Congress Should Codify and Strengthen Hospital and Plan Price Transparency Regulations

People should know the price of health care services at a hospital or health care facility before they receive care, whether it is an X-ray, an MRI or a surgery. Yet, health care is one of the only sectors in the US economy where consumers and purchasers cannot obtain the actual prices of a service before they undergo a procedure or receive care. For the two-thirds of Americans who receive health care through private insurance, health care prices are established in closed-door negotiations between large hospital corporations and health plans, and based on which organization has more market power. These health care prices — often referred to as negotiated rates — are buried in proprietary contracts without insight into or oversight over the price of health care services by the public and policymakers.

The most critical pricing information that must become publicly available for meaningful transparency to be achieved is the negotiated rate, which is widely recognized as the underlying price of health care services and goods.

Although the current Hospital Price Transparency and Transparency in Coverage (TiC) regulations require hospitals and health plans to publicly disclose health care prices, including the negotiated rate, most large hospital corporations have bucked the federal requirements and are actively working to keep their prices hidden.

Congress must require all hospitals and health plans to disclose negotiated rates, in dollars and cents, establish standard formats including a machine-readable file format, eliminate loopholes, and require hospital executive attestation and further increase penalties to encourage greater compliance by hospitals. Importantly these efforts should include codifying strengthened versions of both the Hospital Price Transparency and the Transparency in Coverage regulations. Taken together, these are critical steps toward making price transparency meaningful and accessible to consumers.