Capital Hill, Payers, & the Future of Reimbursement in Healthcare

Summary

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Podcast Summary: Capital Hill, Payers, & the Future of Reimbursement in Healthcare

Becker’s Healthcare Podcast – February 25, 2026
Host: Erica Spicer Mason
Guest: Patrick Veliki, Chief External Affairs Officer, Halo MD

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Episode Overview

This episode delves into current dynamics on Capitol Hill affecting payers and the future of healthcare reimbursement. Guest Patrick Veliki, an industry veteran in advocacy and healthcare policy, shares insights on recent Congressional hearings, challenges with payer-provider alignment, the status of the No Surprises Act, and practical guidance for healthcare leaders navigating the rapidly evolving reimbursement landscape.

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Key Discussion Points and Insights

1. Recent Congressional Focus on Payers and Affordability

(00:40–03:51)

• Major attention on health insurance industry consolidation and affordability.
• Congressional leaders, particularly Chairman Smith (Ways and Means Committee), called out the growing vertical and horizontal consolidation, with large insurers acquiring pharmacies, PBMs, and physician practices.
• Raised key question: Is increased insurer control over care delivery beneficial for the healthcare system?
• Patrick notes a prevalent "deflection" in insurer testimonies regarding the No Surprises Act (NSA), especially concerning dispute volumes in the NSA’s Independent Dispute Resolution (IDR) process.
• Insurers perpetuate outdated claims that the IDR process was designed for only 17,000 annual disputes, which Patrick calls "debunked" and unhelpful for policy progress.

Notable Quote:

“To hear insurers kind of tout out that very outdated and like I said, debunked talking point around volume is, I think, indicative of some of that deflection that I don’t think resonates with policymakers or with the American people.”
— Patrick Veliki (02:48)

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2. Implications for Healthcare Leaders: Importance of Engagement

(03:52–05:28)

• Ongoing hearings present a significant opportunity for healthcare organizations and leaders to engage in education and advocacy.
• Many healthcare leaders underestimate their own credibility and the value they bring when involved in policy conversations.
• Patrick urges leaders to recognize their influence as frontline care providers and to step into advocacy roles.

Notable Quote:

“...what this should demonstrate to healthcare leaders is that there is a real opportunity to engage and start working to improve the policy landscape.”
— Patrick Veliki (04:47)

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3. Disconnect Between Payer Rhetoric and Provider Realities

(05:29–07:41)

• Providers on the ground face decreasing reimbursement rates and increasing financial challenges, with many hospitals operating on thin margins or facing distress.
• Payers publicly frame themselves as cost defenders, but providers experience mounting administrative burdens and difficulty maintaining staff and services.
• The administrative load, such as prior authorizations, detracts from clinical care—contradicting providers’ motivations for entering the field.

Notable Quote:

“There’s a real disconnect there in what plans claim to be attempting to accomplish and what physicians are actually feeling on the ground. And we’ve got to cut through that and figure out how to ensure physicians can do what they got into medicine to do, actually provide care without having to worry about keeping the lights on.”
— Patrick Veliki (07:20)

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4. Legislative Opportunities: Reforming No Surprises Act (NSA) and IDR Process

(07:42–11:32)

• Congress is increasingly attentive to challenges with the NSA’s IDR process, especially regarding timely payment of arbitration awards to providers.
• Bipartisan legislation, the “No Surprises Act Enforcement Act,” seeks to:
  • Create penalties and interest for delayed payments after successful arbitration.
  • Level penalties for violations of patient protections (i.e., ensuring patients are only charged in-network rates as the law intends).
• Evidence points to persistent payer non-compliance with the NSA, justifying stronger enforcement.
• Patrick is optimistic about legislative momentum, highlighting that these proposals, if enacted, could ensure actual implementation matches Congressional intent.

