Lawmakers seek more price transparency from hospitals | Bills & Laws

The skinny

Senators have introduced legislation that is aimed at providing Americans with more knowledge of the costs of a hospital stay.

U.S. Sens. Roger Marshall, R-Kansas, left, and John Hickenlooper, D-Colorado, are sponsoring a bill to require hospitals to provide more price transparency.

Sponsors

U.S. Sens. Roger Marshall and John Hickenlooper are the prime sponsors of the bipartisan bill. Marshall, a Republican from Kansas, is a physician. Hickenlooper, a Democrat from Colorado, is the state’s former governor.

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Summary

Hospitals and health systems would be required to provide more information about the prices of services to consumers. The lawmakers introduced the bill, the Patients Deserve Price Tags Act, last month. (Here’s the text.)

Under the measure, hospitals and other providers would be required to provide the actual prices for 300 different services, and for all services beginning in 2026. The measure would apply to hospitals, ambulatory surgery centers, imaging centers and laboratories.

Health systems would also be required to provide machine-readable files of all negotiated rates and cash prices between health plans and providers. Providers would need to offer more than estimates.

Providers would also have to give all patients statements explaining benefits. And health systems would have to give detailed bills for each service.

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Analysis

Hospitals and health systems have been under more pressure to provide more price transparency for Americans, and this legislation is the latest indication of growing pressure from Washington.

Marshall cast the legislation as another step in the Trump administration’s “Make America Healthy Again” agenda.

“Customers don’t walk into a restaurant only to find out how much the food costs when they get the bill. Patients should know the price of the service they need before they make any decisions,” Marshall said in a statement.

Hickenlooper said the legislation, if passed, would give Americans more reassurance.

“You wouldn’t book a flight if you couldn’t find out the ticket price until you land — or check into a hotel without knowing if you’re paying for the Ritz or a dump,” Hickenlooper said in a statement. “But that’s the absurd guessing game Americans play every time they need medical care. We deserve to know exactly what we are paying for whether it’s a lab test, a colonoscopy, or an MRI.”

President Trump issued an executive order in February calling for hospitals and insurance companies to make it easier for consumers to see and compare prices. Trump first imposed rules on price transparency in his first term.

Businesses have criticized hospitals for falling short when it comes to giving Americans a clear understanding of prices.

Chris O’Dell, senior vice president of market solutions at Turquoise Health, says most hospitals are complying with the federal rules. O’Dell told Chief Healthcare Executive in an April interview that 95% of hospitals are complying with federal law by having a machine-readable file with prices.

O’Dell also acknowledged it’s still not easy for patients to know ahead of time what they will pay, but he says there has been progress.

“Even though we're not quite there, we are putting in place the building blocks that will eventually get us there,” he says.

The Centers for Medicare & Medicaid Services determines compliance with federal transparency rules. Hospitals can be fined up to $5,500 for each day out of compliance, or a maximum of $2 million annually.

Outlook

Lawmakers in both parties have voiced the need for more price transparency for patients, so it’s certainly plausible that this legislation has a shot at passage.

Aside from the push for transparency, analysts and some lawmakers are also calling for more attention to the wide variance at prices in hospitals, even in the same market.

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