Startup CEO proposes automatic enrollment, payment smoothing to ease out‑of‑pocket burdens

Brian Worley, CEO of Patient, urged lawmakers to expand existing market tools to reduce out‑of‑pocket burdens and improve affordability.

Worley said Patient serves employers and partners with insurers and pharmacy programs and that the company helped implement a Medicare prescription payment plan used by millions of seniors. He proposed four near‑term steps: automatically enroll seniors in the Medicare prescription payment plan, expand payment smoothing to include medical (not just pharmacy) costs and ACA/employer plans, enable real‑time opt‑in at the point of sale, and allow workers to receive the cash value of employer health contributions into an HSA or Roth HSA.

Worley argued those tools let patients pay transparent, transactable cash prices and smooth high out‑of‑pocket expenses into manageable monthly payments without eliminating insurance for rare and expensive care. He said market adoption depends on insurers and employers seeing value and that the main barrier is inertia and regulatory friction.

Members pressed Worley on demand and whether such services would grow if people face higher premiums; Worley acknowledged demand increases when people cannot pay upfront and said payment smoothing is a pragmatic approach but not a replacement for comprehensive coverage.

The hearing did not result in legislative action on these proposals; Worley’s testimony was entered into the record for members’ consideration.