168    Mr. Burlison. Forced vertical integration.1169    Mr. Jacobs. And there is also vertical integration within1170the hospital sector.1171    Ms. Tripoli's statement noted the significant amount of1172hospital mergers that have taken place over the years and I1173believe said that 40 percent of those occurred between 2010 and11742015.1175    Well, there was a law Congress passed in 2010. It is called1176Obamacare. And to say that that did not have an impact, I think1177it very clearly did have an impact.1178    Whether it is accountable care organizations, that entities1179wanted to purchase physician practices, they wanted to purchase1180each other to get additional market clout to negotiate more1181power to negotiate with the insurers across the table from1182them.1183    Mr. Burlison. Yes.1184    Dr. Obermeyer, you addressed that in order to move forward1185you need access to data. One of the previous bills that was1186passed before Obamacare was passed was actually to create these1187health information exchanges, but, in my opinion, having worked1188in that space, it has been an abysmal failure. It does not1189work. It does not benefit patients. The data does not go from1190doctor to doctor.1191    And then to hear that you say that it is not even1192accessible for research, you know, anonymized, this is1193something that we have to get our hands on, particularly if AI1194is going to be moving forward. And I worry about where we are1195with that.1196    How do we address that in a way in which we can still1197properly secure somebody's health information?1198    Dr. Obermeyer. We are used to thinking about a tradeoff1199between how easy it is to access the data and how safe it is. I1200think that tradeoff is largely a product of using old1201technology and old data management systems.1202    The most sensitive data in the world are kept on modern1203systems that let people access it when they need it and keep1204out others. I think, paired with a strict approach to law1205enforcement, we can have the best of both worlds.1206    Mr. Burlison. Thank you.1207    I now recognize Mr. Frost for his line of questions.1208    Mr. Frost. Thank you so much, Mr. Chairman.1209    And thank you so much to our witnesses for being here.1210    Mr. Whorley, you were chatting a little bit about in the1211last question line that you guys were able to help 20 million1212people in 2025. How does that compare to other years with your1213company?1214    Mr. Whorley. It is an enormous step up.1215    So, on January 1, 2025, it was the launch of the Medicare1216Prescription Payment Plan. That gave nearly 54 million American1217seniors with Part D coverage the ability to more efficiently1218and effectively get care, to smooth their costs over time.1219    Mr. Frost. Yes. Thank you.1220    So, how would you describe the demand for your services?1221    Mr. Whorley. It is increasing.1222    Mr. Foster. Okay.1223    If more people have to opt in for worse healthcare plans,1224higher deductibles, different things like that, would that also1225increase demand?1226    Mr. Whorley. The demand has increased as insurers and1227employers are recognizing that they can have both a lower-cost1228health plan and compassionately ensure people can access care.1229It is a programmatic approach that enables people to get the1230care they need and pay for that care at the time of service.1231    Mr. Frost. No, I appreciate it.1232    And so, your company, essentially you make money helping1233people to pay their healthcare bills in a more smooth way.1234    If there are more people who cannot pay for their1235healthcare bills at once, will there be more demand for1236software like yours?1237    Mr. Whorley. Yes.1238    Mr. Foster. And if healthcare becomes more affordable, if1239we had, let us say, my North Star, single payer healthcare,1240something like that, people that need to enter payment plans1241for healthcare, there probably would not be as much of a demand1242for the services, right?1243    Mr. Whorley. No. I think that the North Star and what1244affordability is, affordability is an emotion, it is the1245ability to take care of yourself. And what we do is we give1246people the financial ability to manage whatever financial1247responsibility----1248    Mr. Foster. Whatever the costs are, yes.1249    Mr. Whorley [continuing]. May well be.1250    Mr. Frost. No, I appreciate that. And I am not trying to1251paint you as a bad person or anything. It is to make a point.1252Because you are a serial entrepreneur who finds a problem,1253right, and figures out a solution, and that is your1254prerogative, right?1255    And we do have a problem. Healthcare is too damn expensive.1256The cost of healthcare is too high. And I would submit that1257part of the reason why there is such a bigger demand for your1258services than ever before is because the cost of healthcare is1259going up and up and up.1260    And that is why I am confused on why my Republican1261colleagues have you as a witness here on this panel about1262affordable healthcare. Not a dig at you personally but because1263I think it shows--because there is so much more demand for1264companies like yours, it shows that we are failing in Congress,1265and whatever policies are being done right now are not helping1266people afford their healthcare and bring down the cost of1267healthcare.1268    We are here to talk about bringing down the cost of1269healthcare, and if you cannot afford to get it, right, when you1270receive that bill, it means you cannot afford it.1271    My dad was always strict with money. He always told me, if1272you could not afford it when you got it, you cannot afford it1273at all. If you have to buy now, pay later, you cannot afford1274it. And that is part of the issue.1275    And I think it makes sense why more people need services1276like yours, is because healthcare is too damn expensive, and1277President Trump and congressional Republicans are making it1278worse.1279    And that is why I come back to this extension of the1280Affordable Care Act tax subsidies. We have just five weeks1281until the ACA open enrollment ends, and in five weeks 189,0001282people in my district alone are going to see their healthcare1283skyrocket.1284    I cannot tell you how many of my own friends and family1285have called me saying: ``What the hell? What are you guys going1286to do about this? I mean, I used to pay this much and now I am1287going to be paying this much. I cannot afford it.''1288    And this is going to happen to 25 million of our people.1289That's why I keep coming back to this, because there's1290something right in front of us that has to do with1291affordability.1292    I want to talk about the subject of technology and AI in1293healthcare. I think this is an important hearing to have. But1294right in front of us we have a cliff that is coming up, and if1295we do not do our job, more people are not going to be able to1296afford their healthcare and more people are going to have to do1297buy now, pay later plans to be able to pay to stay healthy in1298the richest country on the face of the Earth, which I think is1299disgusting and I think is a failure of our government.1300    Ms. Tripoli, if the subsidies expire how will this impact1301how often people go to the doctor, how sick they get, and how1302much debt they have to take on?1303    Ms. Tripoli. Thank you for the question.1304    If the subsidies expire, we will see premiums more than1305double. For some families, we will see increases of 3001306percent. For older couples, we will see--just above the 4001307percent of poverty--we will see them paying about a quarter of1308their income on healthcare costs.1309    We know in the midst of an affordability crisis that it is1310unaffordable. It will force people to forego care, drop out of1311coverage if they have to. And, of course, when folks drop out1312of coverage, we know that they do not go to the doctor, they1313delay, or they end up in the emergency room, which is the most1314expensive care setting to get healthcare.1315    Mr. Frost. And, Ms. Tripoli, if we have folks who say, you1316know what, I disagree with a lot of different parts of our1317healthcare system--look, I know we have a broken healthcare1318system, but we have this clock ticking, this countdown timer in1319front of us.1320    Would you advise us to let the countdown end and have1321healthcare go up for so many working families while we try to1322figure out a plan that no one really has right now, or would1323you say that we deal with what is right in front of us and then1324have those conversations.1325    Ms. Tripoli. Time is of the essence. The first thing you do1326when somebody is bleeding is you stop the bleed. The tax1327credits need to be passed with a clean extension immediately.1328It is a lifeline for 22, 24 million Americans. And