A series of House hearings last week signaled a bumpy road ahead for hospitals, Caitlin Owens reports.

The big picture: The momentum behind a slew of hospital policy changes will test how well the industry's political power will hold — especially given that one of its key allies is Chuck Schumer.

State of play: House committees are examining a range of policies generally opposed by the hospital industry, including site-neutral payments, more price transparency enforcement, cracking down on consolidation and repealing restrictions on physician-owned hospitals.

• Ashley Thompson, a senior vice president at the American Hospital Association, said at last week's Energy and Commerce hearing that the AHA "strongly opposes" the site-neutral payment cuts being considered and argued that hospitals treat sicker patients and have higher costs than doctors' offices.

What they're saying: "American hospitals are entering a new era of scrutiny," Alex Schriver, executive director of Better Solutions for Healthcare, wrote in a memo Wednesday ahead of four hospital-related House committee hearings.

• "Once unthinkable, these hospital practices are now squarely in Congress’ focus, with patients and policymakers increasingly opening their eyes to the fact that hospital spending is the dominant driver of the healthcare affordability crisis in America today," he added.
• The existence of Schriver's group itself — which includes employers and insurer groups — is a change to the status quo.
• Another group comprising think tanks and individual policy experts from across the ideological spectrum is also launching and will push for site-neutral payments in Medicare and hospital transparency legislation, Victoria reported last week.

Reality check: The momentum is real, but hospitals are a particularly tricky industry group to take on, since nearly every member of Congress represents one and many have struggled financially in the aftermath of the pandemic.

• Key Senate committees haven't shown the same level of interest in hospital reforms, at least not yet. And even if they did, there's the Schumer factor: He's known as a staunch hospital ally.
• Schumer and House Minority Leader Hakeem Jeffries are "longtime supporters of New York’s hospital community, and [the Greater New York Hospital Association] is grateful for their leadership,” Brian Conway, the association’s senior vice president for communications, told STAT this year.

Between the lines: "The Energy and Commerce agenda does not seem to be on the Senate’s agenda. The HELP committee is focusing on PBMs and pharma, the Finance Committee is talking about rural health care and other things, and you don’t see a lot of focus on it over there right now," one hospital lobbyist told Axios.

• "But it's still relatively early in the legislative season."
• Given the importance of New York hospitals to the state, Schumer is "going to be very cognizant of and careful about any policies that are going to affect Medicare beneficiaries and the hospitals that serve them," the lobbyist added.

Yes, but: Protecting hospitals isn't Schumer's priority, of course, and he has a series of negotiations over the debt ceiling and government spending to navigate over the next few months. Plus, hospital policy changes have the potential to win strong bipartisan support.

• "While Leader Schumer is a hospital fan and protector, it is not knee jerk for everything; it depends on the issue, its impact on consumers, the broader legislative vehicle and the politics of the day," one Democratic consultant told Axios.

The bottom line: The details of any legislative proposal will matter, both in terms of how fiercely hospitals oppose it and how likely members such as Schumer are to support it.

With the House out this week, these Senate events should be on your radar.

1. HELP markup of health care costs legislation: This is the one we told you about last week when Bernie Sanders and Bill Cassidy struck their deal on PBM and generics legislation.

• They'll mark up the Pharmacy Benefit Manager Reform Act, a new bill by Sanders, Cassidy, and Sens. Patty Murray and Roger Marshall that would impose transparency measures on PBMs.
• Other bills to be marked up are the Ensuring Timely Access to Generics Act of 2023, the Expanding Access to Low-Cost Generics Act of 2023, and the Retaining Access and Restoring Exclusivity (RARE) Act.
• The markup is Tuesday at 10am ET.

2. Finance hearing on ghost networks: Peter told you about this one in March. It's a big concern for Finance Chair Ron Wyden, who's worried about the impact on mental health care when health insurer networks don't provide enough access.

• The hearing is Wednesday at 10am ET.

3. HELP on PAHPA reauthorization: Who doesn't love a hearing on the Pandemic and All-Hazards Preparedness Act? Check it out Thursday at 1pm ET, and read Maya's smart scene-setter to get ready for it.