Congress Shines Spotlight on Health Insurance Companies' Squeeze on Patients

By: Marcus J. Hopkins, Health Policy Lead Consultant, ADAP Advocacy

The CEOs of four major insurance companies—UnitedHealth Group, CVS Health, Elevance Health, and Cigna—testified before the House Committees on Energy and Commerce and Ways and Means on Thursday, January 22nd, 2026. It went poorly for them.

Photo Source: Kent Nishumara | Bloomberg | Getty Images

It is rare in the Year of Our Lord Two-Thousand, and Twenty-Six, for congressional enemies to join the same team when questioning witnesses, but health insurance companies seem to be one of the few industries left where bipartisan enmity is shared. And with good reason.

UnitedHealth Group, CVS Health, Elevance Health, and Cigna’s most recent financial reports indicate annual revenue growth ranging from 7.8% (CVS) to 12% (UnitedHealth & Elevance), continuing the pattern of insurers delivering for shareholders, but failing to deliver for patients.

In a statement issued after the two hearings concluded, Brandon M. Macsata, CEO of ADAP Advocacy, stated:

Patients in America are facing unprecedented increases in premiums, deductibles, and co-payments, while insurance giants make out like bandits. After Congress allowed the enhanced premium subsidies enacted during the COVID-19 pandemic to expire, marketplace benchmark premiums increased by an average of 21.7%, compared with the 2% annual increases seen from 2020 through 2025. Meanwhile, premiums increased between 6% to 7% in the employer-sponsored insurance market. These marketplace premium increases are both unconscionable and discriminatory, as they specifically target the patients who most need insurance.

These premium hikes are likely to have an outsized effect on People Living with HIV/AIDS, as most state AIDS Drug Assistance Programs assist enrollees through insurance continuation and premium and co-pay assistance.

But the issue runs deeper than premiums—one of the key moments from these hearings included an exchange between Representative Alexandria Ocasio-Cortez (D-NY-14) and CVS Health CEO, David Joyner:

Rep. Ocasio-Cortez correctly identified, explained, and excoriated Joyner for what CVS Health Group refers to as their “captive strategy.”

Photo Source: Rep. Alexandria Ocasio-Cortez | YouTube

CVS Health Group not only owns CVS pharmacies, but also owns:

• Aetna
• The health insurance company providing insurance to over 36 million Americans (Aetna, 2026)
• Oak Street Health
• A system of primary care clinics serving over 350,000 people across 27 states (Oak St. Health, 2025)
• CVS Caremark
• A Pharmacy Benefit Manager (PBM) that negotiates prices for prescription medications, processing nearly 30% of all prescriptions in a given year for more than 110 million plan members in the United States (CVS Caremark, 2026); and,
• Cordavis
• A Dublin, Ireland-based drug maker that works with existing drug manufacturers to commercialize and/or co-produce biosimilar medications for the U.S. (CVS Health, 2023)

When asked whether this collection of companies constituted “market concentration,” Joyner responded:

No, I wouldn't agree that it's market concentration. I would suggest it's a model that works really well for the consumer” (Rep. AOC, 2026).

This response, so glibly delivered, is not unique; rather, it is typical of major corporations like Microsoft, Google, Meta (formerly Facebook), and Amazon, which control multiple companies within the same sector.

It all boils down to this argument:

“This isn’t a monopoly! No! It’s just…vertical integration! It’s what’s best for consumers!”

What they’re really saying is, “It’s what’s best for shareholders and my bank account.”

Over in the House Ways and Means Committee, Representative Greg Murphy (R-NC-03) stated unequivocally:

You have put profits above patients. And you have put profits above those who care for patients. You have squarely abused your position of authority to deliver healthcare to patients in this country (Parduhn, 2026).

Photo Source: WalletInvestor.com

Paul Markovich, CEO of the non-profit parent company that owns California Blues’ largest plan, was also present for these hearings, and spared no words in criticizing the American healthcare system:

Our healthcare system is bankrupting and failing us. I’ve come to the conclusion that the system will not fix itself. The healthcare system needs some tough love and clear direction, and the American government is in the best position to provide both (Parduhn, 2026).

