Executives from five of the country’s largest health insurance companies appeared before Congress on Thursday as lawmakers examined why healthcare has become increasingly harder for Americans to afford.
In one effort to address the affordability crisis, the CEO of UnitedHealth Group, Stephen Hemsley, announced that the nation’s largest insurance company will rebate profits made this year from its Affordable Care Act (ACA) plans to customers, while adding it was a relatively small participant in the ACA individual market.
In addition to UnitedHealth, leaders from CVS Health, Elevance Health, the Cigna Group, and Ascendiun testified before the House energy and commerce committee during a morning session tied to Republican efforts to curb healthcare costs ahead of the 2026 midterm elections.
The hearing was convened by Brett Guthrie, a Republican who chairs the energy and commerce committee, along with fellow Republican Morgan Griffith, chair of the subcommittee on health.
The testimony comes as healthcare expenses continue to climb nationwide. According to a survey by health policy group KFF, premiums for families with employer-based insurance rose 6% in 2025, reaching nearly $27,000 a year.
Overall healthcare spending in the US surged 7.2% in 2024 to more than $5.3tn, based on figures from the Centers for Medicare and Medicaid Services. That total represented 18% of US gross domestic product last year.
Guthrie said in his opening remarks that this hearing would mark the beginning of a broader series involving healthcare industry leaders aimed at identifying ways to reduce costs across the system.
“The insurance market is dominated by a handful of Fortune 50 corporations that control the majority of the national market,” Griffith said in his opening remarks. He went on to say that the market “lacks transparency and is not easily navigable”.
He added: “We owe it to patients to get to the root causes of the challenges we see across the health sector.”
Congress has been focused on insurance affordability for months, particularly as lawmakers in both chambers have been unable to agree on renewing enhanced ACA subsidies that were introduced during the Covid-19 pandemic.
Several lawmakers used the hearing to challenge the insurers directly. Representative Diana Harshbarger, a Republican who is also a pharmacist, questioned the executives on how coverage decisions are made for prescription drugs and how drug prices are set. She accused insurance companies of effectively dictating how the market functions.
“That’s not competition, that is control. And that isn’t just participating in the market, it’s running the rules of the market,” she said.
Representative Alexandria Ocasio-Cortez spoke about corporate consolidation within the industry, noting that CVS Caremark owns Aetna, CVS pharmacies and some drug manufacturers.
“The health insurance gets a cut, the pharmacy benefits manager gets a cut, the drug manufacturer gets a cut and the patient gets screwed,” she said. Ocasio-Cortez added that dismantling corporate monopolies is an area of agreement between capitalists and a “card-carrying democratic socialists”.
UnitedHealth Group, which provides insurance coverage to about 1 million individuals enrolled in Obamacare plans in 30 states, announced at the hearing that it will return profits earned from its ACA plans to customers in 2026.
Hemsley stated in prepared remarks: “Though UnitedHealthcare is a relatively small participant in the individual ACA market, we will voluntarily eliminate and rebate our profits this year for these coverages, as Congress continues to work toward more long-term solutions.”
Donald Trump has stated he opposes restoring the Obamacare subsidies and instead has proposed direct payments for consumers purchasing insurance, which could be deposited into health savings accounts, though his recently revealed framework for healthcare affordability was met with criticism over the lack of detail and clear methods for realization.
Democrats, meanwhile, have pushed to extend enhanced premium tax credits that reduce ACA plan costs. Earlier this month, the US House passed legislation to re-establish tax credits that lowered premiums for ACA health plans after a small group of Republicans broke ranks and joined with Democrats.
Without those subsidies, premiums were projected to double, prompting many individuals to drop their coverage. Last year, a record 24 million Americans purchased ACA plans.
This year, enrollment has fallen behind. About 22.8 million people have signed up so far, according to federal data, roughly 800,000 fewer than at the same point last year. Both new sign-ups and returning enrollees are down.