then let us1329come back to the table and talk about how we address the root1330drivers on drugs, on hospitals, and others to bring down the1331underlying cost of care.1332    Mr. Frost. That is why we have to pass the extensions for1333the Affordable Care Act, because our people are suffering right1334now. The cost of everything is too damn high. And if we do not1335do our job, 25 million Americans are going to see their1336healthcare go up anywhere from 50 to 300 percent. Then let us1337get back to the table and figure out what we do to fix this1338broken healthcare system.1339    I yield back.1340    Mr. Burlison. Thank you.1341    I have a document to submit for the record from the Juniper1342Research Group titled ``No, Obamacare Premiums Are NOT Doubling1343in 2026'' that I am submitting for the record.1344    Without objection.1345    And with that, I recognize----1346    Mr. Frost. Mr. Chairman, I request unanimous consent of a1347UC. I have a UC, a document.1348    Mr. Burlison. You are recognized.1349    Mr. Frost. Mr. Chairman, I ask unanimous consent to enter1350to the record fact sheets from Keep Americans Covered that1351shows that my Republican colleagues on this Committee represent1352738,000 people who depend on the Affordable Care Act tax1353credits.1354    Mr. Burlison. Without objection.1355    I now recognize----1356    Mr. Grothman. I would like to--can I submit for the1357record----1358    Mr. Burlison. Yes. Mr. Grothman.1359    Mr. Grothman [continuing]. A CMS fact sheet with regard to1360historical national health expenditure data and an AMA fact1361sheet on trends for healthcare spending?1362    Mr. Burlison. Without objection.1363    Mr. Grothman. Thank you very much.1364    Mr. Burlison. I now recognize Chairman Grothman.1365    Mr. Grothman. Okay. First of all, I am grateful for an1366opportunity to have this hearing with my Co-Chair, and I want1367to thank the witnesses one more time for coming over here.1368    A few weeks ago, the Health Care and Financial Services1369Subcommittee held a hearing where we heard from the Trump1370Administration about the youth healthcare crisis. Not only are1371our children facing chronic diseases at rates never seen1372before, but the healthcare system seems to only get more1373expensive without any noticeable improvement in outcomes.1374    Recent data published by the Trump Administration and1375confirmed by several other independent sources indicate that1376one-third of healthcare costs are wasteful and do not improve1377patient health.1378    We will start with Mr. Jacobs.1379    Why are one-third of healthcare costs wasteful and fail to1380improve patient health? Do you believe that is true?1381    Mr. Jacobs. I certainly think there is a great amount of1382waste in the healthcare system. Unfortunately, we, as I1383mentioned in my testimony, we do not have correctly aligned1384incentives. The traditional example is the all-you-can-eat1385buffet. Everybody does a good job of spending everyone else's1386money in healthcare.1387    Obviously, there are circumstances. You are not going to1388try to shop for care when you are in an ambulance on the way to1389the hospital or anything else like that.1390    But we do need to realign incentives at the margins to show1391where people can be smarter shoppers of healthcare, but first1392that requires price and quality transparency. I have had1393personal difficulties myself on numerous occasions finding out1394what the heck things cost.1395    Mr. Grothman. I will give you guys another question, and1396anybody can jump in here.1397    Utilization rates vary from doctor to doctor and state for1398state. Does anybody want to comment on that or have any1399information on examples of overutilization which would indicate1400that more is being spent than has to be spent?1401    Dr. Lakdawalla. Well, Chairman Grothman, one issue is that1402if you look at that variation from state to state, it tends to1403be greater in Medicare than it tends to be in the commercial1404insurance market, and I think that indicates that when there is1405oversight in terms of what is valuable care, it helps to1406mitigate overuse.1407    Examples of overuse, a prominent one is what is known as1408defensive medicine. So, it is testing that is undertaken1409because of malpractice risk. It probably adds, our research1410suggests, around ten percent to medical spending. So, that is1411one important source as well.1412    Mr. Grothman. Okay. And that varies from state to state?1413    Dr. Lakdawalla. It does, yes.1414    Mr. Grothman. Can you give examples of a high state and a1415low state or just a shot at a specific example of dramatically1416higher costs in one state than another state?1417    Dr. Lakdawalla. Typically, the states that award higher1418jury awards in malpractice cases tend to have more defensive1419medicine.1420    Mr. Grothman. Okay.1421    I think we can all agree we have a problem when one-third1422of healthcare spending, according to some people, goes to1423waste. Can you explain why that is such a problem and how it1424affects the healthcare market?1425    Mr. Whorley, I guess we will start with you.1426    Mr. Whorley. Yes. Healthcare costs are a combination of the1427volume of care we seek and the prices we pay.1428    Enabling people to pay the price and enabling more and more1429cash prices and direct prices, for there to be a single price1430for all versus a single payer for all, enabling people to1431actually know what the price is ahead of time, the real price1432that intermediaries or AI cannot reprice, that is important to1433enable patients and employers, purchasers of care, to get the1434signal: Is it the right price?1435    I think it is important that in terms of volume, where1436there is overconsumption, there is also underconsumption in the1437market as people are unable to pay for care. That is why nearly143830 percent of ACA markets have built solutions like Paytient1439into ACA plans to ensure that people are able to get care when1440it happens because healthcare is a necessity.1441    Mr. Grothman. Okay. What I will do is go down the line1442starting with Dr. Lakdawalla.1443    How have you personally experienced rising healthcare costs1444in your individual field or from the perspective that you are1445in right now, and specifically what would you like to see1446Congress do to rein in those costs?1447    Dr. Lakdawalla. I would like to see attention paid to1448measuring the value of different healthcare procedures, drugs,1449devices, and the like, and ensuring that we are not continually1450investing in low-value care, which is happening.1451    For example, most Americans say they do not want to die.1452They do not want to spend their last days of life in a1453hospital. Yet a majority of individuals end up there. That is1454wasteful care because it is not aligned with what patients1455value and their families value.1456    Mr. Grothman. In other words, people are--well, go ahead. I1457am running out of time. So, we will go down the line.1458    Dr. Obermeyer. I will just tell you one fact from my own1459experience as a physician.1460    I have ordered a lot of wasteful tests, for example, in the1461ER, tests for heart attack that expose patients to risk and1462costs and come back negative. At the same time, heart attack is1463one of the most common reasons that doctors get sued, because1464we miss it.1465    And so, even though, of course, there is a lot of1466contribution from incentives, fear of malpractice, the core of1467the problem, at least from my perspective, is that it is really1468hard to make decisions about who needs care. And I think that1469is why I am so optimistic that artificial intelligence can help1470us make better decisions. And, thus, reduce the cost of care,1471but also improve the quality by taking some of those costs and1472giving it back to patients who need the care.1473    Mr. Grothman. Mr. Jacobs?1474    Mr. Jacobs. As an exchange customer here in D.C. who is1475facing a premium increase starting next month, I certainly1476understand the cost because I have to pay all of those out of1477pocket. I am self-employed. So, I do not have an employer to1478subsidize.1479    I actually agree with Ms. Tripoli. I think site neutral1480payments--and there is a good amount of bipartisan agreement on1481this--is a good policy that Congress should be enacting. I just1482recently went to a specialist for a second opinion on an1483orthopedic issue, and I ended up paying twice what I normally1484pay at my usual specialist, primarily because the second1485opinion was affiliated with the hospital, and it is a physician1486office visit, but it is billed through a different service. It1487is billed as an outpatient clinic visit, and so I pay twice as1488much.1489    We should not be inviting these kind of disparities, and1490that