Bipartisan Patient Act can protect health care consumers from overcharging and medical debt

Who says bipartisanship is dead?

Following their debt ceiling deal, Democratic and Republican lawmakers are quietly coming together to address one of the country’s biggest problems: the outrageous cost of health care. The Patient Act of 2023, which recently passed the House of Representatives Energy and Commerce Committee by a vote of 49 to 0, codifies and strengthens federal hospital and health insurance price transparency rules.

By ushering in actual health care prices, this legislation can protect patients from rampant health care overcharging and empower them to lower their costs of care and coverage. Upfront prices allow consumers, including employer and union health plans, to spot wide price variations in care that can vary by ten times or more, even at the same hospital, and choose affordable options, improving health care access and equity. 

Actual prices give consumers easy recourse if their final bill does not match the posted price. Ensuing competition will help patients avoid medical debt carried by 100 million Americans.

In no other sector of the economy are consumers required to sign and personally guarantee a blank check as a condition of service. Systemwide health care price transparency shifts power to patients and allows them to hold hospitals and health insurers accountable for price gouging. No longer will consumers be blinded to prices then blindsided with massive bills they often wouldn’t have agreed to if prices were known upfront.

Federal rules that took effect on Jan. 1, 2021, and July 1, 2022, already require hospitals and health insurers to publish their actual prices online. Yet these rules have been plagued by noncompliance and a lack of standards that have severely limited their impact. A recent PatientRightsAdvocate.org study finds that only 24.5 percent of hospitals nationwide are fully complying with the hospital rule by posting their discounted cash prices and all health insurance plan rates.

The Patient Act will make these price transparency rules a reality for ordinary consumers. The legislation significantly boosts the hospital and health insurance noncompliance penalty to $5 million per year. The bill names and shames the hospitals and health insurers that aren’t complying. And it requires Health and Human Services to issue clear data disclosure standards to make price comparisons possible.

The legislation will make it easier for unions and employers to enjoy significant health plan savings, allowing them to reduce runaway worker premiums and boost wages. 

Consider the union SEIU 32BJ, which saved $30 million on its nearly 200,000-member health plan, generating funds to give its members $3,000 bonuses and their largest pay raise in history, by shopping for care. The union excised NewYork-Presbyterian Hospital from its health plan after analyzing its claims data and discovering the hospital was price-gouging its members. For example, the hospital billed the plan an average of $10,368 for outpatient colonoscopies versus $2,185 at other city hospitals.

Bricklayers and Sheet Metal Workers unions in the Northeast say they used price transparency data to determine that their insurer was overcharging them, forcing the unions to redirect money from their pension fund to their health plan. The unions have had to sue the insurer to try to get their plan’s price information to inform care decisions.

This Patient Act will shine sunlight on these prices and empower unions and all health consumers to choose the highest quality care at the lowest possible prices. Multiple polls show a supermajority of nearly 90 percent of Americans support health care price transparency. This is a bipartisan solution for a bipartisan Congress and can reduce crushing health care costs at a time when Americans need it most.

Cynthia A. Fisher is the founder and chair of PatientRightsAdvocate.org.