Hospital leaders testified before Congress. Here’s why it matters here.

In April, hospital and health system CEOs from across the country testified before the U.S. House Ways and Means Committee on the pressing issues of health care affordability and the sustainability of access to care for patients, particularly in rural and safety-net communities.

Their testimony is worth reviewing in full. Taken together, it provides a clear, consistent view of the structural challenges facing hospitals nationally and the policy choices that will shape access to care in the years ahead.

Key themes

1. Rising costs for health care systems – Costs are continually rising, many of which are outside of the control of health care systems. Across multiple systems, executives pointed to the same drivers of cost growth: workforce, wage inflation, increasing pharmaceutical and supply costs and rising administrative complexity. For example, CommonSpirit Health, which operates 158 hospitals in 24 states, reported that labor accounts for more than half of operating expenses and has risen more than 20% in the last five years.

2. Administrative burden – The testimony also underscored the growing weight of administrative burden across the health care system, shaped by both regulatory complexity and insurer-driven practices. Hospital leaders described a landscape defined by overlapping federal and state rules, duplicative reporting obligations and fragmented compliance frameworks that require significantly more resources to manage. In some cases, these layers operate independently of one another, creating inefficiencies that drive up costs while pulling clinical staff and operational teams away from direct patient care. This is not a marginal issue – executives emphasized that administrative infrastructure has become a core cost driver, particularly for systems operating with limited scale and high public-payer mix. An American Hospital Association study found that hospitals spend approximately $50,000 per inpatient bed each year to manage and comply with federal regulations. At the same time, insurance-related processes remain a central component of that burden. Requirements such as prior authorization, claim adjudication and multi-platform billing systems introduce additional complexity into care delivery, often delaying treatment and increasing workload for care teams. A 2024 American Medical Association survey cited in the hearing found that nine out of ten physicians reported prior authorization requirements negatively impact patient outcomes and delaying care, with nearly one in four reporting it had led to an adverse clinical outcome for a patient. Taken together, regulatory and payer-driven administrative demands form a single, deeply interconnected challenge, one that hospital leaders consistently identified as a significant pressure point for both cost and access.

3. Medicare and Medicaid shortfalls – Further exacerbating the financial challenges for health care systems, particularly for safety net hospitals, is the fact that government programs, such as Medicare and Medicaid, do not cover the cost of care for hospitals. CommonSpirit’s CEO noted that Medicare reimbursement is approximately 80% of cost, while other systems reported similar shortfalls. Asante has similar shortfalls for Medicare, and even greater shortfalls for the Medicaid/OHP, where reimbursement covers only 67 cents per dollar spent by the system.

4. Insurance coverage stability – Health care leaders also emphasized the importance of stable insurance coverage. Patients with reliable coverage are more likely to seek care earlier and avoid more complex, emergency-driven treatment. Conversely, when coverage is lost or becomes unstable, hospitals see increases in delayed care and uncompensated services. According to a recent Kaiser Family Foundation report, the recent expiration of Affordable Care Act subsidies has resulted in an estimated 5.8-6.8 million fewer people covered just this year. Over time this will result in patients delaying care and health care providers seeing sicker, more acute patients, often without any compensation for the services they provide.

5. Expanded safety net – Hospitals are serving broader community needs. The testimony also reinforced the expanding role hospitals play beyond traditional clinical care. Hospitals are increasingly filling gaps in behavioral health, supporting public health and investing in workforce development, often without direct reimbursement. HCA Healthcare alone reported $4.5 billion in uncompensated care in one year. For rural systems in particular, hospitals remain the primary access point for entire communities. Policy decisions are shaping financial stability. Perhaps most notably, executives emphasized that financial performance is increasingly driven by policy choices — including reimbursement rates, coverage decisions and administrative requirements — rather than operational efficiency alone.

What it means for Asante
While the testimony reflects national conditions, the underlying pressures are particularly relevant for rural and safety-net providers. For health systems in regions like southern Oregon, where public payer mix is high and access challenges are real, these policy dynamics have direct implications for patients, communities and the long-term sustainability of care in the Rogue Valley.

We encourage policymakers, stakeholders and community members to review the full testimony and consider how these national themes translate locally.

Full hearing and Written Testimony found here: https://waysandmeans.house.gov/event/full-committee-hearing-with-health-system-ceos/