encourages more physician practices to merge with1491hospitals because they can charge more.1492    Mr. Grothman. I am going to break the rules and ask the1493final question to Ms. Tripoli, the Democrat witness.1494    Ms. Tripoli. Well, I actually agree that the underlying1495incentives--the payment incentives of the healthcare system are1496misaligned. All the incentives are to get bigger and bigger and1497to charge more volume of high-price services rather than making1498sure that people are getting the high-value care that they need1499to get healthy and stay healthy.1500    And so, I do think that there is a longer term conversation1501about how do we structurally realign incentives with the health1502and financial security of the American people, but I will tell1503you that it is very hard to have that conversation when you1504have got 22 to 24 million people right now who need the1505enhanced premium tax credits extended. And so that is the1506lifeline they need today.1507    And, then, I encourage Congress to have a conversation1508about how to realign payment incentives in the healthcare1509system. Absolutely.1510    Mr. Grothman [continuing]. Thank you.1511    Mr. Burlison. Thank you.1512    I now recognize Ranking Member Krishnamoorthi for his1513opening statement--or for his line of questions.1514    Mr. Krishnamoorthi. I can do that, too. Thank you. Thank1515you, Mr. Chair, and thank you to the witnesses. Your answers1516have been very thoughtful and really appreciate your1517participation.1518    Ms. Tripoli, I want to share the story of the family of a1519woman named Krystle from central Illinois, which is where I am1520from. She is in contact with my office, and here is a picture1521of her three children, who have some medical--very complex1522medical issues.1523    After growing up on Medicaid, Krystle finally secured a job1524with employer health coverage. But the plan's cost for her1525three medically complex children were so high, the employer-1526sponsored coverage was effectively unusable. With the ACA's1527enhanced premium tax credits, however, she can, instead, buy1528coverage for her three children at $800 a month on the1529exchange.1530    Now, if we let those tax credits expire, her premiums will1531nearly double to $1,400 a month, trapping her in a coverage1532gap.1533    Ms. Tripoli, the Medicaid coverage gap, which Krystle is1534experiencing, affects millions of Americans who earn too much1535to qualify for Medicaid but not enough to afford private health1536insurance coverage. That is why the tax credits were created in1537the first place, to enable people to afford, like Mr. Jacobs1538and others, the health insurance that is available on the1539exchanges.1540    And, Mr. Jacobs, I am also on the exchange like yourself.1541    So, here is my question to you, Ms. Tripoli. Unfortunately,1542Krystle does not have an extra $600 a month to pay for her1543insurance. So, to get out of the coverage gap, she would be1544forced to leave her job so that her kids can qualify for1545Medicaid coverage because the only alternative to risking their1546health is basically going without coverage, which is a choice1547no parent should ever have to face.1548    Ms. Tripoli, Krystle's story is not unique, right?1549    Ms. Tripoli. It is absolutely not unique. And you are1550highlighting the exact reason why we need the enhanced premium1551tax credits extended immediately, not to mention the challenges1552that were imposed from H.R. 1 in terms of Medicaid work1553reporting requirements and how difficult it will be for people1554to meet--who are working, but to meet those requirements under1555the new Federal rules.1556    And so, there is absolutely a need for families like1557Krystle--and there are millions of families like hers across1558the country--to get the relief they need right now, and that is1559through extending the enhanced tax credits.1560    Mr. Krishnamoorthi. Folks, as we approach the holiday1561season, please keep in mind families like Krystle's. I mean, we1562have to extend these. Even if we are going to negotiate future1563iterations of these tax credits, let us do the humane and right1564thing, which is to extend these tax credits for some period of1565time while we negotiate the rest of the ACA.1566    Mr. Jacobs, you recently wrote this article entitled, ``The1567Middle Class Cannot Keep Up With Persistent Inflation1568Forever,'' right?1569    Mr. Jacobs. Yes.1570    Mr. Krishnamoorthi. It was from December 1st of--this1571month, right?1572    Mr. Jacobs. That is correct.1573    Mr. Krishnamoorthi. You wrote, ``American households feel1574stuck in an ever-growing vice by prices rising faster than1575their incomes can keep up,'' correct?1576    Mr. Jacobs. Yes.1577    Mr. Krishnamoorthi. Donald Trump recently claimed that the1578affordability crisis is a ``hoax.''1579    You wrote in this article--and I agree with you--``Trying1580to claim inflation does not exist will not cut it,'' correct?1581    Mr. Jacobs. True.1582    Mr. Krishnamoorthi. You also wrote, ``I see it every week1583when I go to the grocery store. I consider myself luckier than1584most, but the weekly shop still feels painful.'' That is what1585you wrote, right?1586    Mr. Jacobs. Yes.1587    Mr. Krishnamoorthi. You also, in part, blame Trump's tariff1588policy for high prices on things like bananas and coffee,1589writing, ``It seems foolhardy ever to have imposed levies on1590items that our climate will not allow us to grow in sufficient1591quantities domestically, but, at a minimum, ending the tariffs1592will provide a bit of relief.'' That is what you wrote, right?1593    Mr. Jacobs. That is correct.1594    Mr. Krishnamoorthi. Despite controlling the House, the1595Senate, and the White House, Republicans have done nothing to1596bring down high prices. On the contrary, your article title1597could not be truer, Mr. Jacobs. The middle class cannot keep up1598with persistent inflation forever. President Trump's tariffs1599only make them worse.1600    Now, let me turn to my final topic, and that is AI. Ms.1601Tripoli, AI has become increasingly prevalent in healthcare1602settings. In fact, a recent study from Rand, Brown University,1603and Harvard found that one in eight adolescents and young1604adults use AI chat bots for mental health advice.1605    You do not dispute they found that, right?1606    Ms. Tripoli. No, I do not.1607    Mr. Krishnamoorthi. Time Magazine recently reported that,1608when asked about self-harm, some of these bots have offered1609guidance on how to, ``safely cut oneself or what to include in1610a suicide note.''1611    Ms. Tripoli, again, this is what Time and other news1612outlets have been reporting, right?1613    Ms. Tripoli. Correct.1614    Mr. Krishnamoorthi. My home state of Illinois has banned AI1615chat bots from offering any kind of psychotherapy for anyone.1616Other states have similarly instituted different guardrails for1617AI.1618    Unfortunately, there is a move currently from the White1619House to preempt all state laws with a national law preventing1620this type of legislation that Illinois and other states have1621instituted or enacted to put guardrails on AI.1622    Dr. Obermeyer, your testimony today--and I read--we read1623through your testimony--does not endorse preemption and, in1624fact, does not even mention it, correct?1625    Dr. Obermeyer. Correct.1626    Mr. Krishnamoorthi. Mr. Chair, the Majority's own witness1627did not mention preemption in its testimony because it is1628premature. There are great things happening in red and blue1629states alike that are protecting our children.1630    We have one of the few chances right now to come together1631and say ``no'' to a really hasty national preemption plan that1632the White House is initiating, and I hope we do not lose that1633opportunity to work together.1634    Thank you, and I yield back.1635    Mr. Burlison. Thank you. Chairman Grothman.1636    Mr. Grothman. I would like to submit another document for1637the record called ``How much does that MRI cost?'' put together1638by Unleash Prosperity. I want you all to look at it. It shows1639similar procedures varying from $300 to $7500 depending upon1640the provider.1641    Mr. Burlison. Thank you. Without objection.1642    I now recognize Mr. McGuire for his 5 minutes of questions.1643    Mr. McGuire. Thank you, Mr. Chairman, and thank you to the1644witnesses for being here today.1645    The tariffs--by the way, I heard mention of tariffs.1646Tariffs are working. For the first time in a decade, we have a1647surplus. That means our government has been spending more per1648month than we bring in per month.1649    If you ran your house like that, you would be on the1650street. And, if you ran your business like that, you would be1651out of business.1652    Now, the tariffs are important. I mean, American