Congress must get healthcare price transparency right

When I was 21 years old, I drove to the nearest hospital with a leg swollen to the size of a toddler. After hours of pokes, prods and scans, I learned I had a blood clot that was dangerously close to killing me.

Shockingly, that was not the most frightening news of the night.

As a terrified college student, I asked anyone who would listen: how much is this going to cost me? After repeated shakes of the head and assertions that “it didn’t matter,” one hospital worker gave me the brutal answer: $18,000, at least. Forget the blood clot — that number gave me a panic attack.

I had no way of knowing at the time, but that devastating price tag wasn’t real. I later asked the hospital to itemize the exact price of my treatments; it turns out my bill would come out to less than $900 if I paid in cash. But in the convoluted world of healthcare pricing, the hospital was planning to charge my insurance company so much more. The insurer later negotiated it down, but the bill still came out to thousands of dollars, not the much lower cash price.

I’ve been thinking about this traumatic experience as the House and Senate debate legislation on price transparency. Both chambers — and strong majorities of both parties — want to give patients an honest look at real costs with the goal of making healthcare more affordable and shoppable. So does President Trump, who has issued an executive order on price transparency and wants legislation to lock in even stronger reforms.

The case for legislative change couldn’t be more clear. While my experience wouldn’t be covered by price transparency, due to existing laws on surprise billing, it nonetheless shows the healthcare system hides and drives up costs for everyday patients. Hospitals and providers manufacture sky-high prices for the treatments they provide only for insurance companies to negotiate prices down. But nearly half the time , the cash price is lower than the median price insurers negotiate.

This payment system is backward. No American would agree to buy a car, a television or even a t-shirt without knowing the price first. That knowledge sparks the competition that drives down prices. Health care does the opposite, hiding prices on the front-end while encouraging providers and insurers to drive up costs behind the scenes. Health care billing should operate like every other product or service, with transparent cash prices disclosed upfront, so Americans can protect their health and their wallets.

Lawmakers in both the House and the Senate understand this, but unfortunately, the bills they’re debating aren’t created equal.

The Senate bill — the Patients Deserve Price Tags Act — is stronger. It requires that accurate procedure and treatment pricing be disclosed in real dollars upfront. It covers more medical providers and it prevents federal agencies from issuing waivers. In short, the Senate wants to make price transparency real and enforceable.

But the House bill — the Lower Costs, More Transparency Act — falls short. It leaves loopholes and carveouts that continue the status quo. When a price isn’t a fixed dollar amount, it lets that price stay buried in a formula instead of requiring the formula to be disclosed. It covers fewer providers, offers more exemptions, and allows for waivers that a future administration would surely use to gut the reform altogether. Joe Biden failed to fully enforce President Trump’s 2019 regulation on price transparency. Waivers would allow a future president to effectively disregard an entire federal law.

For the sake of Americans, the House and Senate must agree to codify the strongest possible bill. While the Senate language gives this reform the best shot at airtight implementation, it could also be improved. The House is also debating the CHECK Act , which would expose how health-plan middlemen and their affiliates get paid, guarantee patients a clear explanation of benefits, and require the bills they receive to be plainly itemized. That reform is worth including in the final bill, so Americans know exactly what they are paying for and why.

No one should face a financial scare in healthcare, least of all over a manufactured crisis. For me, the panic I felt when I heard the price of my care was $18,000 somehow felt worse than the blood clot itself.

Only the strongest law will protect future patients going into doctors’ offices, getting scans, or receiving treatments to save their lives. For the sake of their wellbeing as well as their wallet, Americans deserve nothing less than full and total price transparency.

Jordan Smith Hart is federal affairs director at the Foundation for Government Accountability.