As a clinician and lifelong New Hampshire resident, I’ve seen hardworking families struggle to afford basic health care. Every year, premiums rise, deductibles climb and prescription drug costs seem to skyrocket. Behind the scenes, two powerful forces, the insurance industry and pharmacy benefit managers are gaming the system for their own gain, using health care not to serve patients, but to extract profit.
That’s not an accident.
This is why the U.S. House of Representatives was right to bring insurance CEOs before Congress on Jan. 22. Those hearings were a long overdue step toward accountability. For too long, insurers and their PBM partners have avoided real scrutiny while families and small businesses absorb the financial fallout. New Hampshire residents deserve answers and transparency about why health care costs continue to spiral while industry profits soar.
The waste, fraud and abuse in our health care system are well documented. A recent report from the Committee to Unleash Prosperity revealed that a large national nonprofit organization generated nearly $9 billion in revenue last year through royalties and related income, largely tied to partnerships with one of the nation’s largest for-profit insurance companies. That’s billions of dollars flowing through an organization publicly positioning itself as an advocate for consumers, yet is financially intertwined with major insurance interests. It’s a stark example of how deeply profit incentives are embedded in the system.
At the same time, insurance conglomerates are rapidly expanding their reach. Large national insurers that also own pharmacy chains and PBMs have acquired dozens of retail pharmacy locations nationwide, including stores here in New Hampshire. This kind of consolidation allows a single corporate structure to control insurance coverage, prescription drug benefits, and the pharmacy counter itself. Less competition means higher prices, fewer choices and less transparency for patients.
PBMs were originally created to negotiate lower drug prices. Today, they function more like toll collectors. They extract fees, control drug formularies and profit from rebate arrangements that patients rarely see at the checkout counter. While PBMs claim to save money, those “savings” often stay within corporate networks instead of lowering out-of-pocket costs for families.
The consequences are especially severe in public programs like Medicare Advantage and Medicare Part D, where insurers and PBMs exploit complex rules to turn taxpayer dollars into profit centers. Seniors pay more. Employers face higher premiums. Small businesses are forced to make impossible decisions about wages and benefits.
Here in New Hampshire, we understand what happens when a system becomes too centralized. State Senator David Rochefort, Chair of the Health and Human Services Committee, has warned about the dangers of vertical integration, when one company controls insurance, PBMs and pharmacies. When corporations dominate every step of the health care supply chain, consumers lose. Prices rise, options shrink and accountability disappears.
For years, federal policymakers have focused almost exclusively on drug manufacturers when addressing high prices. While that’s important, it only tells part of the story. Ignoring insurers and PBMs leaves the biggest drivers of cost increases untouched.
The Jan. 22 House hearings should not be the end of this conversation, they should be the beginning. The U.S. Senate must step up and continue this oversight. Senators Jeanne Shaheen and Maggie Hassan have long championed New Hampshire consumers, but now is the moment for Senator Hassan to lead by convening similar hearings in the Senate. Granite Staters deserve a full accounting of how insurers and PBMs are driving costs and limiting care.
As taxpayers and patients, we deserve a health care system that puts people before profits. We deserve transparency, competition and accountability. Congress must keep asking tough questions, and the Senate must do its part. I know the New Hampshire General Court will do its part and support the bills I have sponsored and co-sponsored to reform health care price transparency, access and PBMs. The health and financial security of New Hampshire families depend on it.
State Representative Julie Miles, RN, BSN, CEN, CPC-A, has over 25 years of experience as a clinical nurse and nurse manager. She has extensive expertise in health insurance, stop-loss clinical review, and Medicare and Medicaid policy analysis.