steel is1653back, bigger contracts than they have ever had. You cannot do1654anything without steel. And gas prices are coming down because1655we are drilling more today than we ever have.1656    In fact, in Roanoke, Virginia, this weekend someone sent me1657a screenshot at the pump, under a dollar--under $2 gas. I think1658it is $2.35 today, but still, we have not seen prices like that1659in five years.1660    Now, we got into a big mess over the last four years, and1661we have only been here about 11 months or so. It takes a while1662to turn the ship. But the One Big Beautiful Bill puts jet fuel1663on our economy, and, hopefully, by the spring you are going to1664see this.1665    The problem is the government does not do a whole lot1666right. If they built you a car, it would cost a million1667dollars, and, you probably would be a year or two late in1668getting it, and it would fall apart. That is why we need free1669market competition.1670    You have heard about COPN, a certificate of public need. It1671is like there is a monopoly and in control from those in1672charge. And, if we had free market competition, it would drive1673down prices.1674    I think the first calculator was this big. It was $5,000.1675But, with innovation and free market competition, it got better1676and smaller and better and smaller, and now you can buy a1677calculator for $1 at the dollar store.1678    We have not been allowing competition because the1679government is involved. And, again, I can talk about the U.S.1680Post Office. I talked--in my district, we have health clinics,168141 I think, and several hospitals. And I asked them, ``You have1682to deliver medications every week to people that rely on these1683medications for life or death. Do you use the U.S. Postal1684Service?'' They said, ``No. We use FedEx and UPS.'' And I said,1685``How reliable are they?'' They said, ``100 percent reliable.''1686And I said, ``How reliable is the post office run by the1687government?'' And they said, ``Not reliable at all. We cannot1688use it.'' I said, ``Well, give me a worst-case example.'' And1689they said, ``Well, we mailed some medicine in 2013, and we got1690it returned to us in 2023.''1691    And so, I think the big problem with the cost overrun is--1692Obamacare, for example, they call it the Affordable Care Act. I1693would call it the un-Affordable Care Act because it took away1694the free market competition, and it totally benefited the1695insurance companies, and they can charge whatever they want.1696    When talking with hospitals about COPN, a doctor would say1697to me, ``Hey, I want to start--in rural Virginia, far away from1698a hospital, I want to start an MRI clinic because I can do it1699for $500 apiece, or you can go to a hospital and spend $1,500,1700$2,000 apiece.'' Sounds like common sense, right?1701    But then the folks at the hospital said, ``Well, the1702problem is there are a lot of things we do at the hospital that1703do not make money. So, then, at the hospital, we charge a whole1704lot, to make up for the programs that do not make money.'' So,1705again, it is nonsensical. It is a mess. And we need free-market1706competition.1707    We also need a preventative healthcare system. When you buy1708a car, it tells you, ``At 2,000 miles, do this; at 5,000 miles,1709do this; at 15,000 miles, do this.'' We seem to have a system1710where you put Band-Aids on it and wish and hope and wing it and1711modify it. And it does not work that way in the business world.1712You would be out of business if you did not have some sense.1713    For example, would you rather find a tumor when it is this1714small or when it is this big, and if you had a system of1715checkups and things like that?1716    But, be that as it may, we are where we are. And so, I1717guess what I would ask is--we do not have a lot of time. Let us1718get some yes-and-noes.1719    Do you agree that a productive rather than reactive system1720would help us shrink government? That is just a yes or no. I do1721not have time.1722    Mr. Whorley. Yes.1723    Dr. Lakdawalla. Yes.1724    Dr. Obermeyer. Yes, and AI can help.1725    Mr. Jacobs. Sure. Yes.1726    Mr. McGuire. I totally agree with that.1727    And, for all the witnesses, do you agree that more1728competition in medical tech will lead to better outcomes for1729patients? Yes or no, because I do not have time.1730    Mr. Whorley. Yes.1731    Dr. Lakdawalla. Yes.1732    Dr. Obermeyer. Yes.1733    Mr. Jacobs. Yes.1734    Ms. Tripoli. More competition is always good, yes.1735    Mr. McGuire. I like it. I like it. All right.1736    I am also hopeful that data-driven approach to healthcare1737can help speed up FDA approval processes and reduce our1738reliance on countries like China for tests, and it is terrible1739that some of our most important medicines are made in China.1740    Do you guys agree with this, yes or no?1741    Mr. Whorley. Yes.1742    Dr. Lakdawalla. Probably.1743    Dr. Obermeyer. Yes.1744    Mr. Jacobs. Yes, I think we should be near-shoring those1745kind of critical materials, yes.1746    Mr. McGuire. You cannot exercise your way out of bad1747nutrition.1748    So, do you guys agree that a preventative healthcare system1749that they say the positive effects of fitness on the brain and1750mental health by having proper nutrition and exercise is very1751important? Do you agree with this?1752    Mr. Whorley. Americans being in better health is better for1753America.1754    Dr. Lakdawalla. Prevention is underused and needs more use.1755    Dr. Obermeyer. Yes.1756    Mr. Jacobs. Yes.1757    Ms. Tripoli. Your best prevention is having access to1758affordable care.1759    Mr. McGuire. Well, thank you. I ran out of time. I yield1760back.1761    Mr. Burlison. Thank you.1762    Ranking Member Frost?1763    Mr. Frost. Mr. Chairman, I have a unanimous consent request1764to enter into the record.1765    The Hill article, states ``Medicaid cuts will harm rural1766Republican communities most.''1767    Mr. Burlison. Without objection.1768    I now recognize Ms. Randall for her line of questions.1769    Ms. Randall. Thank you so much, Mr. Chair, and thank you to1770our witnesses for being here today.1771    I love a robust conversation about how we can improve our1772healthcare system. I do not think any of us on either side1773would say that the system that we have is perfect and is1774working exactly as it was intended to.1775    I do, however, have real concerns about saying, ``It is not1776working. So, we should not reinstate these affordable care tax1777credits so that more people can lose their healthcare so that1778the system is even more broken, and then we have to decide how1779to fix it.'' I do not think that is the way to meet the1780healthcare needs of the American people. It is not the way that1781they are asking us to meet their healthcare needs, and it is, I1782think, frankly, dangerous for our country.1783    We have, as my colleagues have said, a ticking clock on1784these ACA tax credits. We were so quick to act when, you know,1785billionaire and big corporation tax credits were set to expire.1786Congress was called back into session from vacation to make1787them permanent.1788    I do not understand why we would not act immediately for1789the benefit of the American people who are struggling with1790affordability and are struggling with the healthcare system.1791    That said, you know, I think, even the original drafters of1792the Affordable Care Act, including President Obama himself,1793would argue that the ACA was not the be-all, end-all dream of,1794you know, healthcare for people in this country. They did not1795have the votes for public option.1796    So, yes, giving money to the insurance companies is a large1797part of what the ACA is able to do because that is how people1798are guaranteed healthcare.1799    Before the ACA--I do not know how everyone's memories are1800on this. Folks may not have been super-engaged. Before the ACA,1801women who had been pregnant could be denied healthcare1802coverage. Folks who had other preexisting conditions, any1803healthcare needs could be denied healthcare coverage. We had1804very high uninsured rates and high rates of people unable to1805access healthcare.1806    There are lots of ways to make sure that we solve that1807problem. The Affordable Care Act was the bill that had the1808votes to pass at the time. It has been a while. We can revisit1809rebuilding a healthcare system like Mr. Frost has said, like1810single-payer, that meets the needs of the people, lowers costs,1811and ensures a more healthy future for all of us.1812    There are lots of different approaches that countries1813around the world have taken that have been explored. In the1814United States, I, as a member of the legislature in Washington1815State, worked on establishing Washington State's universal1816healthcare