A \u2018Bold\u2019 First Step That Fizzled<\/strong><\/p>\n The 2019 order was \u201cpretty bold,\u201d said Gary Claxton<\/a>, a senior vice president at KFF, a health information nonprofit that includes KFF Health News. \u201cThey basically went at the providers and the plans and said, \u2018All this data you think is confidential we\u2019re not going to make confidential anymore.\u2019\u201d<\/p>\n What followed was, to consumer advocacy groups, a disappointment. Hospitals and insurers posted on websites voluminous, complex, and confusing data about their prices. The information has been a challenge for even experts in health care pricing to navigate, let alone consumers. Some members of Congress filed legislation<\/a> to put the force of law behind price transparency requirements; those bills died. And President Joe Biden\u2019s administration was criticized for not more stringently enforcing the regulations, with one consumer advocacy group even buying a Super Bowl ad<\/a> featuring the rapper Fat Joe<\/a> alleging that \u201chospitals and insurers hide their prices.\u201d<\/p>\n Trump\u2019s new order, signed in February, said that hospitals and health plans \u201cwere not adequately held to account when their price transparency data was incomplete or not even posted at all.\u201d<\/p>\n The Government Accountability Office reported in October<\/a> that the Centers for Medicare & Medicaid Services didn\u2019t know whether prices reported by the health care industry were correct or complete. But CMS, which regulates hospitals, now plans to \u201csystematically monitor compliance\u201d and help institutions understand the requirements, said Catherine Howden, an agency spokesperson.<\/p>\n Howden did not answer questions about whether CMS staffers overseeing price transparency compliance have been fired as part of the Trump administration\u2019s wide-ranging effort to cut the federal workforce.<\/p>\n \u2018Zombie\u2019 Rates and Other Inconsistencies<\/strong><\/p>\n Meanwhile, independent researchers have found numerous problems with the quality of price data both hospitals and health insurers do share with consumers.<\/p>\n A recent report<\/a> from the Peterson-KFF Health System Tracker found that data reported by four health insurers in New York City often included prices that they say they pay hospitals for services that those health providers don\u2019t \u2014 or can\u2019t \u2014 provide. These are called \u201cghost\u201d or \u201czombie\u201d rates. For example, the health plans reported dentists, optometrists, and audiologists receiving payments for knee replacements, gastrointestinal exams, and other procedures unrelated to their specialties.<\/p>\n In other cases, the data included different prices for the same service paid for by the same insurer at the same hospital. UnitedHealthcare, for example, reported paying New York-Presbyterian\/Weill Cornell Medical Center three rates \u2014 $47,000, $64,000, and $70,000 \u2014 to treat a heart attack.<\/p>\n Or, the insurers reported paying the same price for vastly different services. Aetna, for example, said it paid exactly $6,292 to Mount Sinai Beth Israel hospital for the treatment of respiratory infections, heart attacks, cancers of the digestive tract, kidney and urinary tract infections, and psychosis.<\/p>\n Neither UnitedHealthcare nor Aetna addressed the discrepancies in the data. Cole Manbeck, a spokesperson for UnitedHealthcare, said the insurer has met price transparency requirements and urged members \u201cto use our cost-estimator tools for exact costs based on their specific health plan.\u201d Aetna spokesperson Shelly Bendit referred questions to AHIP, a lobbying and trade association for insurers.<\/p>\n Health insurers have \u201cstrongly supported\u201d price transparency, said Chris Bond, a spokesperson for AHIP. The group will work with the Trump administration to provide transparency \u201cin a way that is meaningful for the end user, while also promoting a competitive private market,\u201d Bond said.<\/p>\n What\u2019s a Consumer To Do?<\/strong><\/p>\n Estimates and total prices aren\u2019t very useful for consumers, who are mainly interested in what they\u2019ll ultimately have to pay out-of-pocket, said David Cutler<\/a>, a professor of applied economics at Harvard University. That can vary by health plan, depending on deductibles, copayments, and other fees.<\/p>\n \u201cMost of the price transparency information doesn\u2019t have that,\u201d he said.