Every American deserves access to high quality, affordable healthcare. Right now, our healthcare system is broken. Americans are paying too much, getting too little and nobody has any idea where all the money goes. Our country doesn’t have a healthcare system, it has a healthcare industry. Insurance companies, pharmaceutical giants, and hospital conglomerates have merged into an interconnected web of financial incentives that drive costs up, limit competition, and put the patient last.
I’m proposing the American Healthcare Accountability Act (AHAA) to restore balance by rebuilding transparency, breaking up monopolies and realigning incentives to benefit patients so healthcare works for the people who depend on it.
1. Establish true pricing transparency
When you sit down at a restaurant the waiter gives you a menu with the available dishes and their prices. You order, eat and pay the bill. The foundation of any market economy is customers understanding the price of a good or service before buying it. There remains one glaring exception to this basic norm, and that’s healthcare.
Why do we accept this unique system? We shouldn’t. The healthcare industry needs substantial change and it begins with pricing transparency. A free market requires an informed consumer. Yet consumers have practically no information with which to make life-changing decisions. Healthcare providers rarely disclose the cost of care before treatment. The best a patient can hope for is a rough estimate, if any guidelines are provided at all. Unfortunately, this projection can spike sharply after an unforeseen complication, additional blood tests, or complicated bureaucratic processes. Insurance companies and their allies defend the current system as a free market despite the fact that it’s anything but.
All hospitals, providers and insurers must provide upfront, itemized prices for procedures and medications, thus eliminating “surprise billing” after the fact. This point is non-negotiable. At the same time, national billing codes must be standardized and simplified. Together, these reforms would create a more transparent and competitive healthcare system built around the hallmark of any functioning free market: an informed consumer. In this new model, patients can view and compare prices across care providers. Consequently, they can select the best and most affordable treatment available.
2. Ban direct-to-consumer drug advertising
Big Pharma has developed a business model centered on charging American patients excessive prices for drugs they already funded. The industry insists high prices are the unavoidable cost of medical innovation. Eli Lilly, a market leader, claims the average cost to discover and develop a new drug is $2.6 billion. The reality tells a different story. An independent study found that the average cost of new drug development is only $1.31 billion, less than half Eli Lilly’s claim. Extreme outliers further distort these findings. Removing the two most expensive drugs from the model reduces the average price by another 26%. These claims have allowed the industry to achieve outsized profits. The most recent industry data, compiled in January 2026, shows the pharmaceutical industry generating an 18.54% net profit margin, nearly double the 9.74% margin for the market as a whole. This is not a business teetering on collapse but rather a cartel that has cordoned off an incredibly lucrative section of the market.
The next big question is, who pays for drug development? Naturally, you’d assume it’s the billion dollar companies, but it isn’t. It’s the American taxpayer. The foundational research required to develop their drugs comes from American universities. In 2024, American universities spent $66.8 billion on life science R&D, and $40.1 billion of this funding came directly from public appropriations. Federal financing is critical to drug development. In the 2010s, 99.4% of approved drugs relied at least in part on funding from the NIH.
While concrete data for the 2020s is not yet available, the decade’s best-known drug class, GLP-1s, are dependent on federally funded research. Even drugs developed entirely by pharmaceutical companies often rely on taxpayer funding to make it through clinical testing and reach the consumer. Federal agencies spent about $162 million on the preclinical studies and clinical trials behind remdesivir, a drug Gilead had already patented and now sells for thousands of dollars per course. This research is critical and government investment undoubtedly improves public health. But the question I ask is: if we are funding the development and testing of these drugs, why are Americans charged the highest prices in the world?
One answer is Big Pharma’s multibillion-dollar effort to manufacture demand. Every commercial break has one ad with the same structure: a smiling patient enjoys a sunny day while a narrator touts the drug’s benefits, then races through a long list of possible side effects. These ads are part of a coordinated effort to market more expensive drugs when cheaper alternatives exist. I want to change this, and the first piece is a ban on direct-to-consumer drug advertising. I know that sounds drastic until you remember we did exactly that with cigarettes.
The obvious objection is that patients would lose a source of information about new treatments, and that objection would carry a lot more weight if the information weren’t already sitting in a government filing cabinet. The FDA has published the Orange Book since 1980. It rates approved generics against the brand-name drugs they copy and tells you which ones the FDA considers therapeutically equivalent. Almost no patient has ever heard of it, because it wasn’t written for patients. So rather than build something new, I’d require that existing data to be published in plain language and paired with price, so that when your doctor hands you a prescription you can see for yourself whether an equivalent costs less. Making a database taxpayers already fund actually usable isn’t a new bureaucracy. It’s getting our money’s worth out of an old one.