commission, some of the strongest universal1817healthcare policy to be passed by any state in the last ten1818years.1819    We know that we need improvements, but we also know that1820the free market is not the solution for healthcare. An1821unchecked free market means that, you know, folks who do not1822have coverage, who do not have the ability to afford care just1823will not get it. They will die often.1824    Yes, you cannot shop around in the ambulance, but there are1825ways that we can provide more transparency into healthcare1826costs, like Washington and many other states who have created1827an all-payer claims data base that collects and publishes data1828so that you can look up how much it costs on average to get a1829mammogram and how much those mammograms cost at different1830facilities near you.1831    But the problem for most people, especially in rural1832communities, including many in my own district, many in the1833districts of my Republican colleagues, are that there are not1834that many healthcare facilities available and accessible. And1835those that are, are at risk of closing because of the dramatic1836cuts from the big, ugly bill to Medicaid.1837    Rural healthcare was at risk before we passed H.R. 1, and1838now it is hanging by a thread. What does it matter if you could1839shop around if your nearest two hospitals are two and three1840hours away from you.1841    I also think we need to make space for technology, and I1842know that is what we are here to do today, to talk about how1843innovation and technology can help lower costs for families.1844But I hear a lot from my neighbors on Medicare who are worried1845about unchecked technology and AI impacting their ability to1846access care.1847    Dr. Obermeyer, I am concerned about the Wasteful and1848Inappropriate Service Reduction (WISeR) Model and what that1849unchecked AI implementation will do to folks' abilities to1850access care. That is why I am a cosponsor of the SMARTER Care1851Act, a measure to ban the WISeR Model from Medicare claims.1852    Do you believe that AI systems need independent oversight1853to ensure patients are not denied medically necessary care?1854    Dr. Obermeyer. Absolutely.1855    Ms. Randall. Thank you.1856    I would like to request unanimous consent to enter into the1857record a letter from a retired physician in my district, how1858WISeR will enable companies to profit from pain.1859    Mr. Burlison. Without objection.1860    Ms. Randall. Thank you.1861    Mr. Burlison. And your time has expired.1862    Ms. Randall. I know my time is up. I will just wrap up by1863saying, I agree we have to fight consolidation. I agree we have1864to fight to take some of the costs out of the healthcare1865system. I agree that more people need access to better1866healthcare.1867    And what we know is that vertical integration and1868consolidation of our healthcare systems does not lower costs1869for patients at all. It may lower costs for the provider1870groups. It may lower costs for the shareholders, but it does1871not lower costs for patients. Thank you.1872    Mr. Burlison. Thank you.1873    I now recognize the Governor--I am sorry--the gentleman1874from Florida, Mr. Donalds.1875    Mr. Donalds. Thank you, Chairman. I appreciate your1876sentiment.1877    Before I get into questions, I think it is important to1878acknowledge what was just said. I want to start with some of1879the positives I just heard.1880    The truth is that, yes, more competition in healthcare is1881going to be critical to deliver affordable care to consumers,1882and that is something I think which is a very bipartisan1883statement. I think both sides of the aisle can agree on that.1884    I think one of the things that was also just acknowledged1885is that the entire purpose of the Affordable Care Act was not1886the Affordable Care Act. It was to take the United States1887toward single-payer healthcare. That was the design 15 years1888ago.1889    So, the American people need to understand, the reason why1890costs are rising in healthcare and in health insurance is by1891design, by congressional Democrats at the time, and by then-1892President Barack Obama. They did want a public option. They1893wanted to put a public option in the Affordable Care Act that1894was going to be lower cost than what their own regulatory1895framework would allow in the private markets.1896    The only reason they did not get the public option is1897because they did not have the votes. A guy named Scott Brown1898won a Senate election in Massachusetts--I know that sounds1899crazy today, but he did--and it stopped them from actually1900pushing forward with the public option, which, by the way, its1901entire design was to move America toward single-payer1902healthcare.1903    The arc of history in healthcare needs to be clear on this1904point: single-payer healthcare does not work. It never will1905because, to the point of my colleague from the other side of1906the aisle, single-payer is the very definition of vertical1907integration of the healthcare system, which will not lead to1908lower costs for the American people. But I digress.1909    Mr. Jacobs, you referenced that a single Social Security1910number was linked to over 26,000 days of subsidized healthcare1911coverage across more than 125 insurance policies in 2023.1912    What mechanisms can be put in place to detect and prevent1913this level of exploitation of taxpayer funds, and what1914underlying vulnerabilities contributed to this abuse?1915    Mr. Jacobs. Yes, Mr. Donalds, that is correct. And the1916Government Accountability Office report that was released last1917week was just one of many data points suggesting that there are1918significant amounts of improper enrollment and potential fraud1919on the exchanges.1920    I think some of it is driven by--there are certainly rogue1921agents and brokers that have been acting in CMS both under the1922Biden Administration and certainly under the Trump1923Administration have acted to crack down on that. I think1924eliminating zero premium plans, I think, is a matter of good1925policy that I think, regardless, we should be asking everyone1926to pay at least a little bit of something toward their health1927insurance every----1928    Mr. Donalds. Not to cut you off, but I want to acknowledge1929something that you just said.1930    In your opinion, do zero premium plans lead to fraud and1931abuse?1932    Mr. Jacobs. I think without a doubt. The system responds to1933incentives. And we have only had zero premium plans for the1934past few years under the enhanced subsidy regime, and we have1935seen that the amount--the concerns about improper enrollments,1936whether it is CBO or CMS with the data regarding zero claim1937enrollees in exchange coverage, all of them have been pointing1938to increased incidents of improper enrollments and fraud.1939    Mr. Donalds. Okay. Thank you for that.1940    Dr. Obermeyer, if artificial intelligence becomes1941significantly integrated into medical practice, what impacts1942should we expect on the healthcare workforce?1943    Dr. Obermeyer. I think what we have learned from the1944history of automation and technology adoption is that it does1945not necessarily eliminate jobs. It actually changes the nature1946of those jobs.1947    So, doctors will start to need to interact with these tools1948and learn from them, and I think they will start to augment the1949capabilities of especially nurses, community health workers,1950and others who can now have access to cutting-edge technology1951applied to the data from patients to help them make better1952decisions.1953    Mr. Donalds. Real quick, a quick follow-up to that. Do you1954think that the Affordable Care Act's regulatory framework1955allows for this type of internal innovation in the healthcare1956system?1957    Dr. Obermeyer. I do not know about the ACA specifically. I1958think right now there are not very strong incentives for a lot1959of health systems to adopt this AI technology. I think the1960ACCESS program that was recently announced from CMS is a good1961start in that direction by incentivizing preventive care1962augmented by technology.1963    But I think that government programs can do more by, for1964example, creating payment codes for AI technology that drives1965lower costs, higher value care, and even detects the kinds of1966fraud, waste, and abuse that you mentioned earlier.1967    Mr. Donalds. Well, look, I am all for efficiency. One of1968the things I do have a concern about is I hear that, yes, AI is1969being used in some respects in healthcare, a lot of it for1970upcoding as opposed to pushing for efficiencies. And I think1971that is a major issue that we definitely have to get our heads1972around, both here federally and at the state level.1973    Chairman, if I might indulge, I did want to ask a quick1974question of