Markovich truly hit the nail on the head here. The American healthcare system isn’t so much a system as it is a patchwork collection of profit-driven corporations, all of whom know that they have a captive market:

• Drug manufacturers actively navigate the U.S. patent system to extend patents beyond their initial time period, secure numerous patents to cover the same product, use secondary patents to cover dosage changes, formulation changes (e.g., capsule to tablet), and even delivery methods (e.g., adding dosage counters to inhalers; Tu & Rutschman, 2025). Critics argue that these practices allow manufacturers to maintain control over the available treatment market, justify price increases, and maximize profits.
• Health insurance companies actively utilize formulary management to deny access to life-saving medications either by excluding them from their formularies outright, creating labyrinthine prior authorization processes to access them, or forcing patients to switch to medications they deem as being “similar,” but which have not been actively prescribed as they are no longer the standard of care (Giebenhain, 2017).
• PBMs act as intermediaries between individual or group pharmacies, insurance companies, pharmaceutical companies, and drug wholesalers, each of which is attempting to either save money or make a profit by (Mattingly II et al., 2023):
• Designing formularies (i.e., determining which medications are available to patients)
• Managing drug utilization (e.g., creating prior authorization requirements, including step-therapy, supply limits, and/or tiering medications based on their list prices or utilization)
• Negotiating purchasing prices between pharmacies, wholesalers, and drug manufacturers
• Forming pharmacy networks that lock patients into purchasing covered medications at specific locations (e.g., speciality pharmacies)
• Providing mail-order pharmacy services

PBMs have come under consistent criticism over the past twenty years for creating market conditions that have limited competition. By 2023, 3 PBMs accounted for 79% of prescription drug claims in the U.S., and just 6 PBMs handle 96%. CVS Caremark accounted for 33% of all prescription drug claims, followed by Express Scripts (24%) and OptumRx (22%; Mattingly II et al., 2023).

Corporate profits soar; shareholders get paid; patients suffer.

This is the plight of the American Patient: getting left behind with more and more medical debt. Meanwhile, American life expectancy lags behind that of comparable nations (Sharfstein et al., 2024), even as we’re told we have “the best healthcare system in the world.”

Paul Markovich was right: the U.S. government is in the best position to fix the U.S. healthcare system. In all likelihood, however, it lacks the political will.

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.

References:

[1] Aetna. (2026). About Us. Hartford, CT: CVS Health Group: Aetna: About Us. https://www.aetna.com/medicare/footers/about-us.html

[2] CVS Caremark. (2026). About Us. Woonsocket, RI: CVS Health Group: CVS Caremark: About Us. https://business.caremark.com/about-us.html

[3] CVS Health. (2023, August 23). CVS Health launches Cordavis. Woonsocket, RI: CVS Health Group: New: PBM. https://www.cvshealth.com/news/pbm/cvs-health-launches-cordavis.html

[4] Giebenhain, K. (2017, June). Dirty Laundry: Drug Formulary Exclusions. AMA Journal of Ethics, 19(6): 629-630. https://doi.org/10.1001/journalofethics.2017.19.6.imhl1-1706

[5] Mattingly II, T. J., Hyman, D. A., & Bai, G. (2023, November 03). Pharmacy Benefit Managers: History, Business Practices, Economics, and Policy. JAMA Health Forum, 4(11): e233804. https://doi.org/10.1001/jamahealthforum.2023.3804

[6] Oak Street Health. (2025, May). The Gold Standard of Advanced Primary Care for Medicare Beneficiaries. Chicago, IL: CVS Health Group: Oak Street Health. https://www.cvshealth.com/content/dam/enterprise/cvs-enterprise/pdfs/2025/Oak-Street-White-Paper-2025-v2.pdf

[7] Parduhn, R. P. (2026, January 23). Insurance CEOs’ no good, very bad day on the Hill. Newton, MA: Informa TechTarget: Industry Dive: Healthcare Dive: News. https://www.healthcaredive.com/news/health-insurance-ceos-house-hearings-affordability/810269/

[8] Representative Alexandria Ocasio-Cortez [RepAOC]. (2026, January 22). Rep. AOC Calls Out CVS Health’s Corporate Strategy to Monopolize Patient Care  [Video]. YouTube. https://www.youtube.com/watch?v=ayNKCNhoD7w

[9] Sharfstein, J., Gemmill, A., Appel, L., Angell, S., Saloner, B., Horwitz, J., Villareal, S., Alvarez, K., & Ehsant, J. (2024, December). A Tale of Two Countries: The Life Expectancy Gap Between the United States and the United Kingdom. Baltimore, MD: Johns Hopkins University: Johns Hopkins Bloomberg School of Public Health. https://americanhealth.jhu.edu/sites/default/files/2025-02/2024 Life Expectancy Report.pdf

[10] Tu, S. S. & Rutschman, A. S. (2025, November 14). Mapping Intellectual Property Abuses in the Pharmaceutical Field. JAMA Health Forum, 6(11): e254938. http://doi.org/10.1001/jamahealthforum.2025.4938