<\/p>\n It also doesn\u2019t give consumers information about the quality of care, Cutler added, which can lead to an old bias. \u201cIt\u2019s kind of like wine when you go to the restaurant,\u201d he said. \u201cPeople assume that the more expensive wine is better.\u201d<\/p>\n Cutler said he\u2019s skeptical that price transparency will lower costs for patients. But he said it may offer insight to hospitals and health plans about what their competitors are charging and paying for services \u2014 knowledge that could inadvertently lead to price increases if hospitals that receive a lower rate than a competitor demand higher reimbursement from health plans.<\/p>\n Trump\u2019s recent executive order<\/a> notes that the top quarter of the most expensive health service prices have dropped by 6.3% a year since his 2019 order.<\/p>\n However, the same research referenced in the executive order showed that the bottom quarter of services got more expensive, at a rate of about 3.4% per year, according to the analysis<\/a> by Turquoise Health, a health care price data firm that examined rates at more than 200 hospitals in the 10 largest U.S. markets.<\/p>\n Some patients say that with research and persistence, they\u2019ve been able to make price transparency work for them.<\/p>\n Theresa Schmotzer, 50, of Goodyear, Arizona, said she used hospital price data<\/a> to save nearly $3,000 on outpatient surgery to have a fibroid removed last year.<\/p>\n Schmotzer, who has health insurance, said the hospital first told her she would owe $3,700 for the procedure and wanted the payment upfront. But she was skeptical.<\/p>\n She said her health insurer was unable to quote a price for the procedure or specify how much she would owe. The morning of the surgery, Schmotzer said, she found a spreadsheet online at PatientRightsAdvocate.org that included different prices paid by insurers, including hers. The reported price for the procedure was closer to $700, she said.<\/p>\n Schmotzer said she took a printout of the spreadsheet to the hospital and presented it during preadmission. She paid her $300 deductible and told the hospital to bill her for the rest.<\/p>\n A few months later, she said, the bill arrived in the mail for the remaining $400, which she paid.<\/p>\n When people go for surgery and aren\u2019t clear upfront what the cost will be, it stokes fear, she said. \u201cBecause they\u2019re going in blind.\u201d<\/p>\n Next Steps<\/strong><\/p>\n Hospitals say they want to work with federal regulators and comply with reporting requirements, said Ariel Levin, director of coverage policy for the American Hospital Association, which represents about 5,000 institutions. Levin said consumers should be given the price of services and \u201ca more comprehensive estimate\u201d that represents an entire episode of care and the amount they\u2019ll owe out-of-pocket, based on their health plan.<\/p>\n CMS has developed rules since Trump\u2019s 2019 order to make price information reported by hospitals and health plans easier to understand, and the agency has fined<\/a> more than a dozen hospitals for failing to comply.<\/p>\n Federal rules allow hospitals<\/a> to report an estimate, a price range, or a historical rate for their services, while health plans<\/a> can adjust prices based on factors like the severity of the case, the length of treatment, and a patient\u2019s age.<\/p>\n KFF\u2019s Claxton said that such flexibility doesn\u2019t allow for \u201capples-to-apples comparisons\u201d and that the data must be reliable before researchers can use it to better understand health care costs. \u201cIt doesn\u2019t seem to be that yet,\u201d he said.<\/p>\n Much remains to be done before price transparency lives up to expectations that it will increase competition and lower costs, said Katie Martin<\/a>, chief executive of the Health Care Cost Institute, a nonprofit research group.<\/p>\n Price transparency alone is not a silver bullet, Martin said. It\u2019s \u201ca critical first step\u201d for employers, lawmakers, regulators, and others to better understand how money flows through the health care system and how to make it more efficient, she said. \u201cIt\u2019s not the whole thing.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n![](\"http:\/\/www.walkwithremar.com\/wp-content\/uploads\/2025\/04\/Schmotzer.jpg\")
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