Full Breakdown
Hospital CEOs Face Scrutiny Over Facility Fees at House Ways and Means Hearing
4/30/2026, 5:49:19 AM
Hearing Overview
On Tuesday, the House Ways and Means Committee heard CEOs of HCA Healthcare, CommonSpirit Health, New York-Presbyterian and ECU Health. Chairman Rep. Jason Smith (R-MO) and other Republicans accused the systems of inflating outpatient facility fees; the executives defended the fees as reflecting higher costs and quality.
Background & Data
Hospitals made up one-third of U.S. health-care spending in 2024—about $1.6 trillion. Hospital prices have risen about 300 percent; Rep. Adrian Smith cited a 281 percent increase. A colonoscopy cost $656 at an independent ambulatory surgical center versus $1,222 at a hospital outpatient site, and a JAMA Health Forum study found patients pay more for identical doctor visits when the provider belongs to a hospital system.
Participants
The CEOs were Michael Waldrum (ECU Health) and Wright Lassiter (CommonSpirit Health) with leaders of HCA Healthcare and New York-Presbyterian. Lawmakers included Rep. Jason Smith (chair), Rep. David Kustoff, Rep. Greg Steube, Rep. Greg Murphy, and Democrats Rep. Lloyd Doggett and Rep. Richard Neal.
Official Statements & Responses
Republicans called hospital pricing a subsidy-driven failure, urging site-neutral Medicare payments and labeling fees “insane.” CEOs replied that Medicare and Medicaid reimbursements fall short of costs, that higher fees reflect quality, sicker patients, and a legal duty to treat all. Democrats called the hearing a “deflection” from Medicaid cuts.
Criticism & Opposition
Watchdog groups Save Our States and Consumers Research criticized nonprofit hospitals for low charity-care ratios, soaring executive pay, and “double-dip” claims of both urban and rural subsidies. They also accused large systems of manipulating the 340B drug-pricing program to retain discounts rather than pass savings to low-income patients.
Conflicting Reports & Gaps
Republicans linked high prices to Medicaid cuts; Democrats called that a distraction. Price-rise figures differ—Rep. Adrian Smith cited a 281 percent increase, other data show 300 percent. A claim that H.R. 1 caused a nursing-home closure was denied by CommonSpirit’s CEO. Independent cost data for facility fees are lacking.
Verbatim Quotes
- “The American people are fed up with outrageous prices that seem artificially high,” — Rep. Jason Smith, Chairman, Ways and Means Committee
- “Is an 100% increase in the fee that you charge versus the surgical center, does that seem reasonable to you?” — Rep. David Kustoff, R-TN
- “We’re the only participants in the healthcare value chain that have that obligation. Doctors, nurses, insurance companies, drug companies do not.” — Michael Waldrum, CEO, ECU Health
- “This is more a deflection hearing than a hospital hearing,” — Rep. Lloyd Doggett, D-TX
What’s Next
Committee members are drafting site-neutral payment legislation to align hospital outpatient rates with physician-office rates. The DOJ’s antitrust suit against New York-Presbyterian and watchdog campaigns signal heightened scrutiny of nonprofit hospital finances. Further hearings are expected on Medicaid-cut impacts and the 340B program’s effect on patients.
