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Congress Considers Three Healthcare Pricing Transparency Bills

Elyas Bakhtiari, for HealthLeaders Media, May 10, 2010

Late last week the House Energy and Commerce Health Subcommittee took up the issue of pricing transparency in healthcare and heard testimony on three bills that could change the way providers charge patients for services.

Although Democrats vowed to push for more transparency in healthcare, Rep. Frank Pallone (D-N.J.), the health panel's chairman, cautioned against too much transparency based on a report from the Congressional Budget Office that suggested transparency in some markets could lead to higher prices because providers could see what their competitors are charging and attempt to keep up, according to The Hill.

"The concern I guess is about the unintended consequences of too much transparency," Pallone said.

While all three bills would establish baseline requirements for hospitals and other providers to disclose information about how much they charge and how much patients are expected to pay out-of-pocket, where the bills take different approaches is how they are administered (at the state or federal level) and the broadness of their scope.

The following three bills were discussed:

Transparency in All Health Care Pricing Act of 2010 (HR-4700): Introduced by Rep. Steve Kagen (D-WI), the bill calls for hospitals, physicians, nurses, pharmacies, pharmaceutical manufacturers, dentists, and the insurance entities to "publicly disclose, on a continuous basis, all prices for such items, products, services, or procedures." The bill would require disclosure "at the point of purchase, in print, and on the Internet," and would allow the Secretary of Health and Human Services to investigate and fine entities that do not comply.

Health Care Price Transparency Promotion Act of 2009 (HR-2249): This bill also calls for pricing transparency, but it would require all 50 states to develop disclosure requirements without involving the HHS Secretary. The states would have to develop rules related to the disclosure of hospital charges as well as estimated out-of-pocket costs. The bill also calls for the Agency for Healthcare Research and Quality to develop a report on charges and out-of-pocket costs. The bill has both Democratic and Republican co-sponsors.

Patients' Right to Know Act (HR-4803): The broadest and most specific of the three bills (also with bi-partisan support), the Patients' Right to Know Act explicitly includes ambulatory surgical centers in the group of entities required to disclose pricing information. The bill would allow HHS to define some of the specifics, but would rely on states to enact reporting requirements. It also would require health insurers to disclose information about the limitations and restrictions of a health plan, the process for appealing coverage decisions, the amount of cost-sharing required, the number of providers participating in a plan, and more.

None of the three bills emerged as a favorite during the session, and it was unclear at its conclusion when or if the committee would move forward with legislation.


Elyas Bakhtiari is a freelance editor for HealthLeaders Media.

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