Health care bill is incomprehensible.......

Your health care bill is incomprehensible. Congress is stepping in.

Bipartisan lawmakers are advancing bills that would require hospitals and insurers to disclose their prices.

By Simon J. Levien

Figuring out who’s offering the best deal on heart surgeries or routine physicals isn’t the most pressing issue for everyday Americans. That hasn’t stopped lawmakers on Capitol Hill from trying to turn that kind of price transparency into their marquee bipartisan health care goal this year.

Republican and Democratic lawmakers who advanced bills on the issue through House and Senate committees this past week said making patients more aware of what their hospitals and insurers are charging could translate into big savings on their medical bills and in the insurance premiums consumers pay.

Various third-party estimates say there are billions of dollars in savings for patients, but the numbers are all over the place since some transparency requirements are already on the books. A University of Minnesota study suggested more price transparency rules would yield $17 billion to $80 billion in savings, while another, from Brown University, estimated they would net $120 billion in federal revenue by lowering taxpayers’ pre-tax premiums.

Despite the fuzzy math, the fact that the issue has bridged people as far apart as Sens. Roger Marshall (R-Kan.) and Bernie Sanders (I-Vt.) has inspired lawmakers to run with it. Sponsors of the bills hope the issue will form the centerpiece of a new law Congress can pass during the lame duck session once the political pressure of the midterms has lifted.

“I’m very optimistic that it will pass,” said Senate Health Committee Chair Bill Cassidy (R-La.), whose committee advanced price transparency legislation Wednesday with all Democrats in support. “I don’t care if it’s a standalone. I don’t care if it’s part of a bigger bill. I just care that it passes, and I’m confident that it will.”

More than 40 million Americans on high-deductible health insurance — people who typically pay the full insurer-negotiated rate for the first several thousand dollars in medical bills each year — would benefit if it became easy to shop treatments the way they surf eBay for deals. The many more Americans on traditional insurance plans that cover the bulk of their costs won’t have much incentive to do that. But they could benefit too if price transparency helps insurers restrain increases in premiums, or if employers cut better deals with those companies.

Republicans are eager to show they’re concerned about Americans’ costs after voting last year to reduce spending on Medicaid, the federal insurance program for low-income people, and deciding not to extend more-generous subsidies for Obamacare plans that Democrats created when Joe Biden was president.

Democrats want to retain their edge on health care in voters’ minds and bolster their own bona fides as advocates for working people in their battles with corporations.

“Both sides are trying to message affordability, and price transparency is one of the few areas in the health care space where there’s been agreement,” said John Williams, a hospital lobbyist for the health care-focused law firm Hall Render, of the bipartisan calculus.

Williams doesn’t think the gambit will cause prices to drop, though. “We’ve yet to see the evidence it changes what patients pay,” he added.

Still, the bipartisan consensus runs counter to most everything else on Capitol Hill when it comes to health care policy.

The parties are at each other’s throats over spending on Obamacare and Medicaid and are running for office bashing each other for either cutting people off from insurance (Democrats) or failing to police fraud in public insurance programs (Republicans).

Price transparency is defying the trend. Both the Senate committee in charge of health policy and its House counterparts approved — and literally applauded — bipartisan bills this week to shine more light on opaque health care pricing, in which patients often see exorbitant bills shrink after insurer-negotiated discounts are calculated. At the same time, patients often have no idea what a treatment is going to cost them before they receive it.

Giving them more insight will make a difference in containing costs, said Marshall, sponsor of the Patients Deserve Price Tags Act, in a call with reporters. Marshall’s bipartisan Senate bill would introduce detailed price reporting requirements for hospitals and insurers.

“There’s no other action item that would have as big an impact on the cost of health care as transparency,” Marshall said.

In the House, the Energy and Commerce Committee on Tuesday advanced its own transparency bill by its chair, Brett Guthrie (R-Ky.), and ranking member, Frank Pallone (D-N.J.). Their Lower Costs, More Transparency Act would fine hospitals that fail to reveal their price lists.

Hospitals have pushed back, arguing that more rules create administrative burdens and don’t address the underlying affordability issues weighing on lawmakers about to face the voters.