Ms. Tripoli. I know--I was hearing your dialog with1975one of my colleagues earlier about affordability. I recognize1976everybody has a concern about it. Honest question.1977    Do you really think that a centralized healthcare system1978will lead to efficiencies and lower costs for the American1979people?1980    Ms. Tripoli. I think there are a lot of different models to1981get to a universal system of coverage that make sure that every1982person in the country has access to the affordable high-quality1983healthcare and health that they deserve.1984    In any of those systems, you have to actually address the1985incentives and the way the prices in the healthcare system are1986set. And whether you are in the current system we have now or1987some future system, the reality is that the biggest drivers of1988our affordability crisis in this country on healthcare are the1989massive consolidation from corporate health systems, from1990insurance plans to drug companies to hospital chains.1991    And so, in any universal system of coverage, that issue has1992to be addressed. And, of course, most immediately, if people1993cannot afford care, then they cannot access care. And before us1994right now, there is a decision about extending the enhanced1995premium tax credits, and we urge the Congress to act on that.1996    Mr. Donalds. Well, Ms. Tripoli, we will have some agreement1997on consolidation. I have serious concerns about that1998consolidation as well.1999    I think if we are talking the universe one-size-fits-all2000system, I mean, I have not seen one that has worked just about2001anywhere in any industry that has ever existed on this planet,2002but I know people will continue to try.2003    Sorry, Chair. I know I am over. I yield.2004    Mr. Burlison. Thank you.2005    I now recognize my colleague from Missouri, Mr. Bell, for2006his 5 minutes.2007    Mr. Bell. Thank you, Mr. Chair, Ranking Member, and our2008witnesses for being here today.2009    The purpose of today's hearing is to discuss how technology2010can help reduce the future cost of healthcare, but I find this2011topic very ironic because we cannot look forward to the future2012of healthcare while ignoring the challenges that Americans are2013facing now.2014    The reality is that there are over 24 million Americans2015facing unaffordable healthcare with the pending expiration of2016the ACA premium tax credits. In Missouri alone, premium tax2017credits assist 95 percent of our marketplace enrollees.2018    And so, I heard a few comments that have me over here2019scratching my head. Mr. Jacobs, you said that the ACA has not--2020did not make it--has not met its stated objectives, and costs2021continue to rise faster, and there is a failure to control2022healthcare costs.2023    You remember saying all that, right?2024    Mr. Jacobs. Yes.2025    Mr. Bell. So, I want to use an analogy again. So, would2026everyone agree that Social Security overall is a good thing?2027Any objections to that? Okay.2028    So, when Social Security was created in the 1930s, most2029women were excluded; intermittent workers were excluded; nearly2030half the workforce population was excluded. And then it gets2031really rich with Black folks. Two-thirds of African Americans2032were excluded, 70 to 80 percent in certain regions of the--of2033African Americans were excluded.2034    But, over the years, Social Security was improved. And I2035would say mostly by Democrats, but there was some bipartisan2036efforts there throughout the years to improve it.2037    So, we would--I think it is safe to say that there was a2038point in time Social Security was not necessarily effective and2039a good thing and supporting folks, a lot of folks who needed2040it, and it got better because folks worked at it.2041    So, it is befuddling to me when, when we talk about the2042ACA, when Republicans talk about how bad the ACA is, first, it2043is the best thing we have got going right now. Yes, it could be2044improved, so let us improve it.2045    And so, let us talk about the history. I am a data person.2046So, in 2010, Republicans unanimously opposed the Affordable2047Care Act--we all know that--and did not offer any alternatives,2048right? No alternatives. Just opposed it, every single2049Republican.2050    2011, as soon as Republicans retook control of the House,2051they voted to repeal the ACA. Remember, the whole repeal and2052replace? We never got the replace idea, but that is a different2053subject. Every Republican voted to repeal it.2054    2012, Republicans unsuccessfully challenged the ACA in2055court. Now, was there any court filings that the Republicans2056championed to improve the ACA? No. Just to repeal it.2057    I got a lot here, too. I am going to try to get it in here.2058    In 2013, Republicans refused to fund the government without2059delaying or repealing the ACA. They did not say: ``Hey, we got2060some ways to improve it. We just want to repeal it.''2061    2015, Republicans passed a bill repealing the ACA that was2062voted--that was vetoed by President Obama. No--no help--no2063ways, suggestions to improve it.2064    In 2017, days after taking office, President Trump canceled2065ACA enrollment outreach advertising during open enrollment.2066    Ms. Tripoli, does that help get the word out and help get2067coverage for folks?2068    Ms. Tripoli. No.2069    Mr. Bell. In 2017, Republicans tried and failed to repeal2070the ACA again. In 2017, Republicans passed Donald Trump's tax2071plan gutting the ACA's individual coverage mandate. Notice,2072there was no legislation to improve it, make it better for2073Americans.2074    In 2017, the first Trump Administration cut enrollment2075outreach funding by 90 percent. They did not do anything to2076improve the ACA.2077    So, when we are three weeks away from the end of the year2078in the middle of open enrollment season, and I am still2079waiting, we are all still waiting for a vote to protect the2080American people, so, again, I got to ask, where is it? Where is2081this vote? Where is the help? Where is this plan? Where is the2082action to back up the promises and talking points?2083    And so--where is the evidence that you all truly care about2084the affordable access to healthcare for the American people?2085Because every single thing that we see is just to repeal what2086is--what has done the best to control costs for Americans. Yes,2087it could be better, but Republicans got to work with us.2088    Americans are screaming for relief with healthcare costs.2089And I appreciate some of the things that you are doing,2090particularly Mr. Whorley in Missouri, but these are only layers2091of things that we need to improve healthcare costs.2092    But we have to address these issues head on, and it is2093going to take Democrats and Republicans actually working2094together and stop playing politics and actually get in the room2095and do it. If you do not want to call it Obamacare, great, we2096will call it something else. We can call it the Obama-Trump2097plan. I do not care. Let us just do what we can to work for the2098American people and bring the costs down.2099    And right now Republicans for the last--since this act was2100implemented, have not given us one single plan to improve it or2101to--to help Americans address these issues.2102    Thank you. And I yield back.2103    Mr. Burlison. Thank you.2104    I now recognize the gentleman from Texas, Mr. Gill, for 52105minutes.2106    Mr. Gill. Thank you, Mr. Chairman. Thank you for holding2107this hearing, and thank you to the witnesses for taking the2108time to be here. We certainly really appreciate it.2109    I appreciate my colleague on the other side of the aisle2110and their sincerity and their desire to fix our healthcare2111system and make it better. I would suggest that Social Security2112and our healthcare system are not comparable or perhaps even2113analogous.2114    Our healthcare system is $5 trillion. It is about 182115percent of our GDP. And Social Security does not have the same2116bloated cost structure that is inherent in a single-payer2117healthcare system, which our colleagues on the other side of2118the aisle have been ultimately proposing. And I think we need2119to think a little bit more deeply about ways that we can bring2120those costs down rather than bringing in, I think, incomparable2121and unanalogous other government programs.2122    But, with that said, I do think that there is a lot of2123bipartisanship in healthcare, and I think that there are a lot2124of things that we would agree on.2125    Ms. Tripoli, thank you for being here, and thank you for2126your testimony. I believe in your testimony you urge2127policymakers to get the root causes of high and irrational2128prices in our healthcare system. Is that correct?2129    Ms. Tripoli. Yes.2130    Mr. Gill. And you would agree that healthcare