Imagine if pilots performed safety checks on only 36% of their equipment or a restaurant served 36% of your pizza or Uber arrived 36% of the time. This is what’s happening in hospitals, which ignore government rules on healthcare price transparency a shocking 64% of the time.
Too often, patients receive medical bills far above what they expected, from an exorbitantly costly surgery to a shockingly high copay for a simple checkup. Sticker shock impact from medical bills can shatter lives, further erode physical and mental health, spark bankruptcy or home foreclosure, or worse. An economic agenda that seeks to improve lives must tackle this issue head-on — and quickly.
Under current government rules, hospitals are required to post all upfront prices online and health insurance companies and employer plans must publicly post all actual negotiated prices systemwide under the Transparency in Coverage rule.
Moreover, the Consolidated Appropriations Act of 2021 requires that insurance companies and brokers reveal all historical claims data and broker fees and eliminate gag clauses. Hospitals must not surprise patients with bills after insurance companies refuse to pay more.
Yet these regulations are rarely followed. Just 36% of hospitals fully comply with transparency rules, according to a recent PatientRightsAdvocate.org compliance report. The Department of Health and Human Services only assessed 14 penalties against noncompliant hospitals, and the penalties they charged were de minimis relative to the operations of these medical giants.
Healthcare price transparency is a bipartisan issue, with about 90% public support. The Trump administration took action to require healthcare providers to disclose their prices starting in 2021. That order was delayed by the Biden administration and effectively made toothless.
Economists know that information asymmetry, in which one side has more knowledge than another, tilts the playing field toward the advantaged player. Information is knowledge and knowledge is power.
Without price transparency, the balance of power in our healthcare system is tilted in favor of healthcare providers and away from patients. This is unconscionable, especially when the majority of healthcare costs are generated by the oldest, sickest patients.
The pending Braun-Sanders Senate Health Care PRICE Transparency Act 2.0 would increase penalties against non-compliant healthcare systems. The bill has gained wide, ideologically diverse U.S. Senate support, from Republican Mike Braun (R-IN), ranking member of the Senate Aging Committee, to self-described democratic socialist Bernie Sanders (I-VT), chairman of the Health, Education, Labor, and Pensions Committee. Other co-sponsors include Sens. Chuck Grassley (R-IA), Tina Smith (D-MN), and John Hickenlooper (D-CO).
This bill would make permanent the rights of consumers to upfront hospital prices, including the discounted cash price and all negotiated prices by payer and plan — with no exceptions. This means protecting patients by eliminating the price estimator “loopholes,” which give merely estimates, averages, percentages, or medians.
The PRICE Transparency Act 2.0 would also expand transparency requirements to laboratories, imaging centers, and ambulatory surgical centers, which often have lower prices than hospitals. It would also put some skin in the game for insurers by codifying the requirement for insurers to disclose all negotiated rates, including all data elements, and require attestation by an insurance executive that all prices are accurate and complete.
Finally, the bill would ensure that federal law does not preempt any state laws related to healthcare price transparency.
The United States doesn’t have a healthcare crisis, but we do have a health costs crisis and a health choice crisis. This, in turn, has left many people in an economic crisis.
To be sure, people have access to the best care in the world, with low wait times and high cancer survival rates. But people lack choice, transparency, and effective competition in healthcare. And it is estimated healthcare costs across the board could be 40% lower if we had the ability to see prices up front on the more than 90% of healthcare that is shoppable, nonemergency room care.
People expect companies to honor the rule of law, not ignore laws and regulations like today’s hospitals do 64% of the time.
That’s why we urge all lawmakers and candidates to sign the Independent Women’s Voice’s Patient Protection Commitment. It’s a pledge to fight for legislation that delivers real price transparency and accountability to our healthcare system and ultimately leads to a more prosperous economic future for all.
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Carrie Sheffield is a senior policy analyst at Independent Women’s Voice .
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