April 27, 2026
Dear Ways & Means Committee Members,
We would like to thank Chairman Jason Smith (R-MO-8) and Ranking Member Richard Neal (D-MA-1) for their leadership in examining the drivers of rising healthcare costs and their impact on patients and families. We appreciate the Committee’s continued attention to affordability and access, particularly as these challenges greatly intensify for older adults across the country.
We are acutely aware of these challenges since we hear from Hispanic older adults and caregivers every day who are struggling not only with the cost of care, but with the financial consequences that come after receiving it. Many live on fixed incomes, manage multiple chronic conditions, and face persistent barriers to accessing timely and affordable care. When costs rise or financial pressures increase, these individuals often delay care, skip medications, or take on debt that can follow them for years. Medical debt is not an abstract issue — it directly affects whether individuals can continue treatment, maintain housing stability, or meet basic needs.
In recent months, these concerns have been reinforced by new analysis from the National Consumers League, which found that hospitals participating in the 340B program are more likely to maintain policies allowing aggressive medical debt collection practices, including lawsuits, liens, wage garnishment, and care denial or deferral due to unpaid bills.
At the same time, analysis from Third Way suggests that the growth of the 340B program has created ripple effects across the healthcare system, driving up spending in Medicare, Medicaid, as well as increased annual premiums in the employer-sponsored health insurance marketplace. Not to mention increased drug costs, and federal spending.
For older adults managing serious conditions such as cancer, the risk of lawsuits, wage garnishment, higher drug costs, premium increases, or being turned away from care due to unpaid bills can be devastating. Programs like 340B are intended to support access to care for underserved populations, yet for many patients, the financial pressures associated with care remain a significant barrier.
As Members of Congress examine the drivers of health care costs, it is important to ensure that these programs are working as intended for the patients they are meant to serve. Addressing affordability requires not only reducing system-wide costs, but ensuring that patients — particularly older adults in underserved communities — are protected from financial harm when seeking care.
NHCOA looks forward to working with you as your Committee continues oversight into the factors that shape affordability for patients and families.
Respectfully,
Yanira Cruz, MPH, DrPH
President and CEO
National Hispanic Council on Aging (NHCOA)
About NHCOA:
NHCOA is the leading national organization working to improve the lives of Hispanic older adults, their families, and their caregivers. Headquartered in Washington, DC, NHCOA has been a strong voice dedicated to promoting, educating, and advocating for research, policy, and practice in the areas of economic security, health, and housing for Hispanic older adults, families, and caregivers for the last 51 years.
For more information about NHCOA call 202-347-9733 or visit www.NHCOA.org.
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