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Health Subcommittee Chairman Buchanan Opening Statement – Hearing on Why Health Care is Unaffordable: Anticompetitive and Consolidated Markets

May 17, 2023

As prepared for delivery.

“Today’s hearing will focus on the health care marketplace and how it’s become more consolidated and less competitive in recent years, leading to higher prices and fewer options for patients.


“There are many factors that contribute to this problem, and we need to work together and find bipartisan solutions.


“Whether it’s:


  • PBMs – the drug supply chain black box – warping patient costs at the pharmacy counter
  • Insurers buying large PBMs and pharmacies
  • Insufficient site-neutrality in Medicare
  • Large nonprofit hospitals buying everything in sight
  • Or Obamacare’s prohibition on physician-owned hospitals,


“We must address these systemic failures to help decrease costs and increase patient access to care.


“I represent one of the oldest districts in the country with about 250,000 seniors living there. Some of the best competition in the health care marketplace is found in Medicare Advantage and Medicare Part D, with Part D celebrating its 20th anniversary this year.


“Initially Republican ideas, these programs have found ways to keep out-of-pocket costs down for seniors and have robust marketplaces where enrollees can shop for the plan that works best for them.


“On the other end of the spectrum, one of the worst examples of consolidation over the last few years is an increase in what some refer to as vertical integration.


“This most often occurs when an insurer, PBM and pharmacy merge, creating a huge monopoly, which decreases patient access and increases prices.


“While the FTC allows these mergers to occur since they’re in different areas of health care, they’re no less problematic – they result in fewer options for patients and reduced competition.


“We can all agree that prescription drugs cost too much, but while generics account for 90 percent of the prescriptions filled each year, and three PBMs control about 80 percent of the market share, competition isn’t working how it should.


“Unfortunately, consolidation like this isn’t unique to insurers, PBMs and pharmacies.


“Large hospital systems are moving into areas where they previously had no footprint, buying up smaller hospitals and independent practices in order to increase their size and stamp out competition.


“Hospital care accounts for nearly one-third of all health care spending each year – or over $1.3 trillion in 2021.


“This spending will only continue to increase if we don’t find ways to create more site-neutrality and increase competition in areas where one health system buys up – or drives out – all other providers.


“Actions like these are a disservice to our constituents, and it’s time we shine a light on them.


“We all want to preserve and promote access to high quality care for all Americans, but Congress has looked the other way for too long and we can’t let that continue.


“I worked with my colleagues on Speaker McCarthy’s Healthy Future Task Force to come up with ideas on how to address the lack of competition in health care.


“We released our recommendations last summer, and it’s time we put in the hard work to implement these policies.


“We should look closely at:

  • reforming site-neutral payments;
  • repealing the physician-owned hospital moratorium;
  • slowing down the consolidation of hospital systems;
  • and the practice of insurers teaming up with PBMs and pharmacies to stop the market distortions and bring real competition back to health care.

“It won’t be easy, but our constituents are the ones hurt by our inaction, and we owe it to them to fix the problem.


“As I said before, I am hopeful we can find bipartisan solutions to the problem of consolidation in the health care market.


“I look forward to working with my colleagues on both sides of the aisle to right this wrong.”