Congress can end the year on a rare bipartisan health care high note

Can Congress Finally Bring Transparency to Healthcare Costs?

Despite the looming 2024 election cycle, Congress still has a crucial opportunity to tackle the ever-rising tide of healthcare costs in the United States. Both the Lower Costs, More Transparency Act (LCMT) and the Health Care PRICE Transparency Act 2.0 aim to shed light on often opaque pricing practices and ultimately make healthcare more affordable and accessible for Americans.

These bills, enjoying bipartisan support, build upon the 2019 price transparency regulations introduced by the Trump Administration, widening the scope and strengthening enforcement. With 92% of voters nationwide supporting these initiatives, according to a recent poll, the potential impact could be profound.

One of the LCMT’s coveted goals is to force hospitals and insurers to disclose real prices, including cash rates and negotiated insurance rates. This goes beyond merely listing charges, pushing for cousinly data being made publicly available and easily accessible to researchers, consumers, and employers. This transparency could empower consumers to shop around for better deals, stimulate competition among providers, and ultimately drive down prices.

"Our work has shown that rising costs often erode worker wages and other benefits, particularly for lower-income Americans," says research conducted by the authors.

However, simply disclosing prices isn’t enough. The LCMT seeks to address the stark disparities in payments for the same services depending on where they are delivered. Specifically, it targets the growing trend of "site-of-care payment differentials," where patients are often charged more for the same procedure if it’s performed in a hospital-owned outpatient facility compared to a physician’s office.

This practice, driven in part by hospitals acquiring physician practices, can drive up Medicare spending and incentivize referrals to more expensive settings. The LCMT aims to level the playing field by ensuring consistent payment rates regardless of the setting, potentially reducing costs for Medicare beneficiaries and the program itself.

"Many non-hospital settings have equivalent or better quality than hospital-based settings" according to research cited by the authors. By standardizing payment, the LCMT could encourage more patients to utilize less expensive, yet equally effective, care options.

The LCMT also takes a first step toward tackling the issue of healthcare consolidation by mandating that Medicare Advantage (MA) organizations disclose ownership details. While it falls short of demanding full ownership transparency across the board, this requirement could shed light on potential conflicts of interest and encourage further investigation into the practice of vertical integration, where insurers acquire providers.

“Full ownership transparency can help prevent conflicts of interest, enhance accountability, and promote competition,” highlights research conducted by the authors of the LCMT proposal.

As the 118th Congress enters its final weeks, this is a critical opportunity to create lasting change in the healthcare system. Passing even portions of these bills could provide immediate benefits to patients and taxpayers, while setting the stage for more comprehensive reforms in the future.

The challenge now lies with Congress to put aside political divides and seize this moment to deliver on the promise of affordable, accessible healthcare for all Americans.