18 Mar It’s Time to Hold Hospitals Accountable for Driving Up Healthcare Costs
On March 18, 2026, the House Energy and Commerce Subcommittee on Health will convene a hearing titled Lowering Health Care Costs for All Americans: An Examination of the U.S. Provider Landscape — the third installment in the Committee’s health care affordability series. Chairmen Guthrie and Griffith have committed to examining the role of hospitals and providers in driving up the cost of care, including the impact of payment policies, competition, and transparency.
That evidence points to large hospital systems. Through consolidation, price opacity, and exploitation of federal safety-net programs, these hospital systems are making healthcare unaffordable — and the burden falls most heavily on historically underserved communities and low-income patients who have the fewest alternatives.
Consolidation of Care
Large hospital systems have spent years acquiring physician practices, absorbing competitors, and expanding their market dominance. Today, at least 47% of physicians are employed by or affiliated with hospital systems — up from less than 30% just a decade ago. In theory, the economies of scale lower the cost of care for providers and patients alike. However, once acquired, physician services are frequently reclassified as hospital-based, triggering costly “facility fees” for what used to be a routine office visit. As a result of consolidation, large hospital systems often leave patients with fewer choices and higher bills.
For communities of color, consolidation is not just a cost problem; it is an access problem. Research shows residents in predominantly black communities face four times the odds of hospital closure compared to white communities, regardless of income level. Consolidated systems are more likely to cut essential services, such as maternal care, surgical units, and specialty clinics, which these communities depend on. Black and American Indian/Alaska Native mothers already experience disproportionate pregnancy-related mortality rates compared to white women. Losing nearby hospital services deepens that inequity in care.
Price Transparency
Compounding the problem is the absence of price transparency. Federal rules requiring hospitals to publish their prices have been on the books for years, yet as of 2024, fewer than one in five hospitals were fully compliant. Some hospitals have embedded code in their websites to hide pricing data from search engines and patients. Without visible prices, uninsured and underinsured patients cannot make informed decisions before receiving care. In 2022, 46% of uninsured Americans skipped necessary medical treatment due to cost concerns. As Hispanic and American Indian/Alaska Native populations are least likely to be insured, increasing price transparency represents not only a consumer interest but a major issue of equity.
340B Program Exploitation
The 340B Drug Pricing Program is another glaring example of how large hospital systems manipulate federal safety-net programs to generate profit at the expense of patients. The 340B Program was envisioned to help safety-net hospitals better serve low-income, uninsured, and underserved patients. The program requires drug manufacturers to offer discounts, often exceeding 50%, to qualifying hospitals. Lawmakers assumed those savings would flow to patients, protecting our nation’s most vulnerable communities.
However, the program’s design has instead been subject to rampant exploitation. Large hospital systems purchase drugs at steep federal discounts, then bill insurers, Medicare, Medicaid, and uninsured patients at full list price while pocketing the difference instead of passing savings to patients. In fact, only around half of covered entities offered 340B discounts to low-income, uninsured patients at their contract pharmacies, and among those that did, three-quarters failed to give the full discount.
Lawmakers originally expected approximately 90 hospitals to participate in the program. Total, that number has grown to more than 2,600, with many operating satellite clinics and contract pharmacies in affluent, well-insured neighborhoods rather than high-need communities. Between 2010 and 2021, spending on 340B-covered drugs grew 565%. That rate of growth does not reflect safety-net expansion but rather a perverse mechanism for hospital systems to generate billions in profit at the expense of patients.
Congress Needs to Act:
In order to address the rising cost of care and protect the nation’s most vulnerable populations, Congress should consider:
- Strengthening hospital price transparency enforcement with meaningful monetary penalties and closing loopholes that allow hospitals to hide actual prices
- Addressing anti-competitive consolidation by establishing guardrails on mergers and acquisitions that seek to eliminate competition, raise prices, and strip essential services from underserved communities
- Requiring charity care benchmarks for large, tax-exempt hospital systems that profit from 340B to ensure that proceeds generated in the name of vulnerable patients are reinvested to serve them
The 340B ACCESS Act (H.R. 44) is a great example of a legislative vehicle that can achieve such goals.
Restoring integrity to our healthcare system — and to the 340B program in particular — is not a partisan issue. It is a patient issue. The savings this program generates in the name of vulnerable Americans should reach them. We urge Congress to keep patient access and improved health outcomes at the center of this week’s hearing and to translate that commitment into law.