‘End the blame game’ — Healthcare finance leaders launch a new affordability pledge

Healthcare’s financial leaders want a ceasefire in the fight over who is to blame for rising costs.

The Healthcare Financial Management Association (HFMA) this month called on leaders across the industry to sign its “Declaration on Healthcare Affordability and Sustainability.”

Signers pledge to “move beyond blame” and “end cost shifting in the guise of cost reduction,” and to work together through Vitalic Health, an initiative HFMA launched earlier this year.

“For too long, healthcare stakeholders have accepted a healthcare system that is unsustainable and no longer provides adequate financial security for patients, while burdening employers and taxpayers with exorbitant healthcare costs,” HFMA President and CEO C. Ann Jordan, J.D., said in a news release.

The pledge landed after months in which insurers and hospitals have traded jabs in Congress, in comments to regulators and in dueling reports. Meanwhile, patients say cost now shapes whether they seek care at all.

• Read more: Election 2026 Roundtable: The affordability of care

A system under strain

HFMA calls affordability and sustainability “inseparable” and says “no stakeholder can solve these challenges alone.”

HFMA is seeking endorsements from providers, payers, financial technology executives, employers and purchasers. The HFMA declaration does not call out specific people or organizations under the health care umbrella; it does not endorse or condemn specific policies or legislation on the books or pending.

Nine in 10 healthcare leaders said the system is not financially sustainable in a Vitalic Health survey released in June, and half named misaligned incentives among providers, payers and employers as the leading driver of costs, Chief Healthcare Executive reported.

“You cannot achieve provider sustainability by shifting costs to patients who cannot bear them, and you cannot achieve patient affordability by dismantling the operating models of the institutions that care for them,” Jordan said in her keynote at HFMA’s annual conference.

Voters want that balance, too. A Morning Consult poll commissioned by HFMA in September found 54% of voters said healthcare has become less affordable this year, while 57% were concerned about hospitals closing. Nearly two in three (62%) said healthcare financial leaders working across sectors could help lower costs and keep at-risk hospitals solvent.

Are hospitals to blame?

Insurers have argued hospitals are the main culprit driving up healthcare costs.

This year, AHIP, the trade group for America’s health insurance payers, said hospital costs account for 40.7 cents of every commercial premium dollar, according to an organization statement to the House Ways and Means Committee. AHIP pointed to hospital consolidation, “all-or-nothing” contracting and prices in hospital outpatient departments that can run up to 13 times higher than in physician offices for the same services.

“Instead of blaming others, the hospital industry should stop their anticompetitive consolidation,” AHIP spokesperson Chris Bond said in a statement on the day of the hearing.

Lawmakers pressed the same point. Ways and Means Chairman Jason Smith (R-Missouri), told the CEOs of HCA Healthcare, CommonSpirit Health, NewYork-Presbyterian and ECU Health that “the blame game didn’t work with insurers, and it won’t work today with us,” Chief Healthcare Executive reported.

Hospital leaders acknowledged a share of the problem. HCA CEO Sam Hazen told the committee healthcare is “too expensive for too many people,” and NewYork-Presbyterian CEO Brian Donley, M.D., said hospitals are “one part of a broader healthcare system that contributes to these costs.”

The dispute has touched on billing technology helping or hurting affordability. A Blue Cross Blue Shield Association report said hospitals’ use of artificial intelligence (AI) in coding resulted in an additional $942 million in costs for Blue plans over two years, Chief Healthcare Executive reported. The American Hospital Association (AHA) countered in a blog post that the analysis never reviewed patients’ medical records to see whether diagnoses were clinically supported.

Hospitals point to payers

Meanwhile, hospitals point to insurers as a cost driver in their own right. Hospitals spent an estimated $43 billion in 2025 trying to collect payments insurers owed for care already delivered, including nearly $18 billion overturning claim denials, the AHA wrote in an August letter to the National Association of Insurance Commissioners.

The letter urged regulators to judge affordability by patients’ total exposure, including premiums, deductibles and cost sharing, rather than by premiums alone. A plan that lowers premiums by raising deductibles may not help patients whose out-of-pocket costs exceed what they can pay, the AHA wrote.

At the April 28 House Ways and Means Committee hearing, CommonSpirit CEO Wright Lassiter III said billing Medicare Advantage costs about 25% more than billing traditional Medicare.

“We have $4.3 billion in unpaid Medicare Advantage claims, with nearly $1 billion of that being more than 150 days past due,” Lassiter said.

Hospital expenses rose 7.5% in 2025, about twice the rate of hospital price growth, according to an AHA issue brief. Median hospital operating margins were negative in January and reached just 0.7% by June, according to Strata Decision Technology.

“The margin just continues to be compressed everywhere,” Alina Henderson, Strata’s vice president of healthcare solutions, told Chief Healthcare Executive.

The Insurance Watchdog Coalition, a group critical of large insurers, argues insurance costs are rising much faster than the cost of medical care, and insurers face critics in Congress, too.

The seven largest for-profit health insurers took in nearly $1.7 trillion in revenue in 2025 and at least $54 billion in profits. Since 2015, they have spent more than $137 billion buying back their own shares, Rep. Greg Murphy, M.D. (R-North Carolina), co-chair of the Congressional Doctors Caucus, wrote in an op-ed in The Hill.

“As their profits climb, we are seeing an increasing morass of pre-authorizations, denials, and out-of-network fights that do very little to help get people well,” Murphy wrote.

There is no “evil in profit” when businesses make money, Murphy said. But he would break up the largest insurers and eliminate for-profit health insurance. He also called himself “an equal opportunity offender” who will go after any sector making care harder for patients.

Patients in the middle

For patients, the blame matters less than the bill.

Nearly 1 in 4 patients cite cost as their top concern before care, ranking it above treatment effectiveness, pain and medical risk, according to the 2026 PayZen Patient Affordability Survey of 1,000 adults who had a hospital visit or surgery in the past two years. PayZen sells affordability and payment technology to health systems.

The survey found:

• More than 1 in 4 patients skipped or postponed care because of cost.
• 42% received no cost estimate, payment plan offer, financial assistance information or financial counselor conversation.
• 69% of patients with employer coverage and 74% with Marketplace plans described their most recent hospital bill as stressful or unresolved.
• 63% said flexible payment options would make them more likely to choose a hospital for future care.
• Nearly 9 in 10 said they would lose trust in a provider that does not proactively communicate about payment plans or financial assistance.

“Health systems have done important work to support self-pay and out-of-network patients, but the next step is moving beyond a narrow view of financial risk,” PayZen CEO Itzik Cohen said in the report.

What comes next

HFMA plans to convene leaders through Vitalic Health to share data, test technology-aided approaches and measure whether care becomes more affordable and accessible. The organization also hopes for endorsements.

“The affordability problem is already well defined,” Jordan said. “What matters now is action, accountability and results.”