The Senate Finance Committee led a high-stakes hearing Nov. 19 on the affordability crisis unfolding across the U.S. healthcare system. Lawmakers on both sides of the aisle warned that Americans are facing staggering premium hikes, shrinking coverage options and escalating out-of-pocket costs as Congress remains divided on how to respond.
Five takeaways from the hearing:
1. ‘Our healthcare system is broken’: Sen. Crapo calls for a structural reset
Committee Chair Sen. Mike Crapo (R-Idaho) opened the hearing with a sweeping indictment of the U.S. healthcare system.
“Our healthcare system is broken. Obamacare failed to make health care more affordable,” Mr. Crapo said, pointing to rising premiums and out-of-pocket costs across the individual market. He argued that existing ACA subsidies “mask year-over-year price increases” and that the expiration of ACA premium tax credits accounts for only 3 to 4 percentage points of the increases confronting consumers today.
Mr. Crapo pushed for both short- and long-term reforms: from expanding health savings accounts and funding cost-sharing reductions to accelerate telehealth access, tackle industry consolidation and realign incentives in the drug supply chain.
2. ‘A health cost freight train’ is hitting families during open enrollment
Ranking Member Sen. Ron Wyden (D-Ore.) criticized Republicans for failing to act sooner on the looming ACA premium spikes.
“Millions are logging onto Healthcare.gov and seeing premiums double, triple — or in Oregon, even worse,” he said. “There is a health cost freight train … hurtling into view as we speak.”
Mr. Wyden highlighted the story of Oregon residents facing 500% premium increases, rising from roughly $400 to more than $2,200 per month, calling the situation “catastrophic” with open enrollment ending in less than four weeks.
3. PBM reform emerges as rare bipartisan territory
Despite deep divides over the ACA, both parties signaled momentum to regulate pharmacy benefit managers, according to Politico.
Mr. Crapo said in his opening statement that he and Mr. Wyden will soon reintroduce their bipartisan PBM reform package: “We invite all members of this committee to join us as co-sponsors as we move the bill to the president’s desk.”
The push comes amid increased scrutiny of the three largest PBMs — OptumRx, CVS Health and Express Scripts — which control most of the U.S. prescription market.
The National Association of Chain Drug Stores praised the committee’s unity, with President and CEO Steven Anderson stating: “The problem is the harmful, self-enriching tactics of PBM middlemen. The solution is a package of long-overdue reforms that is ready to deliver for the American people.”
4. Premium spikes are real — and rapidly worsening
Senators from both parties acknowledged the severity of the cost crisis.
“Millions are seeing premiums double or triple,” Mr. Wyden said, while Mr. Crapo noted that only a small share of increases are tied to subsidy expirations and that deeper structural failures are driving the trend. Senators also cited new Joint Economic Committee data showing that ACA subsidies have benefited payers most, with rising stock prices corresponding to higher federal payments.
Several Republican lawmakers and witnesses argued ACA regulations have created a “one size fits all” market that drives consolidation while reducing innovation and consumer choice. Mr. Crapo added that too much vertical integration across health systems and insurers risks “monopolistic powerhouses that block innovative disruptors.”
5. Consumers may see more direct assistance through HSAs under GOP plans
Mr. Crapo suggested shifting subsidies away from insurers and toward consumers through health savings accounts, which he said were recently made available on ACA exchanges.
“If we keep advancing a system that drives up premiums, we will make this problem even harder to solve,” Mr. Crapo said. “Instead, we should set the groundwork for giving Americans more control over their healthcare choices. Rather than accepting the current system of giving billions of taxpayer dollars to insurers, we should consider providing financial assistance directly to consumers through health savings accounts, which are now available on the Obamacare exchanges because of a provision in the One Big Beautiful Bill. Leveraging long-standing provisions in the tax code, like the medical expense deduction, could help patients further defray high out of pocket costs to guide future policymaking.”
He also proposed expanding the medical expense deduction and funding cost-sharing reductions to reduce premiums by more than 10% across ACA plans.
