During his first administration in 2019, President Donald Trump announced rules requiring transparency in health care prices. Some employers are pushing for these provisions to be written into law.
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It seems simple: Require hospitals and insurers to publish their negotiated prices for most healthcare services and – bingo – competition ensues, leading to lower costs for consumers.
But nearly four years after regulations from the first Trump administration required hospitals to post massive amounts of pricing information online, the effect on patient costs is unclear. And while President Joe Biden has added requirements to make price information more user-friendly, Donald Trump’s impending return to the White House has raised questions about what’s next, even though price displays are one area where bipartisan agreement is rare.
Uncertainty about what might happen next has led some advocates to pressure Congress to include price transparency from hospitals and insurers in legislation to be passed before Trump takes office. That would turn his and Biden’s regulations into law, making them less likely to be weakened or repealed by a future administration. But that effort failed this week.
This legislation could also have helped protect against legal challenges following a Supreme Court decision. which limited the regulatory power of government agencies.
Employers are using transparent data to try to slow the growth of their healthcare costs, and “the last thing you want to do is start over,” said James Gelfand, president and CEO of the association. ERISA Industry Committeewhich represents large employers that fund their own health plans. His group is among the organizations continuing to pressure Congress to act next year.
“Congress’s failure to act is deeply disappointing, but employers and other advocates will redouble their efforts,” Gelfand said. “It will be done.”
Although many hospitals do not fully comply with transparency rules, federal regulators have sent thousands of warning letters to hospitals. and fined just over a dozen.
The rules require hospitals to list the prices they accept from all insurers for thousands of items and services, from stitches to delivery room fees to X-rays. For consumers, hospitals must also provide a list of 300 “shoppable” services, including accepted bundled prices for common services such as a baby or a hip replacement. Insurers in July 2022 were also required to report their negotiated prices, not only for care in hospitals, but also in surgery centers, imaging centers, laboratories and doctors’ offices.
This is a massive and often confusing amount of data that has piqued the interest of researchers and business media like Health Turquoisewhich sought to organize information to better help ordinary consumers purchase medical services or employers who oversee workers’ health plans.
The data shows huge price variationboth in what hospitals charge and what insurers pay, for the same services. But the result of publishing these prices is so far difficult to quantify.
A recent study of Turquoise examined negotiated rates in the nation’s 10 largest metropolitan areas for a set of common health services. It found that rates for the top quarter – the most expensive category – fell by 6.3% from December 2021 to June 2024, during the period when transparency rules were in place. But negotiated rates for the cheapest tier of services increased by 3.4%.
This could indicate that hospitals and insurers – who can now see what their competitors are charging and paying – have either reduced their prices or demanded better rates, at least for the most expensive services.
Still, Gerard Anderson, who oversees data research as a professor at Johns Hopkins University’s Bloomberg School of Public Health, said the changes noted by Turquoise were minimal and did not reflect what his team had observed in his own studies.
“So far, we have not detected any impact of this data on behavior, on insurers’ decisions or on what hospitals do to change prices once they realize what others are charging,” he said. Anderson said.
Some health policy experts say the new Trump administration is unlikely to reverse its previous commitment to price transparency.
“I don’t see a world where it imposes its own regulations,” said Joe Wisniewski, associate vice president at Turquoise Health. “There is also broad bipartisan support on the Hill.”
The current price display rules began with the requirements of the Affordable Care Act, which the initial Trump administration defined in more detail. The hospital sector failed in a legal challenge to block these rules, and the Trump era the requirements came into effect in January 2021.
But even after the Biden administration made the data more user-friendly, it still isn’t very useful to consumers, Anderson said.
“This data doesn’t tell them the price they will pay. It tells them the average price paid last month or last quarter for a similar type of service,” he said.
According to Anderson and other experts, price transparency requirements are more helpful. rules that require insurers offer online calculators for hundreds of non-emergency services. Detailed cost estimates should take into account how much patients paid for annual deductibles.
For uninsured consumers or those without access to online calculators, it remains difficult to determine how much a service might cost from information hospitals post online. For one thing, not all hospitals posted their negotiated rates.
The Department of Health and Human Services’ inspector general said in November an audit of 100 hospitals found that 63 of them complied with the price transparency rule, while the rest failed to meet one or more requirements.
The advocacy group Patient Rights Advocate, which examined a sample of 2,000 hospitals, says only 21% were fully compliant, although it used broader compliance measures than the inspector general’s.
“By keeping their prices hidden, hospitals continue to prevent American consumers from comparing prices and protecting themselves from overcharging,” said Cynthia Fisher, founder and president of the group, which has called for rules and enforcement more strict.
KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the major operating programs of KFF .