3. End monopoly medicine
The next step in transforming healthcare from an industry into a patient-focused system is restoring competition. This effort must begin with hospitals. Hospital care accounts for 31% of all health spending in the United States, making it the single largest item on the nation’s healthcare bill. Its cost also continues to climb far faster than inflation, rising by an average of 6.7% annually from 2020 through 2024. Much of this increase stems from consolidation, which has left many communities dependent on a small number of dominant hospital systems. As competition has disappeared, so has the pressure on hospital systems to control costs and improve care.
Independent hospitals are disappearing quickly. According to the latest national data available, in 2024 69% of hospitals belonged to a larger health system, up from 56% in 2010. This trend is only accelerating; in the first two quarters of 2026, 40 hospital mergers were announced. Predictably, these acquisitions have had a devastating effect on local prices. The Robert Wood Johnson Foundation found that hospital consolidation in concentrated markets can drive price increases above 20%. Even cross-market integrations involving hospitals in different geographic regions can raise prices by 6% to 17%. These higher costs have produced no measurable improvement in the quality of care. The evidence is clear. When hospitals are bought, patients pay the bill.
Idaho has been hit particularly hard by system consolidation. Eighty six percent of the state’s hospitals operate in highly concentrated or monopoly markets, placing Idaho eighth nationwide. While some may blame the state’s rural nature for the problem, geography alone does not fully explain it. Boise has several competing health systems, yet St. Luke’s and Saint Alphonsus account for 94 percent of the inpatient hospital market. The result is a health care system in which patients have little meaningful choice over who provides their care.
The first step toward restoring our independent healthcare system is halting its further consolidation. This means actually enforcing the anti-trust laws that are already in place. There is a wealth of research proving the inflationary effect of health care mergers; yet over the past 20 years, the FTC prevented only 13 of the 1,300 proposed mergers. Stronger oversight is only half the solution. Congress must also bolster the laws governing hospital consolidation. Large health corporations often evade regulatory scrutiny by breaking consolidation into a series of smaller acquisitions.
Under current law, private equity firms, insurance companies or large healthcare systems can purchase one clinic here and one surgery center there, gradually rolling up a substantial share of a local market. When each transaction remains below the $133.9 million federal reporting threshold, those acquisitions may proceed without advance notice to antitrust regulators. Instead, any private equity outfit, health insurance organization or corporation above a set size should be required to report every healthcare related acquisition before the deal closes. Therefore, any planned roll-up strategy can be identified and halted while not creating overburdensome hurdles for smaller businesses to rightfully expand. Congress must enforce the law and close these loopholes to restore a competitive balance to America’s healthcare system.
4. Unhook health insurance from employment
Most Americans get their health insurance through work, and almost nobody chose that arrangement, employers included. It’s an artifact of the tax code, a wartime workaround that stuck, and it lets your employer buy your coverage with untaxed dollars while you can’t do the same thing with your own money. That one asymmetry is why a manufacturer in Nampa ends up running a benefits department and negotiating with carriers, and it’s why you take the plan you’re handed or go buy on the individual market without the same tax treatment. A system built around a captive consumer isn’t a free market.
The question worth asking is who knows your health best, and the answer is obviously you, so you should be the one picking the plan. That doesn’t let employers off the hook for contributing. It changes how those dollars move, so workers spend them at their own discretion instead of leaving the choice to a benefits committee. Coverage should be portable too, following you from one job to the next, because right now the fear of losing it keeps people in jobs they’ve outgrown and stops them from leaving to start something of their own. Economists call that job lock, and it’s a drag on exactly the kind of risk-taking that builds a business in Idaho. Changing careers brings enough uncertainty already, and losing your doctor shouldn’t be part of the calculation.
5. Fight corporate socialism
Current federal law draws a bright line at 30 hours a week. Employers with 50 or more full-time employees owe coverage to anyone above that line and owe nothing at all to anyone below it, and businesses under fifty employees sit outside the requirement altogether. That floor should stay exactly where it is. The corner store and the six-person contractor are not the problem I am describing, and no change to this system should land on them.