Notable Quote:

“So the real legislative opportunity here is when it comes to the No Surprise Act, if Congress is interested in doing anything at all, it’s in ensuring that what they pass in the first place actually goes into effect, actually enforcing those patient protections and the expectation that payment is made and made timely once the IDR process is utilized.”
— Patrick Veliki (10:25)

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5. Role of Organizations like Halo MD in Navigating Reimbursement Uncertainty

(11:33–13:30)

• Organizations such as Halo MD can relieve physicians, especially independent groups, of administrative burdens tied to complex reimbursement and dispute resolution processes.
• Relieving these pressures is crucial for the survival of independent practices, which often lack back-office infrastructure to handle administrative demands.
• Supporting independent providers helps preserve choice and reduces forced consolidation with hospitals or insurers.

Notable Quote:

“So I think what Halo MD offers here is that ability to remain independent and let someone else handle administrative burdens while you handle healthcare delivery.”
— Patrick Veliki (13:22)

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6. Final Thoughts: Optimism for the Practice of Medicine

(14:02–14:41)

• Patrick underscores optimism for future improvements in healthcare policy, believing thoughtful implementation can align intentions and outcomes.
• He encourages leaders to persist, confident in the system’s capacity for positive evolution and stability.

Notable Quote:

“I think there are a whole lot more reasons to be optimistic about improvements to the system writ large than reasons to be pessimistic. We’ve got to stick the landing on some of these things and really make sure that outcomes and implementation match intention.”
— Patrick Veliki (14:10)

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Memorable Moments by Timestamp

• [01:03] — Patrick breaks down Congressional hearings on insurer consolidation and affordability.
• [02:48] — Refuting outdated payer talking points on NSA dispute volumes.
• [04:47] — Encouragement for leaders to engage in advocacy.
• [07:20] — Candid assessment of disconnect between payers and providers.
• [10:25] — Emphasis on enforcing Congressional intent behind NSA.
• [13:22] — Importance of administrative support for independent practices.
• [14:10] — Patrick’s closing message of optimism for healthcare reform.

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Summary Takeaways for Leaders

• Congressional scrutiny of payers is intensifying, focusing on affordability, consolidation, and accountability for processes like the NSA.
• Healthcare leaders have both a stake and influence in policy reform—advocacy is valuable and impactful.
• Disconnect remains between payer narratives of stewardship and provider realities of financial strain and administrative overload.
• Bipartisan legislative efforts (notably around NSA enforcement) could reshape reimbursement pathways and protect both providers and patients.
• Support systems—such as partners to offload administrative work—are key to preserving independent medical practice amidst mounting external pressures.
• The tone remains cautiously optimistic: with the right engagement and enforcement, reforms can meaningfully improve healthcare delivery and sustainability.

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Transcript

[A]

Hello, everyone. This is Erica Spicer Mason with Becker's Healthcare. Thank you so much for tuning into the Beckers Healthcare podcast series. So today we're going to talk about Capitol Hill payers and the future of reimbursement in healthcare. And I'm excited to welcome for this discussion Patrick Veliki to the podcast. Patrick is the Chief External Affairs Officer at Halo MD and has spent more than a decade in the healthcare advocacy space with a deep understanding of healthcare policy. He's also spent time in Washington, D.C. supporting congressional representatives and their offices. Patrick, it's so great to have you with us at Beckers today. Thank you so much for being here.

[B]

Thanks, Erica. Nice to be here.

[A]

Patrick. It's. We're so happy to have you with us today, and I'm glad that we have you to help us break down some of the policies and really the broader discussions that we're seeing in the payer and reimbursement space right now. So to kind of set the stage, what stood out to you most in recent testimonies on Capitol Hill, and what do those statements tell us about how payers are thinking about reimbursement at the moment?

