For Big Insurers, Tomorrow’s Congressional Hearings Is the Super Bowl

From “rude question” binders to lawyered-up word salad, this is how I would make sure my old boss wouldn't tank our company's stock price.

If I were still in my role as a Cigna executive, one of my responsibilities would be to prepare CEO David Cordani for his first ever appearance before a Congressional committee tomorrow. When I was the VP of corporate communications, I wrote speeches for the CEO and staffed him for any public-facing appearances. I was also the gatekeeper. Reporters had to go through me to interview anyone at Cigna, and I would rarely allow a reporter to get anywhere close to the CEO. In fact, my colleagues and I were vigilant to keep the CEO from appearing at any event that was open to the general public where a reporter, much less a member of Congress, might ask him a question.

The closest the CEO came to such an open forum during my 15 years at Cigna was the company’s annual spring meeting of shareholders, which reporters could attend, although, incredibly, only two showed up during my tenure, and one of them got stuck in traffic and arrived after the meeting was over and the CEO was long gone. Nevertheless, my team and I would put together a binder of what we called “rude” questions that a reporter – or unhappy shareholder – might ask.

Neither of the two CEOs I staffed during my time at the company was ever invited to testify at a Congressional hearing, but if they had been, we would have put together a similar list of rude questions, along with suggested answers, to help them get through the meeting without saying anything that might lead to a selloff on Wall Street. I would also work with our lobbyists (and our lawyers and investor relations team) to draft the five minutes of opening testimony he would be expected to provide. We would write five minutes worth of a word salad designed to not be quotable or memorable but that nevertheless would make the CEO appear knowledgeable, reasonably likable, and, most importantly, “part of the solution.” The ultimate goal: Baffle ‘em with bullshit and always be spinning.

And if this hearing were happening when I was still in my old job, this would not have been just another day at the office. This would have been our Super Bowl.

I would have rolled up the sleeves of my starched button-down and coyly ask my assistant if her husband would be able to pick up the kids to allude the long days ahead. My team and I would be working the phones, comparing notes with our lobbyists and government affairs staff, mapping out which lawmakers were “friendlies” and which ones we considered “hostiles.” We would have someone combing through members’ social media feeds, old press releases, past hearing transcripts — whatever might hint at what questions were coming and who was most likely to ask them.

We would try to predict not just what would be asked, but who would ask it. And then we would build our answers — evasive, polished and carefully lawyered — to make sure our boss could walk out of the hearing room without delivering a hit to our stock price.

So if I were sitting behind my old boss in that hearing room tomorrow, I wouldn’t be listening for the prepared statements. I’d be listening for whether anyone managed to ask the questions we spent years making sure were never asked.

All that said, if I were a member of Congress and had a chance to ask David a few questions, below are a few of the rude ones I would ask him.

• Mr. Cordani, until 2018, your company was primarily in the health insurance business. In 2017, the year before you bought the big PBM Express Scripts, almost all of your $41.6 billion in revenues came from health insurance premiums and fees. Seven years later – and just six years after the Express Scripts acquisition – your annual revenues had soared by $200 billion, to $247 billion. In your 10K for 2024, you said your revenue increased an impressive 27% from 2023 to 2024 – and that more than $200 billion of that $247 billion came from the division that includes Express Scripts, which along with PBMs owned by CVS/Aetna and UnitedHealth control 80% of the pharmacy benefit business in this country. You also reported that the vast majority of your profits in 2024 came from your pharmacy operations.

• Please explain how a PBM – the middleman in the pharmacy supply chain that determines whether a drug will be included on an insurance company’s formulary and how much patients will have to pay out of their own pockets even if it’s included – how can a PBM capture such a staggering amount of what Americans spend on their prescription medications.

• Mr. Cordani, between 2020 and 2024, Cigna paid you more than $100 million in total compensation, and most of it was in the form of stock grants and stock options. That’s approximately 280 times as much as the median salary at your company. How can you justify making so much money when the average family health insurance premium reached $27,000 last year? And how much of your total compensation is tied to Cigna’s ability to meet your shareholders’ earnings expectations?

• Mr. Cordani, my research shows that Cigna spent close to $30 billion buying back shares of its own stock between 2020 and 2024. Please explain why that money was not devoted to reducing your health plan enrollees’ premiums and out-of-pocket expenses. And please explain how stock buybacks benefit you and other top Cigna executives?

• Mr. Cordani, before the Affordable Care Act, Cigna became a big player in the short-term, limited-benefit business when it bought a company that specialized in those plans. Many if not most of those limited-benefit plans, which consumer advocates have called junk or fake insurance, were not compliant with the essential benefits established by the ACA, and they often had annual and life-time caps along with very high out-of-pocket requirements. Do you think Congress was wrong to establish a set of essential health benefits that insurers would have to cover in their health plans and to outlaw annual and life-time caps? Do you support what President Trump calls his Great Health Care Plan, which would allow you to sell limited-benefit plans like you did before the ACA? Can you tell us what the average medical loss ratio was for the Starbridge limited-benefit plans you sold? Would it be correct to say that they were exceedingly profitable?

I’ll write more in a few days and let you know if anybody did ask these questions and, if so, how David answered them.