As the Senate HELP Committee holds a hearing this week on “Making Health Care Affordable: Solutions to Lower Costs and Empower Patients,” one thing is clear: Americans are counting on Congress to act. Health plans are doing everything in their power to shield consumers from exorbitant prescription drug prices and unfair hospital billing practices, but achieving real affordability demands smart policy solutions that tackle these and other underlying drivers of rising health care costs.
Here are five common-sense actions Congress can take to make health care more affordable for Americans.
1. Extend the Health Care Tax Credits
Enhanced premium tax credits have made coverage more affordable and helped millions of Americans gain health insurance through the individual market. But unless Congress acts, these credits will expire at the end of 2025, causing a sudden and severe rise in premiums and leading many to forgo coverage altogether.
- Middle-income individuals and families could see average premium increases of 75% or more than $700 per person.
- The non-partisan Congressional Budget Office estimates that 4.2 million people could lose coverage if the credits are not extended.
Congress must act before September 30 to protect 24 million Americans and prevent steep cost increases for millions of Americans in 2026.
2. Lower the Cost of Prescription Drugs
No one has more control over prescription drug prices than pharmaceutical manufacturers. They alone set their prices, and they alone can lower them. Yet drugmakers continue to raise prices on Americans multiple times a year, fueling premium increases and higher out-of-pocket costs for patients.
- Drug spending is expected to be a key driver of premium growth in 2026, due to rising unit prices, costly new gene and cell therapies, and growing demand for weight-loss drugs.
- More than 24 cents of every premium dollar goes toward prescription drugs—more than any other individual category.
In April, the Senate Judiciary Committee passed bipartisan legislation to boost competition by stopping practices like patent thickets and product hopping. These reforms would save taxpayers more than $5 billion and curb anti-competitive abuses of our patent system.
3. Protect Consumers with Site-Neutral Payment Reforms
Patients shouldn’t be charged more for the same service just because it’s delivered in a hospital-owned facility. Yet that’s exactly what’s happening in too many cases. When hospitals acquire physician offices, prices jump on average by 14%. In markets with no hospital competition, prices are 12% higher than in areas with more choice.
Site-neutral payment reform would level the playing field, reduce patient cost-sharing, and lower premiums—saving more than $170 billion over 10 years.
It’s time for Congress to hold hospital systems accountable for price inflation and give patients better access to affordable, high-quality care.
4. Stop Private Equity’s Misuse of the No Surprises Act
Congress designed the No Surprises Act to protect patients from unexpected out-of-network bills. However, certain private equity-backed providers and arbitration middlemen are systematically manipulating the law's arbitration process—known as independent dispute resolution (IDR)—to extract maximum payments from employers and patients, often exceeding even the original billed charges.
Working with the administration, Congress should address the flawed, costly arbitration process by:
- Blocking ineligible claims and disputes from entering arbitration;
- Creating clear processes to correct or reject invalid claims;
- Auditing IDR entities and holding parties accountable for false claims;
- Requiring stronger training and oversight of arbitrators; and
- Releasing transparent data on arbitration decisions and patterns of abuse.
These fixes will help restore the law’s original intent: shielding patients from costly, unfair charges from out-of-network providers.
5. Protect & Strengthen Medicare Advantage & Employer-Sponsored Insurance
Nearly 35 million seniors and people with disabilities choose Medicare Advantage (MA), because it delivers better services, better access to care and better value than fee-for-service (FFS) Medicare. Congress must prioritize policies that strengthen Medicare Advantage and build on the success of this vital program. In contrast, policymakers should oppose any changes to the program that lead to higher costs for seniors—including the No UPCODE Act.
It is also vitally important to protect employer-provided coverage from harmful tax changes that would undermine employers' ability to offer affordable, innovative health benefits. Businesses of all sizes offer comprehensive health coverage to employees and their families, providing affordable, private health insurance coverage for the majority of Americans – nearly 180 million people. Policy proposals to eliminate or cap the employer tax exclusion would amount to significant tax increases on working Americans at all income levels. Such changes would cause millions to lose their health coverage and turn instead to public programs at substantial cost to taxpayers. Congress should only consider proposals that support and strengthen the proven framework of the Employee Retirement Income Security Act (ERISA).
To make health care simpler and more affordable for millions of Americans, Congress must act. Extending the ACA tax credits, enacting site-neutral reforms, lowering drug costs, strengthening the No Surprises Act, and protecting access to coverage would be good places to start.