President Trump, joined by the Secretary of Health and Social Services, Robert F. Kennedy Jr. (on the left) and the secretary of trade Howard Lux (right), signed a decree on February 25 on the pricing requirements for the health care industry.
Images Alex Wong / Getty
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Images Alex Wong / Getty
It is a saint grail of health care: forcing the industry to reveal the prices negotiated between health plans and hospitals – information that had long been processed as a commercial secret. And among the burst of decrees, the president of President Trump signed in his first five weeks back, there was a promise to “make America again healthy” by giving patients specific health care prices.
The objective is to force hospitals and health insurance companies to facilitate the comparison of the real prices of medical procedures and prescription drugs. Trump gave his administration until the end of May to find a standard and a mechanism to ensure that the health care industry is in accordance.
But the order in 2025 of Trump is also a symbol of the little progress of the country since he delivered A similar directive Almost six years ago. Consumers only find it partially usefulAnd the quality of the information is uneven.
A first “daring” step that failed
THE 2019 order was “quite daring,” said Gary ClaxtonA vice-president director of KFF, a non-profit organization of health information that includes Kff Health News. “They essentially went to suppliers and plans and said:” All this data, you think we are not going to be confidential. “”
What followed was, for consumer defense groups, a disappointment. Hospitals and insurers published on large, complex and confusing data websites on their prices. Information was a challenge for even health care experts to navigate, not to mention consumers. Some members of the Congress clôtual to put the strength of the law behind the requirements of price transparency; These bills died. And the administration of President Joe Biden was criticized for having either exercised the settlement, with a consumer defense group with the same purchase An ad from the Super Bowl With the rapper fat joe alleging that “hospitals and insurers hide their prices”.
Trump’s new order, signed in February, said that hospitals and health plans “were not adequately considered to have when their price transparency data was incomplete or not even displayed.”
The government’s office of responsibility reported in October that the centers for Medicare & Medicaid Services did not know if the prices reported by the health care industry were correct or completed. But CMS, which regulates hospitals, now plans to “systematically monitor compliance” and help institutions understand the requirements, said Catherine Howden, agency spokesperson.
Howden did not answer questions about the question of whether CMS staff supervising the compliance of transparency prices were dismissed in the broad effort of the Trump administration to reduce the federal workforce.
“Zombies” rate and other inconsistencies
Meanwhile, independent researchers have found many problems with the quality of prices, hospitals and health insurers share with consumers.
A recent report From the Peterson -Kff health system, the health system tracker has revealed that the data reported by four health insurers in New York often included prices that they say they pay for hospitals for services that these health providers do not provide -or cannot -. These are called “ghost” or “zombies” prices. For example, health plans have pointed out that dentists, optometrists and audiologists receiving payments for knee transactors, gastrointestinal exams and other procedures unrelated to their specialties.
In other cases, the data included different prices for the same service paid by the same insurer in the same hospital. Unitedhealthcare, for example, said that it had paid the prices of three prices from New York -Presbyterian / Weill Cornell Medical Center – $ 47,000, $ 64,000 and $ 70,000 – to treat a heart attack.
Or, insurers said they had paid the same price for very different services. AETNA, for example, said that it had paid exactly $ 6,292 at Mount Sinai Beth Israel hospital for the treatment of respiratory infections, heart attacks, digestive tube cancers, kidney infections and urinary tract and psychosis.
Neither unitedhealthcare nor aetna discussed data differences. Cole MANBECK, spokesperson for Unitedhealthcare, said the insurer had satisfied the price transparency requirements and urged members “to use our cost estimator tools for exact costs according to their specific health plan”. AETNA spokesperson Shelly Bendit referred questions to AHIP, a lobbying and commerce association for insurers.
Health insurers have “strongly supported” price transparency, said Chris Bond, spokesperson for AHIP. The group will work with the Trump administration to ensure transparency “in a way that is significant for the end user, while promoting a private competitive market,” said Bond.
What is a consumer to do?
Estimates and total prices are not very useful for consumers, who are mainly interested in what they will finally have to pay for their pocket, said David CutlerProfessor of economics applied at Harvard University. This may vary depending on the health plan, depending on the franchises, copaiaments and other costs.
“Most information on price transparency does not have that,” he said.
Nor does it give consumers information about the quality of care, added Cutler, which can lead to an old bias. “It’s a bit like wine when you go to the restaurant,” he said. “People assume that the most expensive wine is better.”
Cutler said it was skeptical that price transparency would reduce costs for patients. But he said it could offer an overview of hospitals and health plans on what their competitors have and pay services – knowledge that could inadvertently lead to price increases if hospitals receive a lower rate than a competitor require a higher reimbursement of health plans.
Trump recent decree Note that the first quarter of prices for the most expensive health services dropped by 6.3% per year since its order in 2019.
However, the same research referenced in the decree has shown that the lower quarter of services has become more expensive, at a rate of approximately 3.4% per year, according to analysis By Turquoise Health, a data company on health care prices that has examined rates in more than 200 hospitals on the 10 largest American markets.
Some patients say that with research and perseverance, they were able to operate the transparency of prices for them.
Theresa Schmotzer, 50, from Goodyear, Ariz., Said that she had used Hospital prices data To save nearly $ 3,000 in ambulatory surgery to have a fibroid last year.
Schmotzer, who has health insurance, said the hospital first told her that she owed $ 3,700 for the procedure and wanted payment in advance. But she was skeptical.
She said her health insurer was unable to cite a price for the procedure or to specify how much she had. On the morning of surgery, said Schmotzer, she found an online spreadsheet on Patientrightsadvocate.org which included different prices paid by insurers, including his family. The declared price of the procedure was closer to $ 700, she said.
Schmotzer said that she had taken an impression on the spreadsheet at the hospital and presented it during pre -control. She paid him $ 300 in franchise and said in the hospital to invoice it for the rest.
A few months later, she said, the bill arrived by post for the remaining $ 400, which she paid.
When people go to surgery and are not clear in advance what the cost will be, it fears stokes, she said. “Because they go blind.”
Following steps
Hospitals say they You wish to work with federal regulators and comply with declaration requirements, said Ariel Levin, director of the American Hospital Association’s coverage policy, which represents around 5,000 institutions. Levin said consumers should have the price of services and “a more complete estimate” which represents an entire episode of care and the amount they owe in their pocket, according to their health plan.
CMS has developed rules since Trump’s order in 2019 to facilitate information on prices reported by hospitals and health plans, and the The agency has a fine More than a dozen hospitals not to comply.
Federal rules Allow hospitals To report an estimate, a price range or a historic rate for their services, while health plans Can adjust prices according to factors such as the severity of the case, the duration of treatment and the age of a patient.
Claxton de KFF said that such flexibility does not allow “apple comparisons” and that the data must be reliable before researchers can use it to better understand the costs of health care. “It doesn’t seem to be that yet,” he said.
It remains to be done before the transparency of prices is up to the expectations that this increases competition and the reduction in costs, said Katie MartinManaging Director of Health Care Cost Institute, a non -profit research group.
Price transparency alone is not a miracle solution, said Martin. This is “a first critical step” for employers, legislators, regulators and others to better understand how money crosses the health care system and how to make it more effective, she said. “It’s not all.”
Kff Health News is a national editorial room that produces in -depth journalism on health problems and is one of the main operating programs in Kff – The independent source of research on health policies, survey and journalism.