The Healthcare Financial Management Association (HFMA) has issued a formal call to action for healthcare leaders, insurers, and policymakers to cease systemic "finger-pointing" and embrace a collaborative framework to address the nation’s escalating healthcare affordability crisis. This initiative arrives as new polling data indicates that the cost of medical care has become a primary driver for voters heading into next week’s midterm elections. With more than 150,000 members, HFMA—a nonpartisan, not-for-profit organization dedicated to the financial management of healthcare—is leveraging its influence to pivot the national conversation from blame to actionable, cross-sector innovation.
The push for a unified front is anchored by the organization’s newly unveiled "Declaration on Healthcare Affordability and Sustainability." This document serves as a manifesto for financial leaders across the healthcare spectrum, including providers, payers, employers, and financial technology (fintech) innovators. The declaration asserts that the current trajectory of U.S. healthcare spending is unsustainable and that the fragmentation of the industry has historically prevented meaningful reform. By inviting stakeholders to sign this declaration, HFMA aims to create a pact of mutual accountability focused on eliminating waste rather than merely shifting costs between different sectors of the economy.
Public Sentiment and the Political Landscape
The urgency of HFMA’s call is underscored by a recent Morning Consult poll commissioned by the organization. The survey, which queried 2,022 registered voters, revealed a significant shift in public perception regarding medical expenses. According to the findings, 54% of respondents stated that healthcare has become noticeably less affordable over the past year. This sentiment is not confined to a single political ideology; rather, it represents a rare point of bipartisan consensus. The data shows that 61% of Republicans and 83% of Democrats identify healthcare affordability as a factor that will influence their vote in the upcoming midterm elections.
The anxiety surrounding healthcare extends beyond the immediate price of services to the very existence of care infrastructure. Approximately 57% of voters expressed deep concern regarding hospital closures, a statistic that highlights the precarious balance between the need to reduce national healthcare spending and the necessity of preserving local access to emergency and specialty care. This "affordability-access paradox" is particularly acute in rural areas and underserved urban centers where financial margins are razor-thin.
Further validating these findings is a recent KFF (Kaiser Family Foundation) Health Tracking Poll. The KFF data indicates that six out of ten respondents are worried about their ability to afford unexpected medical bills or routine care. Furthermore, half of the electorate believes it is "extremely important" for midterm candidates to articulate clear strategies for lowering costs. Together, these polls suggest that healthcare has transcended its status as a policy debate and has become a visceral economic concern for the American household, rivaling inflation and housing costs.
A Chronology of the Affordability Crisis
The current crisis is the culmination of several years of compounding economic and systemic pressures. While the COVID-19 pandemic temporarily shifted the focus toward public health infrastructure and emergency response, the subsequent "return to normal" has seen a resurgence of high medical inflation and labor shortages.
Earlier this year, HFMA launched the Vitalic Health Initiative, a strategic effort designed to support the financial sustainability of health systems while simultaneously improving patient outcomes. The initiative was born out of the recognition that traditional cost-cutting measures—such as reducing staff or delaying capital investments—often lead to a decline in quality of care, which ultimately increases long-term costs.
Throughout the spring and summer, healthcare providers faced unprecedented spikes in labor costs as the "Great Resignation" hit the nursing and technician sectors. Concurrently, pharmaceutical prices and supply chain disruptions for medical devices continued to climb. By the time the midterm campaign season reached its peak in the fall, the financial strain on both hospitals and consumers had reached a breaking point. The HFMA Declaration represents the latest step in this timeline, moving from data collection and internal initiatives to a public demand for industry-wide structural change.
The Pitfalls of Cost-Shifting and Administrative Waste
Richard L. Gundling, HFMA’s Chief Mission Impact Officer, has been vocal about the dangers of "cost-shifting," a practice where one stakeholder reduces their expenses by forcing another to pay more. In a recent communication, Gundling emphasized that true affordability cannot be achieved through accounting sleight-of-hand.
"If an employer lowers its costs by increasing employees’ deductibles, the bill hasn’t gone away; the employee is paying more of it," Gundling noted. This dynamic has led to the rise of high-deductible health plans (HDHPs), which often leave patients "underinsured"—meaning they have coverage but cannot afford the out-of-pocket costs required to use it.
Instead of shifting burdens, HFMA is urging leaders to target the "low-hanging fruit" of administrative inefficiency. Industry analysts estimate that hundreds of billions of dollars are wasted annually in the U.S. healthcare system on repetitive paperwork, complex billing cycles, and adversarial claims disputes between hospitals and insurance companies. These frictions do not improve patient health but do add significant overhead to every medical transaction.
HFMA’s strategy involves establishing shared measures of success. This includes a clear understanding of how savings in one area—such as streamlined digital billing or standardized prior authorization—will impact the end user. Gundling argues that the metric for success must move beyond individual balance sheets to encompass the "Total Cost of Care."
"We should measure both the expense we eliminate and whether patients, employers, and taxpayers actually benefit," Gundling said. "That means looking at what people pay, the overall cost of care, and whether access and quality improve. Savings have to show up beyond an individual organization’s balance sheet."
Impact on Rural Health and Vulnerable Populations
The HFMA initiative places a specific spotlight on the plight of rural and financially vulnerable hospitals. These institutions often serve as the largest employers in their communities and the sole providers of life-saving services. However, they are also the most susceptible to the "finger-pointing" culture. When insurers lower reimbursement rates or employers opt for narrower networks to save money, rural hospitals often bear the brunt of the financial impact.
The threat of closure for these facilities is not theoretical. Over the past decade, dozens of rural hospitals have shuttered, leaving vast "healthcare deserts" across the country. Gundling emphasized that the goals of affordability and access are inextricably linked. "People want care they can afford and confidence that it will be there when they need it. Those goals go together," he stated.
By fostering collaboration between payers and these vulnerable providers, the HFMA hopes to create "value-based" payment models that provide steady, predictable revenue for rural clinics while incentivizing preventative care that keeps costs low for the community.
Broader Implications and the Path Forward
The "Declaration on Healthcare Affordability and Sustainability" is more than a symbolic gesture; it is a call for a data-driven overhaul of the healthcare economy. The Vitalic Health Initiative, which underpins the declaration, encourages the testing of innovative approaches to cost savings, such as AI-driven administrative tools and integrated fintech solutions that help patients manage their payments without falling into predatory debt.
The implications of this movement are significant for the post-election legislative environment. Regardless of which party controls Congress after the midterms, the pressure to address healthcare costs will be immense. HFMA’s nonpartisan stance allows it to provide a roadmap that focuses on operational efficiency and market-based innovations—concepts that historically appeal to both sides of the aisle.
If healthcare leaders fail to heed this call for collaboration, the alternative is likely increased regulatory intervention. Both state and federal lawmakers have shown an increasing appetite for price transparency laws, "surprise billing" protections, and even direct price controls on certain services and medications. By taking the lead through the Declaration, HFMA is offering the industry a chance to self-regulate and innovate its way out of the crisis.
As the nation prepares to vote, the message from HFMA and its 150,000 members is clear: the era of isolated financial management is over. The path to a sustainable healthcare system requires a holistic view of the economy where the financial health of the provider, the payer, and the patient are viewed as parts of a single, interconnected system. The organization continues to invite healthcare finance leaders and other stakeholders to endorse the declaration and participate in developing concrete, sustainable solutions to what has become the nation’s most pressing domestic challenge.
