Congress examines transparency pricing for healthcare costs

Healthcare is getting more expensive nationwide.

In fact, federal projections show Americans are expected to spend more than $5 trillion dollars this year alone. Those numbers are expected to increase to nearly $8 trillion by 2032.

Across the country, whether it’s a major surgery or an x-ray, hospitals are required to post a list of shoppable services online and how much they cost in an easy-to-access format.

That’s the goal of the Hospital Price Transparency Rule which took effect in 2021. But in a congressional report from Sen. Mike Braun’s office, it found only about 34 percent of hospitals are fully compliant with the rule.

“Can you imagine not knowing how much something that could be thousands of dollars is until after you get the bill and then asking those patients to pay those bills within 90 days? It’s outrageous that we don’t know prices before,” said Patricia Kelmar with the U.S. Public Information Research Group (U.S. PIRG).

Patricia Kelmar is the Sr. Director of Health Care Campaigns for U.S. PIRG. She said price transparency is key for competition.

“We’ll start to see who are the outliers? Who in our community is charging more than every other hospital? What are these prices? Is price gouging happening,” said Kelmar. “It also helps insurance companies pay less, it helps them negotiate lower rates.”

On Capitol Hill, the Senate Special Committee on Aging held a hearing about the issue. Both Democrats and Republicans raised concerns about the impact of rising costs for consumers and even called on hospitals to make changes.

“For anyone that is a CEO in the industry, I would suggest you do what all the rest of us have done that run businesses, embrace competition, deal with an engaged consumer and full transparency,” said Sen. Mike Braun, R – Indiana.

“Hospital costs have risen faster than healthcare costs overall, these increasing costs directly impact Americans’ access to healthcare,” said Sen. Bob Casey, D – Pennsylvania.

The American Hospital Association (AHA) represents thousands of facilities and health systems nationwide.

In a statement to Congress for this recent hearing, it said roughly 93 percent of hospitals have met the requirement to post a machine-readable file.

The organization also raised concerns about efforts to no longer recognize price estimator tools as a method to meet part of the federal rule. “This change would both reduce access to a consumer-friendly research tool and unfairly penalize hospitals that have spent significant capital to comply with the regulation,” in the AHA written statement to Congress.

The Health Care Price Transparency Act 2.0 is a bipartisan effort to try to address these healthcare costs. It would expand these price transparency requirements to clinical diagnostics labs and imaging centers. It would facilities to post prices for services by 2025.

Recently the House passed the Lower Costs, More Transparency Act but it hasn’t been considered in the Senate.

The American Hospital Association also provided this statement from Ariel Levin, director of policy at the AHA, for our coverage:

Hospitals and health systems are dedicated to ensuring patients have accurate and timely estimates about the costs of their care, including through the use of price estimators and other tools. The field is embracing new technologies that make accessing such estimates easier than ever.

We are proud that the federal government, which oversees compliance with the hospital price transparency rules, in 2022 found that 70% of hospitals had complied with both federal requirements and over 80% had complied with at least one. We expect these numbers to continue to increase.

The AHA continues to believe that the best path towards helping patients make informed decisions about their care is to simplify and reduce the amount patients owe in co-pays and other cost-sharing, as well as to ensure all estimates consider the patients’ health care coverage.