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The House Just Passed a Long-Needed Health Care Price Transparency Measure

Posted on Wednesday, January 3, 2024
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by Outside Contributor
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16 Comments
Rising cost of healthcare

When I was pregnant with my second child, in the years following the passage of the Affordable Care Act, I went to the doctor for routine prenatal testing. Despite promises to the contrary, I had lost several health insurance plans during those years, and at least one while pregnant. At the doctor that day, my new deductible was so high that I paid full freight up-front for all my care.

The practice offered me two tests — one a new-fangled version of the old test. When I noticed two tests listed, I told them I’d like to choose one and asked which was more cost-effective. The facility couldn’t even tell me.

On a different trip to the pediatrician, I asked for an estimate of the price. I was quoted about $250, but when I checked out, was presented with a bill almost three times that.

I’m not the only one. Consider Dani Yuengling, who was quoted an estimate of $1,200 to $3,000 for a biopsy that ended up costing $18,000. 

No matter what kind of insurance you have, you’ve probably run into this confusion. In ObamaCare exchanges, employer-based insurance, and government-run programs, figuring out even an approximate price for medical services can be a puzzle. In most of our system, cost is borne by a third payer, so customers and providers alike are disconnected from the actual price of services. As a result, even the same exact procedure can cost wildly different amounts, depending on something as simple as which building you visit to get it done.

A new bill overwhelmingly passed by the House this week (the vote was 320-71) aims to fix some of these problems. Dubbed the Lower Costs, More Transparency Act, the package had bipartisan backing and went through three different House committees. It aims to make changes to our complex health care system to make pricing clearer and site-neutral. 

“We’ve heard countless stories about real patients who were victims of an opaque system and were on the hook for staggering amounts of money,” said Rep. Cathy McMorris Rodgers (R-Wash.), speaking in support of the bill and touting a Congressional Budget Office score that showed more than $700 million in savings. “We will be delivering on results people are counting on.”

Polling suggests that Americans of all stripes might be more comfortable with modest changes like this to their health care plans than the sweeping plans they’ve been sold in the past. Gallup polling shows Americans worry about costs and quality of care, but are more satisfied with their own coverage.

The last time an overhaul of the health care system took centerstage — when the then-candidate Joe Biden and Sen. Bernie Sanders (I-Vt.) wings of the Democratic Party sparred over “Medicare for All” in 2019 — one expert wondered whether “the amount of change being proposed could be scaring people.”

Unlike big changes, which split along partisan lines and make people who like their plans nervous, something like making prices more transparent polls at more than 80 percentregardless of party or demographic. It brings both liberal and conservative advocacy groups together. Americans see prices everywhere they shop except in health care, and it makes sense to them that there should be a clear price for blood draws and X-rays, too. 

As rapper-turned-advocate Fat Joe said this spring in a push for transparency: “This is not a rocket science thing! Show us the prices! So we can know whether we wanna go to this hospital or we wanna go to the other hospital.”

This is not the first time the federal government has attempted to make medical services more transparent. A regulation passed four years ago and enacted in 2021 required hospitals to provide customer-friendly price lists for 300 nonemergency services. A Centers for Medicare and Medicaid Services study in 2022 showed that compliance was slow in the first year of the regulation. Other independent surveys suggest that only a quarter of hospitals are truly following the rules.

These lists are required to include information that is usually withheld from consumers — prices negotiated with different insurance companies, discounted cash prices, and the highest and lowest prices hospitals have charged for a service. The Lower Costs, More Transparency Act would give teeth to this regulation, making compliance efforts and penalties more effective.

The bill would also aim to adjust a regulation so that Medicare pays the same amount for the same drugs and services, regardless of the facility in which they’re administered. Right now, Medicare pays hospital-owned facilities two and three times as much for the same services performed in an independent doctor’s office or facility. The current structure incentivizes smaller physician practices to be acquired and subsumed by hospitals, leading to hospital consolidation, which makes patients wary and prices higher.

The backstory of lobbying and fee schedules isn’t one that reaches regular folks, but the effects of this disparity do. Estimates suggest getting rid of this quirk would save Medicare patients some $94 billion in premiums and cost-sharing over the next 10 years. 

