It’s hard to fix the health care situation without knowing what the real cost of health care is. While Democrats want to look at ways to negotiate with the pharmaceutical companies, the White House wants to understand what the actual costs of providing health care is to see what kind of inflation is in place.
Rules are coming down from the Trump administration to require hospitals and insurers to disclose the real prices for tests and procedures upfront. This will push down costs while also promoting competition.
This proves to be problematic for hospitals and insurers because they rely on people not knowing the actual prices. With these changes comes significant pushback from the healthcare industry. A coalition consisting of several hospital groups have already said that hospitals will sue as a way to block some of the key provisions.
There is likely going to be a learning curve for everyone involved, especially patients and families. The world of healthcare billing could change dramatically under some of the new rules. The same procedure may have different billing codes than once before, especially based on some of the new factors.
When speaking at the White House, Pres. Donald Trump skipped over some of the difficulties. Instead, he focused on the openness of healthcare and its benefits. While he spoke in a way that would make everyone think that it is a done deal, there is still a lot to be dealt with behind the scenes. Trump talked about the importance of transparency. He feels that most will be fully implemented within 12 months. He also predicts that it is going to have a significant impact on prices.
The final rule that was issued on Friday will apply to hospitals as well as the proposed regulation that applies to insurance plans. Hospitals will not have to deal with disclosure requirements until 2021. As for the timing for insurers, it is not clear. The requirements also do not affect doctors directly.
White House officials have said that the rules will help to highlight some of the healthcare prices. Patients will be informed of what services are going to cost. It will allow them to find quality services at lower pricing, too. As an example, an MRI scan can vary by hundreds of dollars depending on the venue in which it is offered.
According to Alex Azar, the Health and Human Services Secretary, American patients have been “at the mercy” of a system that provides them with little access to the data they need to make informed decisions about their health care. He points out that hospital procedures are often scheduled in advance. This advance notice allows patients the opportunity to shop for the best pricing.
The new administration rules would require insurers to give patients individualized estimates online so that they will know what their out-of-pocket expenses are going to be. Most of this information now is provided after the fact in the “explanation of benefits” pamphlet that arrives in the mail.
Hospitals and insurers, however, say that the disclosure goes too far. They don’t want to disclose rates publicly because they are constantly negotiating as part of private contracts. It’s not surprising that they don’t want to disclose the information since most hospitals are in a for-profit status. Further, insurance companies have been making billions of dollars within the healthcare industry for years.
According to the American Hospital Association, they feel that there will be “widespread confusion” – and they are probably right. However, it won’t be for the reason that they think. There will be widespread confusion because people will wonder why they have been charged so much when the costs are so little. They feel that the widespread confusion will result in an anti-competitive behavior with health insurers. The American Hospital Association has also threatened that therefore organizations will join with a number of member hospitals in order to file a legal challenge. They believe that the rule exceeds the authority of the Trump administration.
Insurers are also complaining, saying that the plan could backfire, prompting providers to charge more. Azar has waved this off by saying that all sectors of the U.S. economy where price information is disclosed in a competitively driven marketplace leads to lower prices, not higher ones.
The executive order by Donald Trump is a legal one, though those that have been abusing the system for far too long are against it. They would rather have the Dems fighting for them, allowing the American people to be ripped off with each and every hospital visit that they have to make.