A deeply divided Congress is scrambling to pass bills addressing health care price transparency before the end of the federal fiscal year on September 30.
But measures dealing with price transparency risk being caught up in other health care priorities, including legislation targeting pandemic preparedness, opioid addiction, and funding for health care centers.
Among the bills awaiting final congressional action is the Clinical Laboratory Price Transparency Act, introduced by Rep. Carol Miller (R-WV), on July 25. The bill would require clinical labs to publish their health care prices and the Centers for Medicare and Medicaid Services (CMS) to monitor compliance.
“Unknown health care prices should not be a factor patients are worried about when making health care decisions,” Miller said in a press release. “Patients should know their health care treatment prices upfront and not be surprised by sky-high bills they didn’t know they were getting charged for. This legislation provides price transparency for patients when considering basic lab tests and ensures that the patient is in control of their health care decisions and wellbeing.”
Not Just Labs
Miller’s bill would require labs providing services to Medicare patients to publish their health care prices, starting January 1, 2025, require CMS to provide standard reporting formats for providers, and ensure CMS specifies the services to which transparency will apply while monitoring compliance.
The bill was included in a larger price transparency package that was marked up by the House Ways and Means Committee on July 26 and passed the same day.
Another area of concern is price transparency in imaging services. The same day Miller introduced her lab price transparency bill, Rep. Mike Carey (R-OH) unveiled his Imaging Services Price Transparency Act. His legislation would require hospitals and other medical providers to make public the cost of imaging services like X-Ray, MRI, and CT scans
‘Blindsided by Medical Costs’
“Health care costs are skyrocketing across America,” Carey said in a statement. “Our legislation makes it easier for consumers to know in advance the cost of an X-Ray or CT scan. This will go a long way to ensuring that hardworking Americans are not blindsided by medical costs.”
Like Miller’s bill, Carey’s measure was included in the larger Health Care Price Transparency Act (H.R. 4822), which was approved by the full Ways and Means Committee before Congress adjourned for its August vacation.
“As America’s medical system becomes increasingly consolidated, the legislation takes meaningful steps to ensure vertically integrated health insurers are directing care that benefits the patient—not their bottom line,” states the committee’s press release on the bill.
The committee also approved the Providers and Payers COMPETE Act (H.R. 3284), which requires the U.S. Department of Health and Human Services to examine how Medicare payment rules may affect health care consolidation.
Anti-Corporate Edge
Supporters of the legislative package made little secret of their distrust of the corporate health care world, including Ways and Means Chairman Jason Smith (R-MO).
“The Health Care Price Transparency Act of 2023 is a win for patients who deserve to know the actual price they will pay before they go see a doctor, fill a prescription, or get an x-ray,” Smith said in a statement. “Families should not have to live at the mercy of large medical corporations who are too ashamed to list their prices publicly. This bill is about bringing honesty and clarity to the cost of health care.”
Passage of the bills by Ways and Means came just as a study titled “Health Care Price Transparency: Achievements, Challenges, and Next Steps,” by Theo Merkel, director of the Private Health Reform Initiative at the Paragon Health Institute, was published. The study re-enforces arguments for the price transparency bills.
The package approved by the committee could be passed by the full House in September, probably with some bipartisan support. Challenges will arise in reconciling House bills with whatever health care legislation the Democrat-controlled Senate passes.
‘Puts Customers First’
Katy Talento, CEO of AllBetter Health and a former top health care adviser to President Donald Trump, welcomes the congressional moves on price transparency.
“It is gratifying seeing Congress taking up the urgent problem of secret health care prices,” Talento said. “No other industry gets to hide prices from customers and bill them whatever they want months later. There’s nothing special about lab tests, imaging procedures, or any other health care service that should shield them from market forces and accountability to the patients, employers, unions, and taxpayers who actually foot the bills.”
Requiring providers to list prices is essential for comparison shopping, says Talento.
“Ending secret prices will do to health care what it does to the rest of the economy—it will drive price and quality competition that puts customers first instead of giant hospital conglomerates and everyone else in the Health Care Swamp,” said Talento.
Bonner Russell Cohen, Ph.D. (bcohen@nationalcenter.org) is a senior fellow at the National Center for Public Policy Research.
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