Affordability is top of mind for executives at AHIP as Americans battle skyrocketing healthcare costs.
“We are laser-focused on affordability at AHIP,” said Mike Tuffin, president and CEO of AHIP. “That’s, of course, the issue at every kitchen table. … We see the cost of hospital care, certainly the cost of brand prescription drugs, specialty care, imaging, down the line, just continuing to rise faster than wages, faster than inflation. That’s driving up premiums across all markets. Premiums directly reflect the underlying cost of medical care.”
Tuffin made these comments during a press briefing on Tuesday at the AHIP Medicare, Medicaid, Duals & Commercial Markets Forum in Washington, D.C. AHIP is an advocacy organization for health insurers.
As for what’s leading to the rising cost of care, Tuffin pointed the finger at hospital consolidation, as well as actions by drug manufacturers like patent thickets (in which there is a dense web of multiple patents around one medication).
Tuffin added that AHIP is focused on improving affordability across four zones:
- More competition, especially for prescription drugs, and addressing hospital consolidation
- Site of service reforms, and increasingly using the home as a site of service. According to Tuffin, too much care is delivered at the costliest sites of care, like the emergency room
- Tackling administrative burden, as the healthcare system is still “far too dependent on fax machines”
- Aligning incentives around patient care outcomes and driving value across the system
Both Republicans and Democrats have signaled that they want to address healthcare affordability, though they have different ideas on how to tackle the issue. Democrats have been interested in extending the Affordable Care Act’s enhanced premium tax credits, which expired in December and lowered premiums for those receiving healthcare on the marketplaces. Many Republicans, meanwhile, have been interested in sending money directly to eligible Americans through their health savings account so they can purchase their own coverage.
When asked about AHIP’s position on these differing strategies, Tuffin responded that AHIP is focused on where there’s an opportunity to “move something forward on a bipartisan basis.” He noted that there are several areas with bipartisan support, including addressing anti-competitive practices of drugmakers and opacity in hospital pricing.
As for prescription drug costs, while AHIP is calling for actions against drug manufacturers, much of the attention has been on pharmacy benefit managers. Congress recently passed the Consolidated Appropriations Act of 2026, which included several PBM reforms.
“Now that Congress has tackled PBM reform, which manufacturers spent hundreds of millions lobbying for, we think it’s incumbent upon them to respond by lowering their prices. Multinational brand drugmakers charge Americans orders of magnitude what they charge consumers in other countries,” Tuffin said.
He added that direct-to-consumer marketing of brand drugs needs to be addressed, as consumers are subject to “wall-to-wall advertising that is solely intended to induce demand for the highest cost drugs.”
This conversation comes as insurers face a lot of scrutiny and frustration from both lawmakers and consumers over the rising cost of health insurance. Tuffin claimed that insurers are the “only part of the system working to lower costs.”
“In addition to being the only part of the system that gets up trying to lower costs, we’re the only part of the system that is subject to real accountability and scrutiny and transparency on our rates, on our performance, if premiums meaningfully exceed what’s needed to cover the cost of care. … We welcome that conversation, and we think that the heat and the scrutiny is just reflective of that frustration with cost across the system,” he said.
Source: weiyi zhu, Getty Images