consolidation2131is one of the main drivers of high prices for patients?2132    Ms. Tripoli. Yes.2133    Mr. Gill. I certainly agree.2134    And you also mentioned price disclosure, that hospitals2135should disclose the rates that they charge openly in dollars2136and cents, I believe, were your words. Is that right?2137    Ms. Tripoli. Absolutely, yes.2138    Mr. Gill. I certainly agree. You also mentioned site2139neutrality, that we ought to prohibit health systems from2140charging Medicare more for the same procedure if it is done in2141a hospital versus a doctor's office. Is that right?2142    Ms. Tripoli. Yes.2143    Mr. Gill. Those are, I think, all things that we can agree2144on, which is really, really nice to hear. So, I appreciate2145that.2146    Mr. Jacobs, I want to ask you about Obamacare. Obamacare2147was sold to the American people as a program that would drive2148down premiums. I think the number that was thrown out by2149President Obama at the time was $2,500.2150    Has that promise come to fruition?2151    Mr. Jacobs. No, it has not, Congressman. And premiums on2152individual health insurance policies on the marketplaces and2153the exchange has more than doubled in the law's first four2154years. And that is primarily from the regulatory mandates that2155the law imposed. And prices have continued--premiums have2156continued to increase substantially, and they continue to2157increase substantially more so on the exchanges than for2158employer-sponsored coverage.2159    Mr. Gill. So, you would say that Obamacare did not slow the2160growth of premiums in any meaningful way?2161    Mr. Jacobs. I think, if anything, quite the contrary. I2162mean, Senator Welch, I believe, last month admitted on the2163Senate Floor that the law failed to reduce costs.2164    But, more than that, I think it has accelerated the cost2165growth because of the consolidation that has come about in2166terms of hospital mergers, insurers buying PBMs, et cetera, et2167cetera.2168    Mr. Gill. And that is what I was getting to. Did Obamacare2169address or fix any issues related to price transparency?2170    Mr. Jacobs. Ultimately, there have been regulatory efforts.2171Some of the Trump Administration efforts were actually linked2172to regulatory requirements in the law. But I think we can and2173should do more, and I think we have also seen that hospitals2174are not necessarily complying with that law either willingly or2175easily.2176    Mr. Gill. Did Obamacare address or fix issues related to2177pricing disclosure?2178    Mr. Jacobs. I think we need to do more is what I would say.2179    Mr. Gill. Got it. And it is your testimony as well, if I2180heard you correctly, that Obamacare actually exacerbated2181pricing issues related to healthcare consolidation?2182    Mr. Jacobs. That is correct. And we have seen that in many2183areas.2184    For instance, the Congressional Budget Office recently2185released a report on the 340B program and how the 340B program2186encourages increasing Federal spending and consolidation.2187    Now, Obamacare did not create the program--the 340B2188program, but it certainly dramatically expanded it and is one2189of reasons why it continues to grow and continues to accelerate2190health costs.2191    Mr. Gill. Got it. And, with the remaining 30 seconds, as2192you know, there is a lot of debate right now about potentially2193extending COVID-era enhanced premium tax credits.2194    In your opinion, would that lower overall healthcare costs,2195or would it raise overall healthcare costs?2196    Mr. Jacobs. The subsidy regime is inherently inflationary2197because, once an individual hits their income in terms of how2198it is structured in the law, the percentage of income, every2199marginal dollar of a premium increase gets paid by the Federal2200Government.2201    So, insurers have no incentive to control costs because,2202whether the premium goes up by one percent or 100 percent, the2203Feds subsidize that. And so, it is an inherently inflationary2204structure. We have seen the concerns about fraud.2205    I think those reasons, coupled with the fact that2206enrollments have held study thus far in open enrollment, all2207suggest that we should allow the enhanced subsidies to expire.2208    Mr. Gill. Got it. Thank you.2209    Mr. Burlison. Thank you.2210    I now recognize the gentlelady from California, Ms. Simon,2211for 5 minutes.2212    Ms. Simon. Thank you all for coming today to be a part of2213this conversation. I especially want to say hello to my2214constituent from UC Berkeley, Dr. Obermeyer. Thank you so much2215for being here.2216    And I know we are talking about the affordability of2217healthcare and ACA credits, which I will expand on in my short2218remarks.2219    But I want to say, I am a widow, and I lost my husband, who2220left me parenting two girls by myself. And he was diagnosed2221with a terminal cancer that was so rare, only about ten people2222in the United States get this cancer each year. And, after five2223years, despite the intervention and the treatment, they all2224die.2225    Kevin had T-cell prolymphocytic leukemia. And, even with2226insurance, flying across the country to find just a little bit2227more time and getting into a clinical trial, it took all that2228we had. And, post his passing, myself and my little girls were2229left with a mountain of debt, a mountain of debt. I am so2230thankful to our insurance providers because, without them, that2231debt would have been in the millions, not just a million.2232    $27,000 a day for a bag of Campath that hung while he had2233amino therapy every day for nine months before transplant. I2234could not imagine--I could not imagine where we would be even2235though we struggled without health insurance.2236    In January there will be families, tens of thousands of2237them across the Nation--maybe in the hundreds of thousands--2238they will see their rates, but triple. Many of them will have2239no choice but to just bail out--we know that--and use emergency2240room care.2241    The Democrats and Republicans, for whatever reason--maybe2242we have not independently personally suffered enough in our own2243families to figure out how to put politics aside and get it2244right for families who are suffering, who are waiting on a call2245for a clinical trial, families who are waiting for labs like2246the CRISPR lab to develop just one more innovation that might2247give dad or mom or that baby with TPN in her nose just a little2248bit more time.2249    So, all has been said on this panel. But one of the things2250that I think it is important for me personally and politically,2251having talked to thousands of families as a cancer mom and as a2252cancer widow, we cannot innovate fast enough.2253    You know, during the congressional Black Caucus2254Foundation's annual legislative conference, I actually hosted a2255panel with OpenAI and Akido Labs, and the Hidden Genius Project2256and a brilliant scholar, Rashad Robinson, on how AI is2257transforming medicine and innovation.2258    I am from the Bay Area, the home of AI, the home of biotech2259innovation, and I am so proud to represent that sector. I am so2260proud to represent that region.2261    We know that we can, in fact, democratize medicine. We can2262democratize innovation. New technologies, including AI, present2263exciting opportunities for patients, physicians, scientists,2264and families.2265    We already know that AI is advancing lifesaving early2266detection for cancer, Alzheimer's--right in Berkeley at the2267CRISPR lab. We know we are this close. Doc, you know this--to2268providing sickle cell patients with a new lease on life. This2269close. Unfortunately, the Trump Administration took millions2270from that lab, leaving folks waiting.2271    As someone, myself, who was born a preemie with a2272congenital visual impairment, I know how important these2273technologies are for disabled communities. I know how, as I2274talked about before, important these technologies are for2275clinicians, who, when my husband was diagnosed with T-PLL, they2276were using--you all know who are physicians--they were using2277up-to-date printouts, you know, up to date. Can you imagine in2278ten years where we will be when physicians and pathologists2279will have the technology to immediately access gazillions of2280language models, again, to give patients and families more2281days?2282    So, I have some questions. I do not have the time, but what2283I am committed to doing here with you all in my district and2284beyond and with Members of this Committee across the aisle is2285engaging in a short-and long-term conversation that hopefully2286involves action to get it right for the people who need us2287most.2288    I want to thank you all for coming today. I cannot wait to2289work with you all in my office a little bit more, hopefully a2290lot