[B]

Yeah, thanks, Erica. There's a whole lot of attention right now on the health insurance industry and affordability. To your point, there were two hearings, very high profile within the last couple of weeks on the House side of the Capitol, both Energy and Commerce. And Ways and Means had Several health plan CEOs in front of them to talk about issues facing the health insurance industry and affordability for Americans. I think Chairman Smith really did a great job on the Ways and Means Committee teeing up some concerns that really resonate with, I think, a lot of Americans. He really opened by identifying the degree of consolidation, both vertically and horizontally, that has been occurring within the insurance space and really called out the fact that the vast majority of the large insurers that were there are not just insurance companies anymore. They are also pharmacies and pharmacy benefit managers and even physician practices. And I think it's fair to ask whether the increasing role that insurance plays in the delivery process is what we really want within our healthcare system. So I thought that was really helpful framing for the broader sort of analysis of the insurance market and where Congress is heading in that space and then even more specifically, some of the plan testimony and prioritization around their message. Frankly, I think we're still seeing a lot of deflection in that space. One thing that really stood out to me at least, as it relates to the no Surprises act which happens to be my forte, was the kind of return to claims on the payer side related to the volume of disputes in the NSA's IDR process. There's this debunked notion that the IDR process was only ever designed for 17,000 annual disputes and that the volume we've seen is indicative of a need for reform. To hear insurers kind of tout out that very outdated and like I said, debunked talking point around volume is, I think, indicative of some of that deflection that I don't think resonates with policymakers or with the American people and hopeful there's some further opportunity to instead get to accountability and improvements in the system.

[A]

Yeah, Patrick, such a helpful overview. I appreciate it. And when we, you know, you mentioned some of these talking points around affordability, also consolidation, volume of disputes, really this need for reform, as you think about all of those areas that were addressed in Capitol Hill, how should healthcare organizations really interpret this? In other words, what does it mean for healthcare leaders right now?

[B]

Yeah, I think it actually signifies an opportunity for education among healthcare leaders. What is so great about healthcare, especially physician and hospital leaders, when they do become motivated to get involved in advocacy and policy improvement, is the significant amount of credibility that they bring with them to those conversations. I think there's often a reluctance among healthcare leaders to, to bother getting involved in policy conversations because it feels like such an insurmountable task to actually influence outcomes. But I think if folks understand how valuable their opinions actually are, and again, the inherent credibility that comes with the fact that they are actually directly providing care for the constituents of policymakers, I think. Yeah, exactly your question. What this should demonstrate to health care leaders is that there is a real opportunity to engage and start working to improve the policy landscape.

[A]

Yeah. Thank you so much, Patrick. And it's interesting to hear from where you sit. You're hearing perspectives from the provider side, testimonies at the payer side policymakers, and kind of this general sentiment of the American people as well. But when payers speak publicly about things like rising costs and utilization from where you sit, how closely does that align with what providers are experiencing on the ground?

[B]

Yeah, I think that's maybe the primary question here. Right. It demonstrates in my mind the real disconnect between rhetoric and reality. The reality on the ground for physicians and facilities is that most of them continue to face an erosion of rate and reimbursement and sustainable financial situations. Every year, more and more hospitals are placed on the distressed list, operating on razor thin margins when to hear the payers tell it, they're framing themselves as defenders of the fisc. But for providers, they're seeing challenges in keeping facilities staffed and a growing crush of administrative burden that forces them to spend even less time actually delivering care and instead turn physicians into bureaucrats. 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, but more and more, that's where they're spending their time. So there's a real disconnect there in what plans claim to be attempting to accomplish and what physicians are actually feeling on the ground. And we've got to cut through that and figure out how to ensure physicians can do what they got into medicine to do, actually provide care without having to worry about keeping the lights on.

[A]

Yeah, yeah, absolutely. It's so important, this disconnect between rhetoric and reality as you've highlighted and as you've stated, and equally important, I know, are helping providers and healthcare organizations understand opportunities ahead at the same time to address that disconnect. So from a legislative perspective, what are some of the ideas or proposals that you think have really big potential to. To reshape reimbursement models and challenges over the next few years?

