June 9, 2026
The Honorable Morgan Griffith
Chairman
Energy and Commerce Subcommittee on Health
Washington, DC 20515
The Honorable Diana DeGette
Ranking Member
Energy and Commerce Subcommittee on Health
Washington, DC 20515
Dear Chairman Griffith, Ranking Member DeGette, and Members of the Subcommittee,
National Taxpayers Union, the nation’s oldest taxpayer advocacy organization, commends the Health Subcommittee for holding a hearing on how increasing price transparency in health care can lower costs for patients and employers alike. Layers of state and federal mandates have buried the American health care system in red tape, and often this bureaucratic complexity prevents consumers from fully understanding the prices they pay for care. Just like in any other market, price signals help allocate scarce resources, and any serious attempt to control the growth of federal health spending needs to focus on making prices clear and accessible.
Few issues better illustrate the problem of opaque pricing than unexpected medical bills. Despite Obamacare’s promise to streamline access to care, the legislation’s convoluted insurance mandates have become so confusing that many patients get hit with surprise bills after unknowingly receiving treatment from an out-of-network doctor, even if they are at an in-network hospital.
Between 2010 and 2016, out-of-network billing at in-network hospitals rose from 32.3% to 42.8% for emergency room visits. Public outcry over this spike led to the enactment of the No Surprises Act in 2020. Despite addressing out-of-network charges for emergency room visits, the law contains glaring exemptions. For example, ground ambulances are largely excluded from the law’s protections against balance billing. While the Subcommittee is correct to focus its attention on providers, the goal of enhancing price transparency needs to be balanced against the administrative burden of compiling and listing accurate prices.
And yet, providers are not the only actors in American health care failing to adequately display prices to consumers. By aggregating purchasing power and negotiating rebates, pharmacy benefit managers (PBMs) play an important role in helping control drug spending for employers and government programs. Growing consolidation in recent years, along with opaque pricing practices, raise legitimate concerns that savings are not always passed down to patients and taxpayers.
In particular, the Subcommittee should focus on increasing transparency around the practice of spread pricing, where PBMs keep the difference between what they charge health plans and what they reimburse pharmacies. These hidden markups inflate federal health spending, and taxpayers stand to benefit tremendously from reforms that bring greater accountability and clarity to how federal health dollars are spent.
We appreciate the Subcommittee’s leadership on this issue and stand ready to assist in developing legislative solutions that prioritize patients and taxpayers.
Sincerely,
Alexander Ciccone
Policy and Government Affairs Manager
National Taxpayers Union