Trump rule says health plans must tell real prices
But insurers say disclosing costs upfront would raise premiums
WASHINGTON — Trying to pull back the veil on health care costs to encourage competition, the Trump administration Thursday finalized a requirement for insurers to tell consumers upfront the actual prices for common tests and procedures.
A major health insurance industry group said the regulation would have the opposite effect and raise premiums.
The policy play ahead of Election Day comes as President Donald Trump has been hammered on health care by Democratic challenger Joe Biden for the administration’s handling of the coronavirus pandemic and its efforts to overturn the Affordable Care Act, which provides coverage to more than 20 million people.
A related Trump administration price disclosure requirement applying to hospitals is facing a federal lawsuit from the industry, alleging coercion and interference with business practices.
The idea behind the new regulations on insurers is to empower patients to become better consumers of health care, thereby helping to drive down costs.
But the requirements would take effect gradually over a four-year period, and patients face a considerable learning curve to make cost-versus-quality decisions about procedures like knee replacements or hernia repairs. Add to that political uncertainty about the policy’s survival if Trump doesn’t get reelected, and the effort is running into skepticism.
Administration officials are adamant the changes will stand, arguing the goal of price transparency transcends political partisanship.
“It will be impossible to walk backward 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?”
Insurance companies contend that the rules will boomerang economically, by undercutting their ability to bargain with hospitals, drug companies, doctors and other industry players. Providers now accepting discounted rates will press to get paid more once they see what their upper-end competitors are getting.
“The final rule will work to reduce competition and push health care prices higher — not lower — for American families, patients, and taxpayers,” Matt Eyles, president of America’s Health Insurance Plans, said in a statement. “This is precisely the opposite of what Americans want in their health care.” The new rules 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 costsharing 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.