Trying to pull back the veil on health care costs to encourage competition, the Trump administration on Thursday finalized a requirement for insurers to tell consumers up front the actual prices for common tests and procedures.
Administration officials argued the goal of price transparency transcends political partisanship.
“It will be impossible to walk backwards on this,” Health and Human Services Secretary Alex Azar said.
“How do you fight transparency on prices? How do you actually articulate the argument that you should conceal what something costs from the person trying to purchase it?”
The new rules are being issued jointly by HHS, the Labor Department and the Treasury, which share jurisdiction over health insurance plans. They would:
— Starting in 2022, require insurers to make available data files on the costs of various procedures, allowing technology companies to design apps that let patients see costs not only under their own plan but other insurers’ plans as well.
— Starting in 2023, require insurers to make available to their policyholders cost-sharing details on 500 specific services, medical equipment and other items, as called for by the government.
— Starting in 2024, require insurers to make cost-sharing information available on all the services and goods they cover.
Patients would be able to see the negotiated rate between their doctor and the insurer, as well as an out-of-pocket cost estimate for procedures, drugs, durable medical equipment and any other item or service they may need.
The information would be available ahead of time, enabling an informed decision.
Currently, most patients find out what they owe after they get back from the hospital and receive their “explanation of benefits” statement.
“We need to keep pricing on the front end, not the back end,” Seema Verma, head of the Centers for Medicare and Medicaid Services, said.
“We have seen in every single industry that when this information is provided to consumers, it creates a new era of consumerism.”
Verma said administration officials have been working to foster price disclosure since 2017, soon after President Donald Trump came into office.
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