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New Congress must pass health care price transparency

The divisive midterm elections are finally over, and with the ensuing divided Congress, only bipartisan-supported legislation stands a chance of becoming law. The new Congress can come together and win an early bipartisan victory in addressing one of the most pressing issues facing all Americans: the health care cost crisis.

According to a recent Gallup bearing, nearly 40% of Americans are willing to change their vote to the candidate with the best solutions to the country’s healthcare problem. In other words, many people are willing to put effective health care policies ahead of political party preference.

The healthcare solution that receives the broadest bipartisan support is healthcare price transparency, which is supported by a vast majority of almost 90% from Americans. By codifying and strengthening a federal rule for price transparency in hospitals, Congress could enable Americans to significantly reduce their health care costs through choice and competition.

Tackling runaway health care costs is urgently needed. Recently, the Labor Inspectorate revealed that the cost of health insurance increased by 20.6% over the previous year, almost three times the overall inflation rate. Last month, the Kaiser Family Foundation announced that the average annual employer-sponsored family health insurance premium in 2022 was $22,463, nearly one-third of the national average household income.

Experts to predict next year the costs will rise even faster. Numerous health plans, including those regarding public employees in New Jerseyhave introduced tariff increases of more than 20% for 2023.

Due to skyrocketing health care costs 100 million Americans hold medical debt, and almost two-thirds avoid care every year for fear of financial ruin. Rapidly rising employer health insurance costs are attacking U.S. companies, cannibalizing funds that could otherwise go to pay raises to help workers grapple with historic inflation.

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Inaction in this calamity is evidence of a form of health care Stockholm syndrome.

Simply increasing the number of Americans with health insurance is of little use if consumers cannot afford premiums or care. On the other hand, price transparency can bend the cost curve.

Pre-actual prices enable healthcare consumers, including employers and unions, to spot the well-documented, wild price swings for the same care, even in the same hospital. For example, in a hospital in California, the price of a cesarean delivery ranges from $6,200 to $60,600. A recent study published in the journal Radiology finds CT scans can range from $134 to $4,065 at the same hospital.

Armed with real prices, consumers can avoid rampant hospital pricing in favor of quality, less expensive alternatives to the more than 90% of non-emergency health care expenditures. If the prices are known in advance, no consumer will tolerate paying 10 times more than the person in the bed next to them for the same care.

Employers and unions can use the resulting savings to reduce premiums and raise wages. Consider the SEIU 32BJ union, which represents approximately 200,000 construction workers in the Northeast. It’s recently gave its members their largest pay raises in history and $3,000 bonuses after analyzing the claims data and cut out the price-gouging New York-Presbyterian hospital out of his plan.

On January 1, 2021, a federal price transparency for hospitals rule came into effect requiring hospitals to publish their cash prices and all health insurance rates. This information can make it easier for healthcare consumers to follow the lead of SEIU 32BJ and other innovative employers.

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Unfortunately, the rule has been marred by widespread non-compliance by hospitals. A recent study by means of PatientRightsAdvocate.org notes that only 16% of hospitals fully comply.

Congress can encourage compliance and improve the rule by codifying it into law. It could make the rule more effective for consumers by requiring hospitals to adhere to clear data disclosure standards so that third-party tech innovators can aggregate prices into easy-to-use web applications like travel websites collect airline tickets from sites like Kayak or Expedia.

Lawmakers can further improve the rule by removing a loophole that allows hospitals to publish estimates rather than actual prices. Cost estimates are bogus transparency. Only actual prices allow consumers to compare and save substantially with the peace of mind that the final bill will match the stated price.

The new Congress could win an early victory in reversing runaway health care costs through robust price transparency, a solution backed by an overwhelming bipartisan supermajority. The divided Congress should make this health care its top priority.

Cynthia A. Fisher is founder and president of PatientRightsAdvocate.organd the founder and former CEO of ViaCord Inc. She wrote this column for The Dallas Morning News.

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