of bit more, and to continue to be someone who yells from2291the rooftops about what our people deserve and what, hopefully,2292they will get.2293    And I will yield back. Thank you so much.2294    Mr. Burlison. Mr. Frost?2295    Mr. Frost. Mr. Chairman, I ask unanimous consent to enter2296into the record a Commonwealth Fund report entitled ``Expiring2297ACA Premium Tax Credits Could Lead to nearly 340,000 jobs lost2298across the United States in 2026.''2299    Mr. Burlison. Without objection.2300    Mr. Frost. And one more. This is from the Center on Budget2301and Policy Priorities, entitled ``By The Members, Harmful2302Republican Megabill Will Take Away Healthcare Coverage Away2303from Millions of People and Raise Families' Costs.''2304    Mr. Burlison. Without objection.2305    In closing, I want to say thank you again to our witnesses2306today for your testimony.2307    And, with that, I will yield to Ranking Member Frost for2308his closing remarks.2309    Mr. Frost. Thank you so much to our witnesses for being2310here, and thank you so much to Chairs, plural, for having us2311here today.2312    This conversation of healthcare affordability is incredibly2313important, very personal to so many people on this panel. And2314it is important that we look at what is right in front of us,2315which is the expiration of the Affordable Care Act tax2316subsidies.2317    Like I mentioned and I entered into the record earlier, my2318Republican colleagues on this hearing represent 738,000 people2319who depend on the Affordable Care Act tax credits.2320    In Missouri Seventh; that is 59,000 people. In Wisconsin2321Sixth, that is 34,000 people. In Alabama Sixth, that is 56,0002322people. In Arizona's Ninth, that is 44,000 people. In2323Louisiana's Third, that is 44,000 people. In Texas 17th, that2324is 76,000 people. In Florida's 19th, that is 149,000 people. In2325Florida's 13th, that is 101,000 people. In Pennsylvania's 10th,2326that is 25,000 people. In Virginia's Fifth, that is 36,0002327people. In Colorado's Fourth, that is 24,000 people. And, in2328Texas 26th, that is 90,000 people.2329    These are not just statistics and numbers. Behind every2330number, there is a person who is at risk of having their2331healthcare going up from anywhere from 50 to 300 percent. I2332think this conversation is an important conversation we need to2333have after we deal with the healthcare crisis right in front of2334us.2335    Let us pass and extend these tax credits to make sure that2336working-class people in this country do not see their2337healthcare costs go up so much that so many of them will just2338decide not to have health insurance, and then let us get to2339fixing this broken healthcare system.2340    I yield back.2341    Mr. Burlison. Thank you. I now recognize myself for a2342closing statement.2343    We heard from expert panel witnesses on how to make2344healthcare more affordable for the American people. And2345Americans want simple, affordable, transparent healthcare, but2346our current system hides the prices. It blocks competition and2347routes every decision through an unnecessary regulation and2348bureaucracy. We must prioritize innovative technologies and2349pathways forward to help lower these costs.2350    Today our witnesses spoke about their personal experience2351navigating the healthcare market. They testified on how2352misaligned structures in the current healthcare system are2353keeping healthcare costs high because there are not incentives2354to drive the costs down.2355    Artificial intelligence will eliminate unnecessary costs,2356if allowed, and may allow providers to direct their efforts2357fully toward making patients healthier. And the Trump2358Administration is paving the way forward for entrepreneurs to2359develop the best healthcare in the world while also promoting2360consumer choice.2361    We need this innovation because the status quo is totally2362broken. The American people are suffering from the un-2363Affordable Care Act passed by the Democrats.2364    Since 2014, Obamacare has skyrocketed the costs of2365healthcare and has not led to better patient health outcomes.2366The one thing that we might be unanimous on in this country is2367that Obamacare has failed in its goal of reducing healthcare2368costs. In fact, it has made it worse.2369    We hear you, America. You are not getting simple,2370affordable, and transparent healthcare right now. And that is2371why, rather than have the hearing and just have conversations,2372I am taking action. That is why I am introducing a bill called2373the Make America Healthy Again (MAHA) Act that will put2374consumers back in the driver's seat and allow for free market,2375as intended, to spur competition and lower costs and give2376people back their freedom and their choice.2377    The MAHA Act will allow consumers to shop on the price and2378the quality of healthcare services. Unlike under Obamacare,2379this will force providers to compete in the open market,2380driving down costs and making those costs actually transparent.2381    Consumers will have access to tax-free health wallet that2382patients can use as real money as opposed to coupons that are2383controlled by an insurance carrier. This account will be2384portable from job to job, giving workers their freedom back2385instead of being locked into a job because of fear of losing2386their health coverage.2387    This program will also make prices clear by encouraging2388price posting and upfront costs, creating a true consumer-2389focused market. The American healthcare system is facing a2390nationwide shortage across all major category of providers, and2391my plan would encourage the elimination of medical education2392inflation and scope creep, expand and modernize residency2393training, and eliminate arbitrary hospital caps on residency2394slots, increasing the supply of doctors and medical2395professionals.2396    The American people have spoken. They want more affordable2397healthcare. Today's hearing lays the foundation for a more2398affordable healthcare system in America by focusing on2399innovative technology and new pathways forward.2400    The Democrats have failed. Obamacare has failed. The2401American people and Republicans are ready to act. And this act,2402my MAHA Act, will fix this broken system, lower healthcare2403costs for Americans, and put American families back in the2404driver's seat for their healthcare decisions.2405    And I now recognize Chairman Grothman for his closing2406remarks.2407    Mr. Grothman. Thank you. Sorry, I had another hearing.2408    First of all, I would like to thank the chairman for2409getting us together on this very informative hearing, and I2410would like to thank all of you for coming from all the country,2411four corners of this nation, to educate us on the higher cost2412of healthcare.2413    I think we have seen consensus here today that there is2414probably too much being spent on administration and that, in2415some areas, there is overutilization driven by greed.2416    I want to thank our witnesses again. Americans want2417transparency on where their money is going, and we have the2418responsibility to deliver solutions and provide our citizens2419with the best healthcare system.2420    We learned today that implementing the innovative2421technology can provide a solution to tackle wasteful spending2422and misaligned pay incentives. The application of technology2423has the potential to address the large administrative cost2424burden that many patients must pay that they do not have2425knowledge of.2426    Many of us have experienced high cost within the healthcare2427without receiving high-value care for ourselves and families.2428One-third of healthcare spending in the United States goes to2429waste, and we must act now to address this growing problem.2430    It is going to be tough because, of course, if we spend2431less money in our healthcare system, somebody is going to be2432getting no check or a smaller check. So, the special interests2433will be out looking to protect the status quo.2434    But I think the Republican Conference is up to it, and I2435think we will stand up to those special interests and find a2436way to reduce the out-of-control costs, which is such a burden2437on your average American patient.2438    Thank you again for letting me in the room.2439    Mr. Burlison. Thank you, Chairman Grothman.2440    Thank you, Ranking Member Frost.2441    And, with that, without objection, all Members have 52442legislative days within which to submit materials and2443additional written questions for the witnesses, which will be2444forwarded to the witnesses.2445    And, if there is no further business, without objection,2446the Committee stands adjourned.2447    [Whereupon, at 11:58 a.m., the Subcommittee was adjourned.]24482449                                 [all]