What is the Lower Costs, More Transparency Act?
We need lower costs and more transparency when it comes to health care.
Congress has begun to realize that high prices and unfair billing practices are major problems for American health care. Unlike any other consumer good or service in America, you only know the price for health care services after you’ve gotten treatment. In addition, that price can vary by hundreds or thousands of dollars depending on the location. This is an inherently unfair system that often leaves patients and their families in untenable financial situations. In fact, about 40% of Americans have medical debt, and 2 in 5 patients delay care out of fear of the cost.
In 2021, federal agencies required hospitals to post their prices so that consumers could compare and shop around for some non-emergency services. However, compliance with that rule is mixed at best.
Now, there are several pieces of legislation that would address high prices and unfair billing practices, including the Lower Costs, More Transparency Act. This bill does two major things: improve and strengthen price transparency, and require providers to charge the same price to Medicare for certain services regardless of where they are provided.
Improve and strengthen price transparency
The Lower Costs, More Transparency Act codifies the rule which requires hospitals to post their prices for at least 300 shoppable services. It also extends that requirement to non-hospital providers like ambulatory surgical centers, which are typically lower cost than a hospital. Moreover, the bill requires stricter monitoring and enforcement of transparency requirements, ensuring that every hospital will be audited for compliance at least once every three years. The bill also creates meaningful penalties for noncompliance as well as a public list of entities that fail to comply with the transparency requirements.
Same service, same price
The Lower Costs, More Transparency Act also requires further distinction between hospital and outpatient departments. This will prevent non-hospital locations from using more expensive hospital billing codes to charge patients and Medicare higher prices. Finally, the bill requires non-hospital providers to use the same rates for certain medications regardless of where they are provided.
Patients should be able to understand the price of their care and what the final bill will look like before receiving services. Billing practices should be clear and uncomplicated, with rates based on services rather than location or ownership. The Lower Costs, More Transparency Act is a good start to addressing these problems.
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Authors
Maribeth Guarino
High Value Health Care, Advocate, U.S. PIRG Education Fund
Maribeth educates lawmakers and the public about problems in health care and pushes for workable solutions. When she's not researching or lobbying, Maribeth likes to read, play games, and paint.
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