Congress has just days to deliver online health care prices for patients

As any good consumer knows, price transparency gives the “buyer” power. But when it comes health care, most patients don’t know prices before getting treated. PIRG, with a strong coalition of stakeholders, wants to change that.  And Congress has just days to deliver reliable online health care prices to patients.  

On Tuesday, November 19, PIRG hosted a briefing in the U.S. Capitol on health care price transparency. We gathered a panel of experts to explain to Senate staff why the Senate should pass S.3548, the bipartisan Health Care PRICE Transparency Act 2.0. 

We packed the room – over thirty staff heard why the lack of health care price transparency is a consistent problem in health care: if consumers don’t know prices before they get care, they can’t shop for the best prices or even determine what a fair price should be. And price transparency will increase price competition among hospitals and providers in every community. 

Our expert panel included many perspectives (patient, employer, union):

• Patricia Kelmar, U.S. PIRG’s Senior Director of Health Care Campaigns
• Cynthia Fisher, Founder and Chairman of Patient Rights Advocate
• Guy D’Andrea, Executive Director, Catalyst for Payment Reform
• Patrick Keenan, Director of Consumer Protections and Policy, Pennsylvania Health Access Network
• Connor Coursey, Government Affairs Associate, Small Business Majority
• Cora Opsahl, Director, 32BJ Health Fund

The panelists noted how health care treatment can break the bank for a family and put incredible strain on a small business’ bottom line when they bear the cost of insurance. We called for a strengthening and expansion of a 2020 federal rule requiring hospitals to post prices. 

The existing price transparency rule requires hospitals to post online both a consumer friendly price list of the top 300 shoppable services and a downloadable file of prices for all services in that hospital. Both cash prices and negotiated insurance prices must be shared on hospital websites. But we need a stronger law.

We need a stronger law because too many hospitals are ignoring the rule. A recent report from the Department of Health and Human Services Office of Inspector General “estimated that 46 percent of the 5,879 hospitals that were required to comply with the [Hospital Price Transparency] rule did not comply with the requirements to make information on their standard charges available to the public.”

Shortly after our panel, PatientRightsAdvocate.org issued a report showing even worse compliance: only 21% of hospitals they reviewed were fully compliant with the price transparency rule. And that shows hospital compliance is getting worse with time, not better. Previous reports by the group showed the highest observed compliance rate was 36%. 

U.S. PIRG spotlighted spotty hospital price transparency Cleveland, OH and Dallas, TX. Our researchers looked for prices for a total knee arthroplasty (total knee replacement surgery), a common procedure and one for which hospitals should post a price. We didn’t always find a price as required.

But we also found that, when done correctly, hospital price transparency can help patients find real savings. 

Cleveland knee surgery prices: 

•  Cash price difference of over $200,000 between the highest and lowest self-pay cash prices
• Insured price difference of over $3,200 between the highest and lowest insured prices

Dallas knee surgery prices

• Cash price difference of over $150,000 between the highest and lowest self-pay cash prices 
• Insure price difference of over $2,800 between the highest and lowest insured price

With just days left before Congress retires, we sent a coalition letter urging Congressional leadership to get the job done and pass price transparency provisions. In December 2023, the House of Representatives overwhelming passed the bipartisan Lower Costs, More Transparency Act (H.5378).

Help send a message: Take action today by urging your Senator to support health care price transparency!