The House just passed a long-needed health care price transparency measure

When I was pregnant with my second child, in the years following the passage of the Affordable Care Act, I went to the doctor for routine prenatal care. Despite promises to the contrary, I lost several health insurance plans over those years, at least one while pregnant. When I went to the doctor that day, my new deductible was so high that I paid full shipping for all care up front.

This exercise gave me two tests – one was a new version of an old test. When I noticed the two tests listed, I told them I wanted to choose one and asked which one was more cost effective. The facility couldn’t even tell me.

During another visit to the pediatrician, I asked for an estimate of price. I was quoted about $250, but when I checked out I was billed for almost three times that amount.

I’m not the only one. In Dani Yuengling’s case, his biopsy cost an estimated $1,200 to $3,000 and ended up costing $18,000.

No matter what kind of insurance you have, you’ve probably experienced this confusion. Even figuring out the approximate price of medical services can be a challenge amid the Obamacare exchanges, employer-based insurance and government-run plans. In most of our systems, costs are borne by third-party payers, so both clients and providers are disconnected from the actual price of services. So even for the exact same procedure, the amount spent can vary greatly depending on which building you visit to get this simple thing done.

The House of Representatives this week overwhelmingly passed a new bill (voting 320 to 71) aimed at addressing some of these issues. The package, known as the Lower Costs, Improved Transparency Act, has bipartisan support and has passed three different House committees. It aims to transform our complex healthcare system to make pricing clearer and site-neutral.

“We’ve heard countless stories about real patients who were victims of an opaque system and lost huge sums of money as a result,” said Rep. Cathy McMorris Rodgers, R-Wash., of the Congressional Budget Office. The score showed savings of more than $700 million. “We will deliver the results that people expect.”

Polls suggest that Americans of all stripes may be more willing to accept such modest changes to health care plans than the sweeping plans that have been marketed in the past. A Gallup poll shows Americans are worried about the cost and quality of health care but are more satisfied with their insurance coverage.

The last time health care system reform was in the spotlight — then-candidate Joe Biden and Sen. Bernie Sanders (D-Vt.) feuded over “Medicare for All” in 2019 — one expert wondered Whether “the number of proposed changes might scare people.”

Unlike major changes, which split along party lines and make people who like their plans nervous, such as making prices more transparent, polls show support above 80 percent regardless of party or demographics. It brings together liberal and conservative advocacy groups. Beyond health care, Americans see prices everywhere they shop, and it makes sense to them that blood draws and X-rays should also have clear prices.

As rapper-turned-advocate Fat Joe said this spring when pushing for transparency: “This is not rocket science! Show us the prices! So we know if we want to go to this hospital or another hospital.” “

This isn’t the first time the federal government has tried to make health services more transparent. A regulation passed four years ago and enacted in 2021 requires hospitals to provide customer-friendly price lists for 300 non-emergency services. A 2022 study from the Centers for Medicare and Medicaid Services showed that compliance was slow in the first year of the regulation. Other independent surveys show that only a quarter of hospitals actually follow the rules.

The lists must include information often hidden from consumers — prices negotiated with different insurance companies, discounted cash prices and the highest and lowest prices a hospital charges for a service. The Lower Costs and More Transparency Act would strengthen this oversight and make compliance efforts and penalties more effective.

The bill also seeks to adjust a provision so that Medicare pays the same amount for the same drugs and services, regardless of which agency administers them. Currently, Medicare pays hospital-owned facilities two and three times more for the same services provided in a freestanding doctor’s office or facility. The current structure encourages smaller physician practices to be acquired and gobbled up by hospitals, leading to hospital consolidation, which makes patients wary and prices higher.

The backstory of lobbying and fee schedules is not something that the average person can understand, but the impact of this difference is. It is estimated that eliminating this quirk will save Medicare patients approximately $94 billion in premiums and cost-sharing over the next 10 years.

The health care debate has long been defined by utopian dreams and grand plans, many of which fall short of goals for Americans. Maybe it’s time to start favoring simplicity over spring cleaning. In the words of Fat Joe, it’s not rocket science.

Mary Katharine Ham is a mother, author, and author living in Virginia.

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