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Jon Greenberg
By Jon Greenberg January 15, 2021

Trump delivers some headway toward health care price transparency

Letting people know how much it will cost to go to the hospital has been a prime goal of everyone who wants to use market forces to drive down the cost of care. The idea is that if patients can shop around, health care providers will need to compete on price.

From the very start, President Donald Trump made price transparency part of his health care plan. He said he would "require price transparency from all health care providers, especially doctors and health care organizations like clinics and hospitals."

Trump delivered on the hospital part.

Under new rules, as of Jan. 1, 2021, every hospital is required to list the prices of about 300 of the most common services. That would include X-rays, colonoscopies, outpatient visits, and more. The idea is to make this as easy as possible for the public to understand. One key requirement is hospitals have to bundle the costs of everything tied to a certain procedure. The rules get at one of the trickiest parts of medical billing — hospitals negotiate different prices with different insurance companies. The new rules say hospitals have to show the price linked to each insurer.

Health policy researcher Neeraj Sood at the USC Schaeffer Center for Health Policy and Economics wrote that the move is a good first step.

"Transparency will be disruptive, but I believe it is a risk worth taking," Sood wrote Nov. 27. "Making prices more transparent saves money. The regulations will spur greater price competition and reduced prices will benefit all consumers, not just those who will shop around."

The rules, however, leave a piece of the promise unfulfilled. 

"It doesn't require non-hospitals to provide this information," said Nisha Kurani, senior policy analyst at the Kaiser Family Foundation. "It doesn't apply to doctors who have their own practices."

In addition, Adam Sacarny at Columbia University's Mailman School of Public Health warned that even physician charges at a hospital could fall into a gray zone. 

"When you get care at a hospital, there are two billing entities," Sacarny said. "There is the hospital. And then there are the physician professional services, and that's not covered."

The bottom line is that knowing the cost in advance could still be a bit of a puzzle.

More transparency is in the pipeline. Starting in January 2023, nearly all insurance companies — covering those in the individual and group markets and self-funded employer plans — will have to publish prices and cost-sharing estimates for many of the same common services.

We rate this promise Compromise.

 

Our Sources

Centers for Medicare and Medicaid Services, Hospital Price Transparency, Sept. 30, 2020

Health Affairs, 10 Things to Expect from the New Hospital Price Transparency Rule, March 6, 2020

USC Schaeffer Center for Health Policy and Economics, What the Trump Administration Gets Right About Hospital Price Transparency, Nov. 27, 2019

BMJ, Opinion: American patients can't shop their way to a low cost healthcare system, July 7, 2020

Peterson-KFF Health System Tracker, Price Transparency and Variation in U.S. Health Services, Jan. 13, 2021

Interview, Adam Sacarny, assistant professor, Health Policy and Management, Mailman School of Public Health, Columbia University,Jan. 5, 2021

Interview, Nisha Kurani, senior policy analyst, Kaiser Family Foundation, Jan. 5, 2021

Jon Greenberg
By Jon Greenberg March 15, 2017

Additional pricing transparency not included in House GOP bill

President Donald Trump and his fellow Republicans want market forces to drive down the cost of health care. During the election, Trump promised he'd deliver on a step to help get there.

"Require price transparency from all health care providers, especially doctors and healthcare organizations like clinics and hospitals," he had on his website. "Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure."

The House GOP bill that has emerged as the leading option to repeal and replace the Affordable Care Act includes no added price transparency provision. (Senate rules limit that bill to tax and spending measures, and transparency rules wouldn't qualify.)

Changes could come through other legislation or through regulatory moves at the Health and Human Services Department.

Michael Tanner, senior fellow at the libertarian-oriented CATO Institute, told us, "as far as I know there haven't been any indications of changes."

The press office at the American Hospital Association, a group with a direct stake in publicizing the cost of services, also said they hadn't heard of anything.

We asked Ryan's office if something was in the works, but didn't hear back. Ditto for the White House.

Already, under Obamacare, the Centers for Medicare and Medicaid Services issued guidelines for hospitals to list the price of standard procedures. Those have been in place since 2014, but they give hospitals some wiggle room. They could post their charges online, or supply them only if patients and their families requested them.

"We believe hospitals are in the best position to determine the exact manner and method by which to make the list public," the regulations said.

Seeing no action on the transparency front, we rate this promise Stalled.

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Promise Stalled
Promise: Require price transparency from health care providers
On Trump's campaign website
Wednesday, March 15, 2017

Our Sources

Donald Trump for President, Health care reform to make America great again, accessed March 15, 2017

U.S. Department of Health and Human Services, Requirement for Transparency of Hospital Charges Under the Affordable Care Act, Aug. 22, 2014

The Hill, New price transparency rules for hospitals, April 30, 2014

Commonwealth Fund, Health Care Price Transparency: Can It Promote High-Value Care?, April/May 2012

Email interview, Marie Watteau, press office, American Hospital Association, March 15, 2017

Email interview, Michael Tanner, senior fellow, CATO Institute, March 15, 2017

 

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