Legislation codifies Trump Administration’s hospital and insurance price transparency rules
WASHINGTON, D.C. – In a move to empower patients and lower healthcare costs, today Senator Mike Braun (R-IN), Senator Joni Ernst (R-IA), Senator Mike Enzi (R-WY), Senator Chuck Grassley (R-IA), Senator John Kennedy (R-LA) and Senator Kelly Loeffler (R-GA) introduced the PRICE Transparency Act.
This legislation would codify the two health care price transparency rules that came out of President Donald Trump’s Improving Price and Quality Transparency in American Healthcare Executive Order—–which requires hospitals and insurers to reveal their low, discounted cash prices and negotiated rates to consumers before they receive medical care.
Last November, the Trump Administration issued two separate regulations requiring price transparency for hospitals and health insurance companies. Some hospital groups brought suit in an attempt keep consumers in the dark when it comes to information about how much their health care will cost. The hospital regulation, scheduled to take effect in January 2021, was challenged in court by the hospital lobbies that sued to keep their prices and negotiated rates secret. The hospital lobbies lost this legal battle—with a federal judge upholding the legality of the hospital transparency rule intended to expose private, negotiated rates with insurers—and noting in the opinion that the rule would “allow patients to make pricing comparisons between hospitals.”
There will be continued legal challenges brought by hospital and insurance lobbies to keep their prices and negotiated rates secret until after patients get care.
Continued legal challenges will likely be brought by hospital and insurance lobbies to keep their prices and negotiated rates secret until after patients get care.
Full text of the Health Care PRICE Transparency Act.
The Health Care PRICE Transparency Act would effectively codify these rules and overcome the court challenges.
“As a Main Street Entrepreneur who provided quality healthcare to my employees, this legislation will give Americans the chance to see the true costs of their healthcare visits, which will increase competition and lower healthcare costs,” said U.S. Senator Mike Braun. “President Trump has been the leader on healthcare reform and this legislation takes his executive orders and makes it the law of the land, which is a win for all Americans.”
“Americans often leave their health care visits frustrated not knowing what price to expect on the bill,” said U.S. Senator Mike Enzi. “But for many procedures, if you can know the cost beforehand, you can choose the hospital that fits your needs. The Administration issued these no nonsense health care price transparency rules. I am glad that our legislation would help cement them so patients can stay informed about the real cost of their treatment before they receive the care they need.”
“Every year on my 99 County Tour across Iowa, I hear from folks who are concerned about the high costs of health care. Iowans should be able to access information about the costs associated with their health care in advance, so that they can make the best decisions for themselves and their families,” said U.S. Senator Joni Ernst. “By improving transparency we can increase competition, empower patients, and ultimately lower health care costs. I’m glad to join my colleagues in support of this bill which is a critical step toward achieving these important goals.”
“An extra dose of transparency will bring more accountability and competition to the health care industry. It’s time for Americans to have more financial information available to them when going to the hospital and working with their insurance companies. I applaud President Trump’s continued commitment to bring more sunlight to the health care industry,” said U.S. Senator Chuck Grassley.
“Louisianans should be able to find out what the real price of their health care is. This bill creates transparency so that patients finally have access to pricing information that has been out of reach for far too long,” said U.S. Senator John Kennedy.
“Now more than ever, we need transparency in our health care system,” said Senator Loeffler. “This legislation builds off President Trump’s executive order to encourage competition among providers and decrease health care costs for Americans. I’m committed to working with my colleagues and President Trump to find additional commonsense solutions that improve our health care system and make quality care more affordable.”
BACKGROUND …
Pursuant to the Improving Price and Quality Transparency in American Healthcare Executive Order, the Administration issued two rules to increase price transparency, empower patients, and increase competition among all hospitals and insurers. These rules were not welcomed by hospital and insurer groups—even though they were generally lauded by consumers. Some hospital groups even brought suit in an attempt keep consumers in the dark when it comes to information about how much their health care will cost.
Codifying the Administration’s Health Care Price Transparency Rules Would:
- Ensure that the rules are implemented—to the benefit of consumers.
- Empower Americans to shop for healthcare and coverage, creating a competitive, functional market.
- Reduce the cost of care and coverage, saving individuals and businesses hundreds of billions of dollars and creating a vital economic stimulus.
The Health Care PRICE Transparency Act Would Require Hospitals to:
- Provide patients with clear, accessible information about their “standard charges” for the items and services they provide, including through the use of standardized data elements, making it easier to shop and compare across hospitals, as well as mitigating surprises.
- Make public all hospital standard charges (including the gross charges, negotiated rates and charges, the amount the hospital is willing to accept in cash from a patient) for all items and services on the Internet in a single data file that can be read by other computer systems (i.e., machine readable format).
- Make public negotiated rates and charges, cash prices, etc. in a manner that is consumer-friendly and up-to-date.
The Health Care PRICE Transparency Act Would Require Insurers to:
- Give consumers real-time, personalized access to cost-sharing information—including an estimate of their cost-sharing liability for all covered healthcare items and services.
- Publish this information online and available to all of their beneficiaries, and in paper form, at the beneficiaries’ request—empowering consumers to shop and compare costs between specific providers before receiving care.
- Disclose on a public website their negotiated rates for in-network providers and allowed amounts paid for out-of-network providers.
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