Opinion - Congress must deliver substantive health care reform in 2026

Health care costs continue to rank highly among concerns for everyday Americans, and many are calling on lawmakers for significant reforms: lowering those costs while restoring patient power.

Lawmakers are attempting to tackle the problem, with the House Energy and Commerce Subcommittee on Health recently holding hearings on health care affordability. I was fortunate enough to participate in the latest one on hospital costs .

The House committee is homing in on a central problem: too many government policies direct funds to insurance companies and big hospital systems rather than to patients themselves. Fund The Patient, an organization that supports policies to redirect those funds to patients, recently conducted a poll that reinforces this conclusion.

The polling reflects real life for millions of patients nationwide. Americans are reporting declining access and rising prices, including increasing hospital costs and insurance premiums. Hospital conglomerates are a major reason why. Rising premiums are not only an insurance story; they reflect exploding hospital prices driven by hospital consolidation.

Consolidation to this degree has significant ripple effects. The health care landscape has become so treacherous that one-third of Americans have  either cut spending in other areas or have gone into debt to pay for medical care, according to The New York Times. And polling shows that 75 percent of patients don’t believe our health care system is meeting the needs of most Americans.

When funding is tied more closely to patients, things change. Fewer resources are lost to fraud, administrative bloat, and opaque hospital pricing. Americans are realizing that today’s health care policy too often funds the “system” through institutional subsidies rather than empowering patients to find personalized care in a competitive marketplace.

With midterm elections expected to be contentious, lawmakers are eager to deliver tangible wins for Americans. Pursuing health care reforms that put health care dollars back in patients’ pockets through budget reconciliation would be a good place to begin.

In the current system, much of U.S. health care funding goes towards large corporations. For example, ObamaCare subsidies go directly to insurance companies rather than patients. Subsidies meant for low-income patients, such as disproportionate share funding and the 340B drug discount program , accrue to hospital systems instead of empowering the patients themselves.

When prices continue to rise despite massive subsidies to corporations, it’s no wonder that patients question where all the money is going.

We can start addressing these systemic problems by understanding where power currently sits and how to return it to patients. Lawmakers must recognize that patients are increasingly frustrated and are pushing back against entrenched “system” interests: insurance companies, hospitals and wasteful government programs. The poll cited above shows that patients overwhelmingly favor a health care system that uses subsidies to empower patients rather than large corporations.

Patients are also starting to understand what that looks like in practice: directing subsidies into health savings accounts, allowing those funds to support alternative practice models such as direct primary care, and allowing physicians to contract and compete more freely with large hospital conglomerates.

The poll demonstrates the support behind these policies: 80 percent of respondents supported allowing any American to have a health savings account, and nearly two-thirds favored price transparency measures to achieve truly shoppable care.

Luckily, Sens. Bill Cassidy (R-La.) and Mike Crapo (R-Idaho) have unveiled legislation that would allow millions of patients to have Affordable Care Act subsidy dollars redirected to pre-funded health savings accounts. Another bill from Reps. Kat Cammack (R-Fla.) and Greg Steube (R-Fla.) would expand access to health savings accounts for countless Americans who do not currently qualify for them.

Both of these bills move in the right direction, but they need to cross the finish line.

Congress already made significant progress on health care reform with the One Big Beautiful Bill’s health savings account measures through budget reconciliation. There is no reason they cannot use similar methods to advance more of the changes patients need.

But Americans also need long-term reforms, not just a Band-Aid fix. These polling numbers reflect growing dissatisfaction with American health care after more than a decade of mediocrity. If lawmakers take action, it should be the first step in a broader effort to restore power to patients.

Lawmakers need to listen to patients about the direction of health care reform. These polling numbers confirm what policy experts, patient advocates and doctors have been saying for years: fund patients, not health systems.

Anthony DiGiorgio is an assistant professor of neurological surgery at the University of California, San Francisco. He is also an advisory council member of the Fund The Patient, a nationwide health policy movement focused on returning health care dollars back to patients.

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