Insurers face new GOP pressure on affordability

• But the administration and Congress have less leverage than they have with drugmakers, and would have to address underlying drivers of health costs to really do something about premiums.

Driving the news: House Republicans have called CEOs of five of the largest health insurance companies in back-to-back hearings on Thursday, where they will be pressed on costs of coverage.

• Executives from UnitedHealth, CVS, Elevance, Cigna and Ascendiun will appear before the House Energy and Commerce and Ways and Means committees.
• Energy and Commerce Chair Brett Guthrie (R-Ky.) said on Wednesday the companies cover over half of the insured lives in the U.S., "so everybody's being affected by the high cost of health insurance."

Between the lines: It's one thing to bash insurers, but quite another to match the talk with substantive health system changes.

• "I think it's interesting that they're adopting some of the anti-insurer, populist rhetoric, but it needs to be backed up with actual policies that hold the health industry to account," said Anthony Wright, executive director of consumer group Families USA.
• He added that the hearing also should not be used to "distract" from the need to extend the ACA subsidies.

The other side: Insurers agree that health care costs are too high, but say they're the part of health care that's working to bring costs down. Executives blame high premiums on the prices charged by hospitals and drug companies.

• "Congress is doing its job," Mike Tuffin, CEO of the insurer trade group AHIP, told Axios when asked about the pressure from Republicans.
• But he added that "a thorough evaluation of the causes of higher premiums clearly demonstrates that it's the underlying cost of medical care that is the reason that premiums continue to go up."

What they're saying: Stephen Hemsley, CEO of UnitedHealth Group, will strike a note of contrition in his testimony, saying "like all of you, we are dissatisfied with the status quo in health care," according to prepared remarks.

• "The cost of health insurance is driven by the cost of health care," he adds. "It is a symptom, not a cause."

• Still, Hemsley will say his company will rebate its profits this year from ACA coverage back to consumers, though he notes the company is a "relatively small participant" in that market. It's unclear how much money will be rebated.
• UnitedHealth became the object of widespread consumer anger just over a year ago, when the killing of CEO Brian Thompson unleashed a wave of social media-fueled rage over coverage denials and other business practices.

The big picture: Insurers say they support a range of policies aimed at lowering health care costs by targeting hospitals and drug companies.

• Those include "site-neutral" payment policies to address hospital outpatient billing, efforts to curb hospital consolidation and a crackdown on tactics drug companies use to delay cheaper generic competition.
• But lawmakers have broached other changes that would directly strike health plans, like targeting what many experts say are overpayments in Medicare Advantage, or restricting pretreatment reviews that can lead to denials of care.

What's next: Trump earlier this month said he wanted a meeting with health insurance executives to press them on costs, but nothing is on the schedule and it's unclear if that will happen.

• Tuffin said he also expects future House hearings on health care costs with other parts of the health care industry besides insurers.
• An Energy and Commerce Committee spokesperson confirmed there's more to come but declined to provide details.