[B]

So staying within the NSA for just a minute, because again, it's what I really know well, there is opportunity from both legislative and regulatory perspective to improve the NSA's ability and the IDR process's ability to really ensure physicians are getting those sustainable rates of reimbursement. I think Congress has already demonstrated a willingness to look at this issue. You had Congresswoman Houchen on the Energy and Commerce Committee raise an issue that enc, Ways and Means have both looked at when she asked a question of Gail Boudreau, CEO of Elevance, about concerns being raised by physicians and hospitals. Timely payment of arbitration awards. That's something that the committees have really spent significant amount of hearing time on examining. Hey, why is the rate of timely payment after the no Surprises Act's arbitration process so abysmal? 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? There's legislation that's pending related to that, as well as shoring up the patient protections? Bicameral, bipartisan. Introduced in the House by Congressman Murphy and Panetta, in the Senate by Marshall and Bennett, the no Surprises Act Enforcement Act. And it would create penalties and interest for failure to pay timely on arbitration awards. But even More importantly, would create parity in the penalty structure for violations of the actual patient protections. One thing that Congressman Murphy has talked about in the past is there's lots of evidence around payer non compliance with the actual core of the no Surprises Act. It was passed in order to ensure patients were only held accountable to their in network cost sharing. And there's a long, long list of examples where payers have not provided that protection or they've treated protected claims as though they were subject to the rules that existed prior to no Surprises Act. So I think it's worth noting that that is the only piece of legislation related to no Surprises act that's pending. So the real legislative opportunity here is when it comes to the no Surprise act, if Congress is interested in doing anything at all, it's in ensuring that what they pass in the first place actually goes into effect, actually enforcing those patient protections and the expectation that payment is made and made timely once the RDR process is utilized. So I think there's good reason for optimism on the legislative side and I think that proposal really has a huge potential to get the NSA working and the IDR process working in the way that was was always intended.

[A]

Yeah, Patrick, it's great to hear some of these comments around optimism around legislation, especially the no Surprises Act. And you know, I know the policy landscape also changes frequently and it's of course challenging for health care organizations of any kind to keep up. So as you look ahead, I'd love to know a little bit more about the role that organizations like Halo MD can play in helping providers navigate this reimbursement uncertainty, especially as legislative pressures and payer scrutiny are continuing to intensify.

[B]

Yeah, I think at the end of the day, the real hope here is that organizations like KLMD can allow physicians to focus a whole lot less on some of those administrative burdens and get back to actually delivering care. Most especially independent medical groups don't have the administrative backend to deal with the very complicated process of the IDR system. And back to how I kind of started this conversation, the concern around consolidation, both vertical and horizontal, 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, whether by becoming part of a larger group, becoming part of a hospital, or by being part of an insurer. So I think what Halend offers here is that ability to remain independent and let someone else handle administrative burdens while you handle healthcare delivery.

[A]

Yeah, so well said Patrick, and I think a sentiment that will resonate with a lot of leaders listening in, especially on the clinical side. So appreciate you synthesizing so much of this information for our listeners. I know it does not come without complexity, especially when we're talking healthcare policy. So again, I want to thank you for the time you've spent helping to break down the latest in terms of what we're seeing with payers and reimbursement. But is there anything else that you would like to share? Maybe something we glossed over too quickly or even any final thoughts?

[B]

No. You know, I think more than anything else I want to reiterate my optimism for the future of the practice of medicine. I think there are a whole lot more reasons to be optimistic about improvements to the system writ large than reasons to be pessimistic. We've got to stick the landing on some of these things and really make sure that outcomes and implementation match intention. But I think we've got the ability to do that and I'm excited to see the further evolution and stability of the practice of medicine.

[A]

Well, thank you Patrick, and we hope to have you back again for the next time. We need a bit of a policy debrief and what's next for healthcare leaders. It's been great having you with Beckers today, so thank you again for your time.

[B]

Thanks Erica, really appreciate it.

[A]

We'd also like to thank our sponsor for today's podcast, Halo md. Listeners. Be sure to tune into more podcasts from Becker's Healthcare by visiting our podcast page at beckershospitalreview. Com.