Republicans and Democrats in the House Budget Committee spent Wednesday blaming each other for the steep cost of healthcare, and arguing for diametrically opposed ideas to lower it. However, a few areas of bipartisan agreement emerged, including targeting healthcare consolidation — once an unheard-of view for members of the GOP.
“We got problems in Peoria with consolidation, with too much power and too many assets in too few market participants,” said Chairman Jodey Arrington, R-Texas, referring to a small community in Hill County. “You know how we feel about big government ... but the most important thing here is, I think there’s common ground here.”
“We ought to huddle up at some point, probably not during a hearing, and figure out where we can deal with big medicine monopolies in pharma, hospital, insurance — the whole gambit. And I just want you to know I’m down with that,” Arrington continued.
Democrats have long railed against corporate consolidation, arguing that excessive mergers drive up prices for consumers by suppressing competition. But Republicans agreeing with their counterparts across the aisle highlights a notable pivot for the party.
Still, the GOP has become more populist under President Donald Trump’s MAGA movement. Republicans also face intense public pressure to lower healthcare costs after more generous financial assistance for plans on the Affordable Care Act expired at the end of 2025. More than 20 million subsidized Americans are facing steep premium hikes for coverage this year as a result. About 4 million of those people are expected to go uninsured.
However, this year’s ACA affordability cliff exists within a larger debate over the nation’s growing healthcare bill.
The amount the U.S. spends on healthcare has been ticking up slowly for decades. According to national spending data released by the CMS this month, U.S. health spending reached $5.3 trillion in 2024, up 7.2% from the year prior.
Worryingly, healthcare’s share of the nation’s overall economy has also risen, from 17.7% in 2023 to 18% in 2024.
“That is by no measure sustainable in the long run,” Benedic Ippolito, a senior fellow with center-right think tank the American Enterprise Institute, said during the hearing.
Consolidation is a major driver of rising healthcare spending, according to research and health policy experts that testified at the hearing.
The U.S. healthcare industry is highly consolidated. Years of largely unchecked mergers and acquisitions have created a few dominant health systems or insurers controlling most markets in a given region. It’s a growing concern for policymakers, given concentration is directly linked to higher healthcare prices without a commensurate improvement in patient outcomes.
For example, 90% of hospital markets were highly concentrated in 2017, and data suggests concentration has only increased since, according to a MedPAC analysis and research from the Urban Institute.
As for health insurers, exact percentages differ by insurance market and geographic area. But the 10 biggest insurers cover more than half of all enrollees in private insurance, Medicaid plans and privatized Medicare coverage, according to health policy research firm the KFF and the Peterson Center on Healthcare.
“Congress must start by breaking up the monopolies,” testified Joel White, the president of the Council for Affordable Health Coverage, which advocates for strengthening private insurance. “Market consolidation is foundationally increasing prices in almost every area of the country.”
“We got to break up the monopolies. I couldn’t agree with you more,” said Rep. Becca Balint, D-Vt. “Why are we not taking up the issue of consolidation? Why are we not taking on the monopolies? I look forward to actually doing that work.”
In the past few years, Democrats introduced a few bills that would target concentration in the healthcare industry, including the “Stop Anticompetitive Healthcare Act,” which would give the Federal Trade Commission enforcement authority over nonprofit hospital mergers, and the “Patients Before Monopolies Act,” which would forbid pharmacy benefit managers from owning pharmacies. Both have Republican cosponsors.
“An area we agree, or at least we have in this committee today, and that is on taking on consolidation within the healthcare system,” Rep. Pramila Jayapal, D-Wash., said during the hearing.
Still, despite the bipartisan agreement, attempting to break up healthcare conglomerates is a steep uphill battle. Other areas with support on both sides of the aisle, like increasing price transparency, equalizing medical costs between sites of care or cracking down on PBMs, would be easier to enact into law — indeed, Congress is set to vote on a funding agreement that includes PBM reform later this month.
Though, such piecemeal actions are unlikely to significantly move the needle on healthcare affordability, experts say.
