HFMA presses for a unified affordability strategy as election-season pressure builds
Healthcare affordability has moved from a policy talking point to a voting issue, and the Healthcare Financial Management Association is trying to turn that pressure into coordinated action. With midterm elections approaching, HFMA is urging healthcare leaders to stop treating rising costs as someone else’s problem and to sign its Declaration on Healthcare Affordability and Sustainability.
The timing is politically consequential, but the underlying problem is structural. When voters say healthcare is becoming less affordable, they are not describing a single price tag or one bad billing experience. They are describing a system in which premiums, deductibles, hospital charges, claims administration, and access concerns are all felt at the same time.
HFMA’s message is aimed at the financial leaders who sit across that system: providers, payers, employers, purchasers, and fintech leaders. The organization wants them to endorse a framework that treats affordability as a shared responsibility rather than a zero-sum contest over who absorbs the next round of costs.
Polling shows affordability is driving voter concern on both sides
A Morning Consult poll commissioned by HFMA found that 54% of 2,022 registered voters said healthcare has become less affordable this year. The partisan spread was striking and politically relevant: 61% of Republicans and 83% of Democrats said healthcare affordability will affect how they vote in the upcoming election.
A separate KFF poll pointed in the same direction. Six in 10 respondents said they were worried about being able to afford healthcare, and about half said it is extremely important for candidates in the midterm elections to talk about the cost of care.
Those numbers matter because they show affordability is not confined to one constituency or one income bracket. Cost pressure can land in the form of higher deductibles, more expensive prescriptions, narrower provider networks, or delayed care because patients are trying to avoid an out-of-pocket bill. For hospitals, the same pressure can show up as uncompensated care, tighter margins, and a greater risk of closure, especially in rural communities.
The declaration targets cost shifting, not just cost cutting
HFMA is asking stakeholders to move beyond the familiar habit of shifting expenses from one part of the system to another. Richard L. Gundling, HFMA’s chief mission impact officer, framed the issue in plain financial terms: if an employer lowers its costs by increasing employee deductibles, the bill has not disappeared, it has simply moved.
That distinction is central to the declaration. The point is not to congratulate one organization for reducing its own spending while patients, taxpayers, or employers carry the burden elsewhere. The goal is to identify unnecessary costs, remove them, and measure whether any savings reach the people who actually use the healthcare system.
There is a practical clinical consequence embedded in that argument. When costs rise faster than wages, patients delay visits, skip medications, or avoid follow-up care. In chronic disease management, that can mean more avoidable complications and more expensive downstream care, which then feeds back into the same financial spiral the declaration is trying to interrupt.
Administrative waste sits at the center of HFMA’s argument
Gundling pointed to administrative inefficiencies as a major opportunity for savings, including repetitive paperwork and unnecessary claims disputes. Those frictions are not abstract overhead. They consume staff time, prolong payment cycles, and create friction at the point where care delivery meets reimbursement.
In a system already strained by tight margins, these inefficiencies can be especially punishing for rural and financially vulnerable hospitals. HFMA said those facilities face the risk of closure, and the impact of a shutdown reaches far beyond the balance sheet. Entire communities can lose local access to emergency care, inpatient services, and routine treatment options.
The policy logic here is straightforward. If cost reduction efforts simply push more burden onto patients or weaken the financial footing of hospitals that already operate on thin margins, affordability becomes a paper achievement rather than a real-world improvement. Shared savings only matter when they can be tracked across the full care continuum, from what patients pay to whether access remains intact.
Vitalic Health broadens the effort into a measurement agenda
HFMA’s Vitalic Health Initiative, launched earlier this year, is meant to support the financial sustainability of health systems while improving outcomes and access. The initiative encourages data-driven decision-making, testing of new approaches to cost savings, and careful measurement of whether those changes actually reduce spending without compromising quality or access.
That measurement piece is critical. Healthcare organizations often celebrate cost reductions inside a single department or payer contract, but those gains can be misleading if they produce higher out-of-pocket spending elsewhere, increase administrative burden, or reduce the availability of care. HFMA is pushing a wider accounting that looks at what people pay, the overall cost of care, and whether access and quality improve at the same time.
The message is directed at a sector that routinely debates costs in fragments. Hospitals defend margins. Payers manage utilization. Employers balance benefits against labor costs. Patients absorb whatever is left over. HFMA’s declaration tries to force those interests into the same room, with affordability treated as a linked financial and access problem rather than a series of disconnected complaints.
Rural access and patient burden remain the clearest pressure points
The strongest appeal in HFMA’s call is its warning about what happens when affordability failures reach the community level. Rural closures do not just reduce convenience; they narrow the safety net. When a local hospital disappears, patients often travel farther for emergency treatment, specialty visits, and inpatient care, and that added distance can worsen outcomes before anyone gets to the billing desk.
For patients, affordability is also inseparable from trust. Gundling said people want care they can afford and confidence that it will be there when needed. In practice, those expectations are linked. A system that becomes cheaper only by excluding patients through cost sharing or by hollowing out local access does not solve the problem that voters are describing.
HFMA is inviting healthcare finance leaders and other stakeholders to endorse the declaration and participate in developing durable solutions to the affordability crisis. The challenge is whether the sector can move from recognition to actual coordination, and whether any savings can be traced to lower patient burden rather than a new version of the same bill under a different name.