WASHINGTON, D.C. — The Insurance Watchdog Coalition (IWC) today voiced strong support for the House Energy & Commerce Subcommittee on Health’s hearing, “Lowering Health Care Costs for All Americans: Examining Policies to Increase Health Care Transparency.”
We call on the Subcommittee to forcefully address the insurer and PBM “black box” that is driving up health costs for patients, employers, and taxpayers.
“Corporate insurers and PBMs make billions in the shadows, and each dollar comes out of a patient’s pocket. Transparency isn’t just good policy — it’s the best way to bring health costs down,” said Mark Merritt, Executive Director of the Insurance Watchdog Coalition.
Health insurers and PBMs operate as powerful, vertically integrated middlemen — collecting hundreds of billions in premiums, fees, and spread pricing while shielding their costs, denial practices from public scrutiny.
IWC backs provisions that would:
- Require insurers to publicly disclose overhead costs and claim payment percentages — exposing plans that prioritize profit over care and restoring the market discipline that’s been missing for years;
- Require public disclosure of prior authorization denial rates, including appeal outcomes and decision timelines — prior authorization should not be a backdoor rationing tool that delays medically necessary care;
- Close the MLR loophole — vertically integrated insurers are gaming medical loss ratio requirements by routing profits through affiliated subsidiaries like pharmacy chains, provider groups, and PBMs.
- Make Medicare Advantage plans report what they spend on medical care — encounter data gaps let insurers manipulate risk scores, upcode diagnoses, and collect billions in overpayments from the federal government;
- Build on CAA 2026’s PBM reforms — while the new law is a welcome step, its key provisions don’t take effect until 2029 and leave Medicare Advantage PBM arrangements largely untouched. Congress should close those gaps now; and
- Crack down on PBM overseas affiliates — PBMs have stationed their Group Purchasing Organizations (GPOs) on foreign soil to evade oversight. Unlike other healthcare GPOs that use buying power to reduce costs, these offshore entities exist to avoid accountability.
Medicare Advantage demands special attention. The program remains plagued by prior authorization abuse, manipulated encounter data, and broker compensation schemes that persist because opacity enables them. Patients should know this information before choosing a plan.
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Insurance Watchdog Coalition’s mission is to educate legislators, regulators, key opinion leaders, the media and the American people about the harmful impacts of vertically integrated insurance monopolies, especially in our healthcare system, which in turn will help create more competition in the marketplace, lower healthcare costs, and ensure that healthcare savings go to patients, not big insurers.