On the side of the transparency-minded lawmakers is an odd-bedfellows alliance of progressive advocacy groups, large employers managing benefit plans and a leading conservative health think tank.

That kind of rare agreement has prompted a transparency push bigger than the measures in committee this week.

Earlier this month, the Ways and Means Committee approved multiple transparency bills, including one from Jason Smith (R-Mo.), its chair, that would require hospital executives to personally verify that posted prices are accurate. The Education and Workforce Committee in June approved Missouri GOP Rep. Bob Onder’s bill to disclose more health insurance plan data.

And on Tuesday, two senators on the Finance Committee, Republican Marsha Blackburn of Tennessee and Democrat Mark Warner of Virginia, introduced a transparency bill targeting private insurers who run Medicare Advantage plans.

The last time Congress made a big push to boost health care price transparency was in December 2024, when leaders of both parties agreed to tack them onto a year-end government funding bill. Elon Musk, who was soon to become head of President Donald Trump’s Department of Government Efficiency, called them out on X, saying the measure was packed with pork-barrel spending.

“Kill the bill,” Musk wrote, adding that “any member of the House or Senate who votes for this outrageous spending bill deserves to be voted out.”

Though it wasn’t clear if Musk had any objections to price transparency, Republicans stripped out extraneous provisions to overcome his objections. The contentious downsizing of federal agencies that Musk’s Department of Government Efficiency then led meant the bipartisan provisions stayed on the backburner for most of Trump’s first two years in office.

They’re reemerging now as a weakened Trump and congressional GOP face daunting midterm elections. After that, lawmakers believe, there is a chance for bipartisan dealmaking during a lame duck session before the next Congress takes over in January.

Marshall said there’s keen interest in transparency from the White House. Agency staff helped his office draft hundreds of line items in his bill. Trump during his first term implemented new transparency regulations for hospitals and insurers. They haven’t had much impact, given how difficult it remains to enforce the rules and decipher the data industries are technically required to reveal. Part of lawmakers’ objective is to codify those rules, give them more teeth and make the data comprehensible.

In February, Trump issued an executive order pledging stricter enforcement of the transparency rules.

A top Medicare aide to Trump on Monday touted that enforcement at an unlikely venue, a symposium put on by Families USA, the left-leaning health advocacy group. “We’ve ramped up our enforcement efforts to focus on a lot of, frankly, larger well-resourced organizations who certainly have the capability to be in compliance,” said Alec Aramanda.

Many hospitals say they already post prices and question the benefit of layering more paperwork on top of them.

“Transparency is working when it produces meaningful information and not just more data,” said Charlene MacDonald, the Federation of American Hospitals president. She supports transparency efforts but argues that Marshall’s bill would create administrative headaches.

The hospital and insurer lobbies blame each other for consumer confusion about prices.

AHIP, the trade group for health insurers, wants to “rein in the anticompetitive tactics and opaque pricing practices of hospital systems and brand drugmakers that are driving costs higher,” said its spokesperson, Chris Bond, in a statement.

MacDonald, on the other hand, said lawmakers ought to shine a light on insurers.

Meanwhile, health care transparency advocates see the lame-duck session as the most likely window of opportunity to bring the House and Senate committees’ transparency bills together. A must-pass spending bill to fund government agencies in fiscal 2027 could be the vehicle to make them law.

“It will likely come out of a House exercise of stitching together various policies, so they have a stronger end product in the House to bring into a year-end discussion with the Senate,” said Melissa Bartlett of the ERISA Industry Committee, which represents self-funded large employer health plans and has given input on several transparency bills.

Senators on the Health Committee consider their approach more forceful and comprehensive. The House transparency bill that made its way through the Energy and Commerce panel cobbles together policies from nearly a dozen smaller bills.

To settle on what’s in the final package, lawmakers will need to wade through the competing solutions: patient-specific cost estimates; disclosed cash prices and insurer-negotiated rates; prices posted in public areas; tax-form disclosures; and more claims data for employers.

Sen. John Hickenlooper, the Colorado Democrat who co-sponsored the Health Committee’s bill, said lawmakers’ eagerness to work with each other on price transparency bodes well.

“Good bills don’t come out of nowhere,” he said. “There’s painful, long-term negotiation and compromise, and that’s where this one came from.”