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The Biden administration and Congress are tackling skyrocketing health care and health insurance costs by extending expanded Pandemic-era Affordable Care Act (ACA) subsidies in Inflation Reduction Act. Yet simply shifting rising costs onto taxpayers does nothing to address the underlying crisis of unaffordable health care. In fact, increased subsidies make it even easier for health insurers to raise premiums and boost their record profits. Major insurers have already announced plans to increase ACA exchange premiums by up to 15-20% next year.

A better way to bend the healthcare cost curve and make care and coverage affordable is to ensure system-wide healthcare price transparency. Real upfront prices allow consumers to choose the highest quality care at the lowest possible price. Real prices enable patients to avoid endemic hospital overloads and get the care they need at affordable prices, expanding access and equity. Price transparency exposes wide price variations for the same care, even in the same hospitals.

A hospital price transparency rule that came into effect on January 1, 2021 and a health insurance price transparency rule that came into effect on July 1 of this year can usher in this competitive healthcare market and pro-consumer. Unfortunately, a new study from PatientRightsAdvocate.org (PRA) reveals that only 16% of US hospitals follow the rule that requires them to publish online, in a single file, their discounted cash and health insurance rates per procedure and per procedure. regime.

The Biden administration can make this rule a reality for consumers and spark a healthcare affordability revolution by strengthening compliance through strong and timely enforcement.

The PRA study finds that most of the 2,000 hospitals surveyed do not publish all payer-specific negotiated fees “clearly associated with the names of each third-party payer and plan” as required. The largest US hospital system, HCA Healthcare, which made $59 billion in revenue and $7 billion in profit in 2021, has a zero compliance rate.

This obfuscation prevents consumer choice. It prevents tech developers from aggregating prices into user-friendly web apps like Kayak or Expedia. And it hampers the competition that makes goods and services affordable in almost every other economic sector.

Hospitals and insurers blind consumers to real prices, then blind them with massive bills they would never have accepted, weeks and months after care. This opaque dynamic allows American hospitals to bill an average of seven times their cost of care. Last year, the Los Angeles Times reported on leaks in hospital pricing practices, revealing automatic markups of 675%. Health care spending has increased each year at more than double the rate of inflation for the past two decades.

As a result, 64% of patients delay care for fear of financial ruin, and 100 million Americans are in medical debt. A new mini-documentary released by the New York Times portrays ordinary patients bankrupted by this predatory healthcare system. “I had these procedures done, and now I get the awards?” says a patient. “It seems to be the opposite way of doing things. It should have been the prices first.

The Biden administration can bolster hospital compliance through strong and swift enforcement of the rule. So far, it has only fined two hospitals out of thousands that do not comply. However, these two hospitals quickly brought themselves into compliance and posted exemplary price sheets, demonstrating the power of repression. The administration can replicate that success by immediately fining other non-compliant hospitals, starting with 101 which, according to the PRA report, didn’t even bother to post a price list.

When all hospitals post their actual prices, consumers can rest assured that their care will not go out of business. They can choose to pay $300 for an MRI, rather than $3,000, or $6,000 for a C-section, rather than $60,000.

Employers, who provide coverage for most Americans, can steer their employees toward quality, less expensive care and share the resulting savings in the form of higher pay, helping workers cope with the historical inflation. When the prices are known, no employer will tolerate paying 10 times more than its competitors for the same care, even in the same hospital.

Policy makers looking to make health care affordable should take note: system-wide price transparency can actually reverse the exorbitant costs of health care and health insurance, rather than simply shifting these costs to taxpayers. The Biden administration should be applauded for its efforts to increase access to health care. But now it has to tackle affordability. Strong and timely enforcement of the Hospital Price Transparency Rule can significantly reduce costs through choice and competition and put “affordability” back into the Affordable Care Act.

Cynthia A. Fisher is a life sciences entrepreneur, founder and president of PatientRightsAdvocate.organd the founder and former CEO of ViaCord.