By Andrew O'Reilly
Published June 24, 2019
President Trump on Monday signed an executive order demanding the upfront disclosure by hospitals of the actual prices for common tests and procedures.
Trump's order also requires that patients be told ahead of time what their out-of-pocket costs like deductibles and copays will be for many procedures.
“This landmark initiative continues our work to put American patients first,” Trump said at the White House. “We are fundamentally changing the nature of the health care marketplace.”
Health and Human Services Secretary Alex Azar told reporters before Trump’s remarks that the idea is to give patients practical information that they can use to help save money. For example, if a hospital charges your insurer $3,500 for a type of echocardiogram and the same test costs $550 in a doctor's office, you might go for the lower-price procedure to save on copays.
The executive order calls for a rule-making process by federal agencies, which typically takes months or even years. The details of what information will have to be disclosed and how it will be made available to patients must be worked out as part of writing the regulations. That will involve a complex give-and-take with hospitals, insurers and others affected. Consumers will have to wait to see whether the results live up to the administration's promises.
Lack of information on health care prices is a widespread problem . It's confusing for patients, and experts say it's also one of the major factors that push up U.S. costs. The same test or procedure, in the same city, can cost widely different amounts depending on who is performing it and who is paying the bill. Hospital list prices, which are available, don't reflect what they actually get paid by insurers and government programs.
The health insurance industry said disclosing negotiated prices will only encourage hospitals that are now providing deeper discounts to try to raise their rates to match the top-tier facilities. "Publicly disclosing competitively negotiated proprietary rates will reduce competition and push prices higher — not lower — for consumers, patients, and taxpayers," Matt Eyles, head of the industry group America's Health Insurance Plans, said in a statement.
While the prices Medicare pays are publicly available, private insurers' negotiated rates generally are not. Industry officials say such contractual information is tantamount to trade secrets and should remain private.
Azar pushed back against that argument, saying insurers do ultimately disclose their payment rates when they send individual patients an "explanation of benefits." That's the technical term for the form that patients get after they've had a procedure or seen the doctor.
The president used his remarks to also take shots at former President Barack Obama’s Affordable Care Act as well as 2020 presidential hopeful Bernie Sanders and his “Medicare for all” plan. Sanders’ plan would replace job-based and individual private health insurance with a government-run plan that guarantees coverage for all with no premiums, deductibles and minimal copays for certain services.
“Democrats in Congress support Bernie Sanders’ socialist takedown of American health care,” Trump said. “Under my administration, we will not let that happen.”
The Associated Press contributed to this report.