Jason Smith: Restoring a health care system that puts patients first

(From Eighth District Congressman Jason Smith)

For too many American families, workers, and seniors, health care is increasingly unaffordable, with double digit premium increases now going into effect on an annual basis. When many Americans think of health insurance, they think of higher costs, soaring deductibles, denied claims, and increased stress from something that is meant to improve their lives. But what enrages so many working families even more is that while they are struggling to find the money to pay for it all, health insurers are posting record profits and consolidating greater control over America’s health care system. 

That is exactly why I called the CEOs of five of the nation’s largest health insurance empires to testify in front of the Ways and Means Committee: to get answers about why costs keep climbing, figure out what can be done to fix our health care system, and to hold folks accountable for their decisions.

Today, the average family health insurance plan costs roughly $27,000 a year. Individual deductibles routinely exceed $3,000, and family deductibles can reach $10,000 or more. Since the Un-Affordable Care Act (ACA) — also known as Obamacare — was enacted, premiums in Obamacare’s Health Exchanges have increased by roughly 80 percent, while families face out-of-pocket maximums exceeding $20,000. But the exploding cost of health insurance extends well beyond Obamacare, which covers only about 7 percent of Americans. Employer-sponsored plans — covering more than 160 million people — are now experiencing their largest premium increases in more than a decade.

One of the most troubling revelations from the hearing we held was how difficult insurers are making it for patients. Roughly one in five medical claims is denied. Patients are left navigating bureaucratic systems designed around insurer priorities instead of individual needs, while consolidation has reduced competition and choice. Today, just three insurers control nearly half of the national market, and three pharmacy benefit managers dominate roughly 80 percent of drug benefits. While costs for families rise, these health insurance empires rake in nearly $1 trillion in annual revenue, while their executives are rewarded with tens of millions of dollars in bonuses.

The hearing also underscored the role Democrats’ failed health care policies have played in driving these outcomes. Open-ended subsidies and rigid Washington mandates that may have been intended to expand access and lower costs, have instead rewarded higher spending, consolidation, and complexity. Federal programs lacking proper guardrails have become magnets for waste and fraud, with taxpayers footing the bill. Despite trillions of dollars flowing through the system, families are paying more and getting less in return.

These failures are felt even more intensely in rural communities like south-central and southeast Missouri. When costs rise and access shrinks, rural hospitals and clinics — already operating on thin margins — are often the first to feel the strain. Families in rural areas already face fewer provider options, longer travel times for care, and higher out-of-pocket burdens, making affordability not just a financial issue, but a question of access to care itself.

The takeaway from the Ways and Means Committee hearing was clear: the status quo is not working, and Americans deserve better. That is why President Trump’s Great Healthcare Plan — which he announced on January 15 — is so important. The President’s plan lays out a framework focused on restoring affordability by strengthening competition, increasing transparency, and holding abusive middlemen accountable. It expands health savings options, promotes direct primary care and telehealth, cracks down on fraud and abuse, and puts patients — not insurers or Washington bureaucrats — back at the center of the system.

Lowering health care costs will not happen overnight, but it starts with honest oversight, tough questions, and a willingness to challenge a broken system. Health insurers are one piece of the health care system, but they are by no means the only industry in need of oversight — and the Ways and Means Committee plans on continuing to pursue answers on behalf of American patients and families. With President Trump’s leadership and the continued work of Congress, we can build a health care system that delivers affordability, access to quality care, and peace of mind for families in every corner of the country — urban and rural alike.