Fifteen years ago, Congress promised Americans price transparency in healthcare. The Affordable Care Act (ACA) required hospitals and insurers to make their prices public. That promise was never fulfilled. Hospitals posted partial or unusable information. Insurers buried their pricing files in formats no patient or employer could interpret. Enforcement was minimal, and the public remained exactly where it began — unable to know what care would cost before receiving it. Transparency without enforcement is optional, and optional transparency simply does not occur.
The Patients Deserve Price Tags Act, introduced by Republican Sen. Roger Marshall of Kansas and Democratic Sen. John Hickenlooper of Colorado, is the first serious effort to correct this failure. It does not rewrite the ACA. It enforces a commitment Congress already made. The bill requires hospitals and insurers to publish clear, accurate, and comparable prices; it sets standards for how that information must be presented; and it establishes meaningful penalties for those who continue to hide what care actually costs. In short, it makes transparency real rather than aspirational.
The public’s frustration with healthcare pricing is well-founded. Hospitals and insurers know exact negotiated rates for every service. Patients do not. Prices for identical procedures can vary by ten-fold across facilities in the same city. Companies that manage drug benefits add fees and markups that are invisible to consumers. These hidden prices are not an accident. They are a business strategy that protects revenue for every major player in the system except for the consumers who ultimately pay the bill.
The pattern is familiar: Americans pay more for healthcare than any country in the world, yet they are routinely denied access to the most basic information about cost. A system that people fund for years becomes impenetrable and inaccessible the moment they need it. Families fear seeking care because they have no idea what it will cost and if a necessary procedure will bankrupt them. They pay large monthly premiums but face denials when they are sick. Surprise bills remain common. The uncertainty is not incidental. It is the predictable result of a pricing structure no one outside the industry is allowed to see.
Employers who provide coverage for more than 165 million Americans face the same barriers. Most are not large corporations with internal analytics teams. They are small and mid-sized businesses trying to offer coverage to their employees without any real insight into the value of what they are purchasing. Premiums rise each year, but employers cannot determine whether those increases reflect higher quality, higher utilization, or simply higher prices negotiated behind closed doors. As costs climb, wages stagnate and benefits narrow. Hidden pricing leaves employers with responsibility but no information.
Itemized prices also create a check on upcoding and hidden fees. When patients and employers can see every charge and middleman spread, they have proof and recourse against overbilling by insurers and the vertically integrated subsidiaries that profit from the same encounter.
This is why the Patients Deserve Price Tags Act is essential. It does not create a new regulatory framework. It clarifies expectations that were in the ACA and enforces them. The bill requires hospitals and insurers to post prices in standardized, usable formats. It mandates predictable, bundled prices for routine and shoppable services such as imaging, colonoscopies, and common surgeries. It prohibits hidden fees and forces consistency across disclosures so patients and employers can make meaningful comparisons. Most importantly, it imposes penalties for noncompliance that cannot be ignored.
Transparency will not solve every problem in healthcare, but it is the necessary foundation for solving any of them. Families need to know the cost of care before receiving it. Employers need tools to evaluate what they are buying. Taxpayers should no longer subsidize inefficiency made possible by concealed prices. When real prices are available up front, it becomes far more difficult for insurers and intermediaries to take advantage of a system that was built to function without scrutiny.
Congress required transparency a decade and a half ago when the ACA originally was passed. The requirement failed because it had no teeth. The Patients Deserve Price Tags Act provides the enforcement the original law lacked and finally makes honest pricing an expectation rather than an exception. Americans have waited long enough. Congress should pass this bill.
Monique Yohanan, MD, MPH, is senior fellow for health policy at Independent Women.
The views and opinions expressed in this commentary are those of the author and do not reflect the official position of the Daily Caller News Foundation.
(Featured Image Media Credit:Â Screen Capture/PBS North Carolina Channel)
All content created by the Daily Caller News Foundation, an independent and nonpartisan newswire service, is available without charge to any legitimate news publisher that can provide a large audience. All republished articles must include our logo, our reporter’s byline and their DCNF affiliation. For any questions about our guidelines or partnering with us, please contact [email protected].
