Trump Administration is right to enforce hospital price transparency rule

More than five years after hospitals were required by law to post prices for their services, over 500 nationally, including 19 in the Mountain West (9 Washington; 4 Montana ; 3 Idaho; and 3 Wyoming), failed to meet transparency requirements this year – keeping healthcare costs higher for everyone.

They received warning letters or requests for a corrective action plan earlier this month from the Trump Administration. Among the 2021 requirements are that hospitals must provide a machine-readable digital file with the standard charges for all services and products, including the full, undiscounted prices, discounted cash prices, negotiated prices with various insurance companies, and minimum and maximum prices. They must also provide an easily readable display of the hospital’s shoppable services, so consumers can compare prices at different health centers.

Posting prices seems like a no-brainer. Can you imagine going to the grocery store and only finding out how much you owed at checkout? The same goes for furniture and clothing stores, salons, ranch stores, car dealerships, and literally every other retail outlet. Would anyone spend money at a place that didn’t post prices? What makes it even more egregious is that hospitals in the same city frequently charged radically different prices for the same service because no one could find out.

Maintaining their secret pricing was so important that hospitals sued the government in 2019 prior to the rule becoming law. The plaintiffs included the American Hospital Association, the Federation of American Hospitals, and the Association of American Medical Colleges. Their argument: forced transparency was compelled speech which violated the First Amendment. In other words, in their opinion, obfuscating costs from consumers and the government – aka, taxpayers who subsidize a hefty portion of their operations – was their right under the Constitution. They also argued that demanding that hospitals post negotiated prices with insurance companies would force them to disclose trade secrets.

This fails to account for the fact that many Americans today have health savings accounts paired with high-deductible insurance. The ability to know the cost of services is especially critical for this cohort of healthcare consumers.

Businesses across the country have to negotiate prices with their suppliers, and those negotiations are reflected in their store prices. Hospitals do not deserve different rules because they don’t like competing for business. Thankfully, this argument lost. As U.S. District Court for the District of Columbia Judge Carl J. Nichols ruled, “The publication of charges will allow the agency (HHS) to further its interest of informing patients about the cost of care, which will in turn advance its other interest – bringing down the cost of care.”

Wyoming passed a law this year and Washington in 2025 requiring price transparency at the state level. Those laws add another level of scrutiny to protect patients from unfair pricing with the ultimate goal of reducing costs through competition. Montana and Idaho should follow suit. If the Biden Administration had enforced the original rule, states wouldn’t have had to consider the issue. Because of the inconsistent, if not non-existent enforcement, however, patients around the country and in the Mountain West often did not have the option to shop around years after the law was enacted.

The Foundation for Government Accountability found that nearly 2/3 of hospitals were not complying in 2022, and most still weren’t in 2023. As Rep. Jason Smith (R-MO) said in 2023 of the Biden administration’s non-enforcement, “We can get more information about a local restaurant from YELP than you can get about your local hospital from CMS (Centers for Medicare and Medicaid Services).”

A review of the 19 hospitals' websites flagged by the Trump Administration shows varying degrees of compliance, with some on the list apparently in full compliance as of recent months. It should not have taken threats of fines and over five years to follow the law, however. Patients on all sides of the political aisle will benefit by being able to choose which hospital best suits their needs from both a medical and financial standpoint.

With medical debt – often incurred without a patient knowing the price of services – one of the leading causes of bankruptcy in the United States, everyone should cheer a reform that allows patients to choose the most affordable service for their needs. Hospital price transparency is not political; it’s the only fair, compassionate, and honest way to operate our healthcare system.