As lawmakers intensify scrutiny of the insurance industry, healthcare providers are watching closely.
During a recent Becker’s Healthcare podcast sponsored by HaloMD, Patrick Velliky, chief external affairs officer at HaloMD and a longtime healthcare policy advocate, unpacked the implications of recent Capitol Hill hearings focused on payer consolidation, affordability and reimbursement practices.
He examined how policy is shifting and why providers have both an opportunity and an obligation to engage.
Here are four key takeaways from the conversation:
1. Payer consolidation and accountability
Recent hearings before the House Energy and Commerce Committee and the Ways and Means Committee brought several large health plan CEOs to Capitol Hill to address concerns about affordability and market power.
Mr. Velliky said the framing from lawmakers signals a deeper examination of insurers’ expanding roles across the healthcare ecosystem.
“The vast majority of the large insurers that were there are not just insurance companies anymore,” Mr. Velliky said. “They are also pharmacies and pharmacy benefit managers and even physician practices.”
He noted that this vertical and horizontal consolidation raises important questions about whether insurers’ growing role in care delivery aligns with policymakers’ and patients’ expectations for the healthcare system.
At the same time, he pushed back on payer narratives surrounding the volume of disputes under the No Surprises Act, reflecting on what he described as outdated or misleading claims. For example, he pointed to what he called a “debunked notion” that the independent dispute resolution process was only intended to handle 17,000 disputes annually, arguing that such assertions deflect from broader accountability conversations.
2. A persistent disconnect
While payers often frame themselves as stewards of affordability, Mr. Velliky said many providers are experiencing a different reality.
Hospitals and physician groups continue to face eroding reimbursement rates, rising administrative complexity and growing financial strain. Mr. Velliky pointed to the increasing number of hospitals operating on thin margins and the mounting burden of prior authorization requirements.
“I’ve never met a physician who got into medicine because they were excited about filling out paperwork or sitting on the phone trying to get prior auth approved,” Mr. Velliky said. “But more and more that’s where they’re spending their time.”
For healthcare leaders, he said the current environment underscores the need to advocate for policies that allow physicians to focus on delivering care rather than navigating bureaucracy.
3. Cautious optimism
Much of the discussion centered on the No Surprises Act, which took effect in 2022 to protect patients from unexpected out-of-network bills and established an independent dispute resolution process for payment disagreements.
Mr. Velliky highlighted bipartisan legislation — the No Surprises Act Enforcement Act — introduced by Reps. Greg Murphy, MD, R-N.C., and Jimmy Panetta, D-Calif., in the House and Sens. Roger Marshall, MD, R-Kan., and Michael Bennet, D-Colo., in the Senate. The bill would impose penalties and interest for failure to pay arbitration awards on time and strengthen enforcement of patient protections.
He referenced concerns raised by Rep. Erin Houchin, R-Ind., during a recent hearing about delays in payment following arbitration decisions.
“Why is the rate of timely payment after the No Surprises Act’s arbitration process so abysmal?” Mr. Velliky said, summarizing the issue lawmakers are examining. “Why can’t insurers seem to figure out how to pay in a timely manner after an independent third party says that they need to?”
If Congress acts, he said, the focus appears to be less about overhauling the law and more about ensuring it is implemented as intended, particularly around timely reimbursement and compliance with patient protections.
4. The role of providers
For healthcare executives who may feel disconnected from federal policymaking, Mr. Velliky emphasized that their voices carry weight.
“When physicians and hospital leaders engage in advocacy, the significant amount of credibility that they bring with them to those conversations can meaningfully shape outcomes,” Mr. Velliky said.
He acknowledged that policy engagement can feel daunting but encouraged leaders to recognize that they are directly caring for policymakers’ constituents and that perspective matters.
Organizations like HaloMD, he added, can help independent medical groups navigate the administrative complexity of the independent dispute resolution process, alleviating cash flow pressure and reducing the risk of forced consolidation.
“Being able to focus on that care delivery and not face ongoing cash flow pressure and reimbursement pressure is the difference for a lot of independent groups between remaining independent or having to consolidate,” Mr. Velliky said.
As payer scrutiny intensifies and reimbursement models evolve, proactive engagement, both operationally and legislatively, may be essential to protecting financial sustainability and preserving the practice of medicine.
Despite the challenges, he expressed optimism about the future of the profession.
“I think there are a whole lot more reasons to be optimistic,” Mr. Velliky said. “We’ve got to stick the landing on some of these things and really make sure that outcomes and implementation match intention. But I’m excited to see the further evolution and stability of the practice of medicine.”
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