Yesterday, Sam Hazen, CEO of HCA Healthcare, sat before the House Ways and Means Committee and argued that physician-owned hospitals are not on a level playing field with corporate hospitals because they lack functioning emergency rooms and do not treat unfunded patients. Hazen delivered this argument while representing a company that posted $70.6 billion in revenue and $5.76 billion in net profit in 2024. He was not offering a neutral observation about healthcare access. He was protecting a market position. Congresswoman Van Duyne did not let the testimony pass unchallenged. She pointed directly to HCA's own Research Medical Center in Kansas City, Missouri, which closed its labor and delivery unit, its neonatal intensive care unit, and all associated obstetrics emergency services effective September 8, 2025. HCA cited an 80 percent decline in community use of those services over several years as its justification. Nurses at the facility publicly protested the planned shutdowns and called on HCA to reverse course. HCA proceeded anyway. That is a full-service corporate hospital making a purely financial decision to eliminate essential community services when they stopped generating adequate volume. The same CEO who told Congress that physician-owned hospitals fail community obligations made that decision. The emergency room argument deserves particular scrutiny. Mr. Hazen's implication is that operating an ER is a financial burden that justifies the premium reimbursement HCA collects across its outpatient system. The capital record contradicts that framing entirely. In January 2024, Hazen personally told HCA investors that the company's freestanding emergency room capacity would "grow consistently" in 2024 and 2025 to meet rising patient demand. In October 2025, HCA committed nearly $60 million to construct three new freestanding emergency rooms in Virginia alone, expanding its footprint there from eight to eleven standalone ER facilities. HCA has simultaneously been opening freestanding ERs in South Carolina, Florida, and throughout its other markets. In the first quarter of 2026, HCA reported that its emergency room capacity grew 4 percent year-over-year. A peer-reviewed analysis published in Health Affairs found that hospital emergency department revenue exceeded costs by $6.1 billion nationally as far back as 2009, a margin of 7.8 percent overall, with privately insured ED patients generating $17 billion in profit. Companies do not invest tens of millions of dollars in freestanding emergency infrastructure because that infrastructure is a burden. They expand aggressively into emergency care because it is profitable, particularly for commercially insured patients. When physician-owned hospitals choose not to operate ERs, they are not avoiding a community obligation. They are declining to compete in HCA's most profitable and most aggressively expanded service line. The uncompensated care argument carries an equally significant contradiction. Through its Surgery Ventures division, HCA jointly owns and operates approximately 150 ambulatory surgery centers with more than 3,400 physician partners across 16 states. Those ambulatory surgery centers have no emergency rooms. They do not accept unfunded patients. They perform elective procedures on commercially insured patients and return profits to both HCA and its physician co-owners. By the precise standard Mr. Hazen applied to physician-owned hospitals before the Ways and Means Committee, his own company's Surgery Ventures facilities are doing exactly what he described as an unfair advantage. The distinction HCA is actually drawing is not between facilities that serve whole communities and those that do not. It is between facilities that HCA controls and those that it does not. When physicians own a hospital independently, HCA calls it cherry-picking. When HCA installs those same physicians as partners in ASCs under its corporate umbrella, it calls it innovative care delivery. The history of how HCA treats physician partners outside of its direct control is documented in a Harris County, Texas courtroom. Fondren Orthopedic Ltd., a group of orthopedic surgeons, entered a limited partnership with what was then Columbia Hospital Corporation in 1993 to jointly own and operate Texas Orthopedic Hospital in Houston. The agreement ran for 57 years. For roughly two decades it functioned as written. Around 2017, HCA, which had assumed Columbia's position, began employing orthopedic surgeons at competing facilities across the Houston area, ultimately opening 10 competing hospitals offering the same services as the joint venture, in direct violation of the non-compete provisions of the partnership agreement. Simultaneously, HCA invoked those same non-compete clauses against the Fondren physicians, blocking them from doing what HCA was openly doing. In September 2024, a Harris County jury returned a verdict of $25.6 million against HCA for breach of contract. Lead attorney Joe Ahmad stated publicly that HCA owned 60 percent of Texas Orthopedic Hospital with Fondren, but 100 percent of the competing facilities it quietly opened to redirect patients away from their jointly held hospital. The jury found that HCA had the size, the scale, and the power to disregard a contractual obligation it found inconvenient, approximately 28 years into a 57-year agreement. The legislative response is already written. H.R. 4002, the Patient Access to Higher Quality Health Care Act of 2025, introduced by Congresswoman Van Duyne and Congressman Henry Cuellar (D-TX-28), would repeal Sections 6001 of the Affordable Care Act, which banned new physician-owned hospitals from Medicare participation in 2010 and capped existing facilities at their March 2010 capacity. That ban was not derived from patient outcome data. It was a lobbying achievement. The evidence accumulated in the 15 years since passage shows that physician-led facilities consistently deliver care at lower cost with higher patient satisfaction than large corporate systems. Thank you @RepBethVanDuyne for being a champion for patients, physicians, and communities!