The problem is companies large enough to build a staffing strategy around the line. A national retailer with a compliance department can work out precisely how many hours to schedule to stay on the cheap side of thirty, and it can do that at a scale no small business could attempt even if it wanted to. When that happens the cost does not vanish, it lands on Medicaid, which means it lands on every other taxpayer, including the small business owners down the street who are paying to cover their own people.
By misclassifying staff and manipulating schedules, large employers avoid providing benefits. Rather than hire two full-time workers to cover 80 hours, a company can divide 87 hours among three people, schedule each for 29, and deny coverage to all of them. These and similar abuses shift enormous costs from private employers onto public programs and taxpayers.
I asked the Idaho Department of Health and Welfare where our Medicaid expansion enrollees actually work, and the report it produced put Walmart and Sam’s Club at the top with 444 Idaho employees on the program, with Amazon, McDonald’s, Albertsons, and Winco all in the top 25. Restaurants and fast food led every industry at 2,378 enrollees, and the state could only match about a third of the roughly 87,500 Idahoans on expansion to an employer at all, so the real count runs higher.
Nevada has tracked this longer and can put a price on it. Its most recent report found 4,914 Amazon employees enrolled in Medicaid along with 5,226 of their dependents, at a cost to taxpayers of $34.12 million, and Amazon has topped that list every year since 2020. Across the country, similar practices shift private labor costs onto Medicaid, increasing public spending while leaving fewer resources for those who depend on the program. Medicaid exists to support Americans down on their luck, not pad the bottom line of major corporations.
From an industry to a functional system
America needs a healthcare system where companies make money the way companies are supposed to, by competing to serve people better and cheaper than the firm next door. There is nothing wrong with earning a profit in medicine. What is wrong is a profit earned by capturing the regulator, buying the only competitor in town, hiding the price until after the procedure is over, or pushing employee costs on to taxpayers. Those are not market outcomes, they are what happens when a market stops working. The American Healthcare Accountability Act would restore the core elements of a functioning market by reintroducing transparency, choice, competition and accountability while preserving the safeguards protecting those who fall through the cracks.
Price reform comes in two parts. Pricing transparency so customers understand costs prior to receiving care, and banning direct to consumer drug advertisements to combat artificially high prices. Stronger anti-trust enforcement will re-introduce competition and give patients more choices to find the healthcare that works best for them. Portable insurance will give patients greater agency to find the best coverage for their lives without tethering them to an unfulfilling job. I would pair these patient-focused reforms with a proportional employer responsibility standard to prevent companies from shifting their healthcare responsibility onto taxpayers.
Each provision addresses a different abuse, but they share one purpose: returning power to the American patient. For decades, corporate interests have written the rules, hidden the costs and limited our options. The result has been higher prices, fewer choices and worse care. It is time to replace this healthcare industry with a healthcare system built to serve the people who rely on it.
Paid for by Todd Achilles for Idaho / J. Patrick Riceci, Treasurer. Copyright (C) 2026 Achilles for Idaho. All rights reserved.
This is terrific! i would add a couple of elements.
1) Combine health, dental, vision, hearing, drug, and addiction/mental health coverage into one product with one master deductible. Slicing care into so many different pieces with separate coverages just wastes money on overhead.
i need to have an 18 year old root canal redone. Depending on the scope of the problem once the endodonist starts the work, the cost can be $2200 to $10000.
Why couldn't that cost be reimbursed thru an expanded Medicare Part B?
2) Start thinking about standardized health professionals licensing. Does it really make sense to have 50 different licensing systems for physicians? Dentists?
3) At some point we need to rethink ambulance service. 2 years ago, i was stung by a swarm of bees. EMS was called but after about 30 minutes of on-site observation, I declined ER/hospital transport because of fear about the cost even though i am on medicare. I got quite ill on the drive home ...
If you need an air ambulance the cost is tens of thousands of dollars. I assume virtually all of those services are private sector not public. Coverage?
Thankyou for this effort! Few others have the guts to take on this albatross of an industry.
I particularly like the proposal to ban direct drug advertising to consumers. It will be tough. I doubt that the media will give up this lucrative source of advertising without a fight.
Several years ago I noticed the massive quantity of drug advertising filling the slots on evening TV broadcasts. I decided to keep track of them and my list of individual drugs has now grown to 137! From Abbvie to Zepbound.
It’s impossible to get away from the constant onslaught of happy people dancing and living their lives after swallowing the latest drug. Of course, there is the constant suggestion to “ask your doctor”. Are they part of the “con”?
Keep up the good work!