The president accused the Biden administration of “slow walking,” enforcement of the regulations, which originally directed HHS to develop rules requiring hospitals to publish prices “that reflect what people actually pay for services in a way that’s clear, straightforward and accessible to all.” Under the new order, the departments will ensure hospitals and payers disclose actual prices, not estimates, and take action to “make prices comparable across hospitals and insurers, including prescription drug prices.”
To date, 18 hospitals and no insurers have been fined by CMS for alleged price transparency violations.
Becker’s sat down with Emily Porter, vice president of external affairs at insurer Sidecar Heath, on the Payer Issues podcast to chat about the EO.
Question: President Trump’s executive order aims to crack down on price transparency requirements for hospitals and insurers, following his original EO on healthcare price transparency in 2019. What do insurers need to know about this new EO?
Emily Porter: This new executive order requires health plans and hospitals to disclose actual prices. Previously, many prices were estimates, but now the order mandates the disclosure of actual prices. It also requires HHS to determine enforcement policies to ensure compliance. This means healthcare entities will have to figure out how to disclose prices consistently, whether in Toledo, Ohio, or Jacksonville, Florida. This is a meaningful and different way for consumers and plans to share pricing information that is constructive and useful.
Q: Insurers have been required to disclose a lot of pricing information since 2022 — what’s compliance been like across the industry?
EP: Insurers are supportive of transparency. The crux of the issue has always been applicability and making sure the data is applied uniformly and presented in a consumer-friendly format. That’s where it can be a real game changer for consumers. There has been a delay in enforcement, likely due to legal battles. This second executive order will push us in a positive direction for the next generation of healthcare pricing.
Q: Where do things stand in terms of third party companies’ and consumers’ ability to use this data to know what healthcare costs will be?
EP: It’s crucial for consumers, hospitals, and insurers to provide this data in a more actionable way. This helps create a more educated healthcare population, which is the next step in public policy development. The Trump administration’s initiative is smart in making public policy more effective for consumers. We want providers to offer this information in a digestible, uniform format, similar to how people shop for other products in their daily lives. It’s a step forward for healthcare, allowing consumers to choose their providers without having to go through prior authorization or pay a middleman. Immediate payment and the ability to choose providers based on transparent pricing gives the customer more control. This kind of data sharing also opens doors for innovation in healthcare. It will likely lead to opportunities for tech companies to create models that help consumers make smarter decisions, whether through artificial intelligence, website tools, or more intuitive ways to access information.