The health care debate has for too long been defined by utopian dreams and giant plans, many of which fall short for Americans. Maybe it’s time to start favoring the simple over the sweeping. In the words of Fat Joe, it’s not rocket science.

Mary Katharine Ham is a mother, author and writer based in Virginia.

Reprinted with Permission from The Hill – By Mary Katharine Ham 

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Chuck Richardson
Chuck Richardson
3 months ago

Government needs to get out of the business of health care. Let the market open up to fill the consumer needs and wants without restricting the sale of health insurance by state. After all, what does living in any particular state have to do with my need for insurance to offset medical expenses? This is the simplest healthcare option but takes away bureaucratic power from the overlords, so it’s not likely to be made this simple. By the way, this goes for me unconstitutional policies affecting my life every day.

Kaiju
Kaiju
3 months ago

As a healthcare provider with 39 years in the “system”, I can tell you IT’S BROKEN. We no longer have a “healthcare system”, we have an INSURANCE AND PHARMA SYSTEM. All of my healthcare provider colleagues are SO frustrated and disillusioned with Third-Party Payer system (insurance companies and government), mostly due to the complete lack of transparency regarding fees paid to us by them. Before you think my comment is “greed” on the part of providers, know that WE (all providers of healthcare) are tired of NOT being able to inform our patients of what their costs will be because WE do not even know, in most cases, what OUR compensation and the PATIENT’S co-pay will be. The patients are then angry and frustrated, and we’re angry because the insurance industry tells the patient that we’re dishonest and greedy. The end result? STRAINED doctor-patient relationship which leads to LESSER QUALITY of healthcare. Don’t believe me? Ask your healthcare providers next time you see them. It’s time for healthcare providers AND patients/consumers to JUST SAY NO to the insurance industry AND the government.

Carol
Carol
3 months ago

I have to get cataract surgery the end of the month and next month: my cost: $6000!!!! Had to finance this! This is ridiculous!!! Had surgery back in 2022 and no one could tell me what the costs were! They just said insurance will pay for it! That year I maxed out my deductibles for the first time! Something has to change…only the government moochers, leeches, and parasites get off free!

Musaiga
Musaiga
3 months ago

I have been a customer of the Medical-industrial complex since my first bout of cancer in 1990. I also worked in healthcare in hospitals for at least half of that time. This was and is a no-brained. Even Newt Gingrich’s 1990s “plans” didn’t address this simple concept. It is about fing time. But too little, too late for some folks.

anna hubert
anna hubert
3 months ago

Big money making operation that has nothing to do with the health Prescriptions procedures treatments is the aim of the game not the health as such What would happen to all of that if we all were reasonably healthy

barney
barney
3 months ago

Long term care for the elderly. The real plan’s name is, “Long Term Care for the Elderly Democrats Retirement Funds:. It is designed to help secure voters with empty promises and be used by the Dems as a piggy bank for future empty promises. It will also ensure that the price of Long Term Care goes up by 10% a year going to Democrat coffers forever.

MariaRose
MariaRose
3 months ago

Also what is needed besides the transparency of the costs is a cap on the price for any service regardless of what location it is offered. —in other words eliminating costs determined by geographic location or prestige hospital name like college costs have become because they can get away with it because government subsidies. Since 46% of Medicaid healthcare is guaranteed paid by government funding, those covered services have to be capped and not overcharged to get more cost passed down to the patient in out of pocket costs. Control the prices charged from the get go.

Robert Zuccaro
Robert Zuccaro
3 months ago

I thought Obamacare solved everything?

Michael
Michael
3 months ago

I don’t stand for excuses like obumacare is a tax. Gimme a break.

Laura Bentz
Laura Bentz
3 months ago

I am 68 years old and taking all kinds of vitamins and supplements to stay healthy. Also, i eat a healthy diet and try to stay active. Therefore, I have not had to pay out a lot for healthcare my entire life and even for 10 years had no insurance. If everyone followed my example, just think how much better off we would be. And it’s all by the grace of God, of course…

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