Hickenlooper, Marshall Celebrate Committee Passage of Bipartisan Bill to Make Health Care Costs Transparent

Transparency for medical services will lower cost of health care and help Coloradans compare prices

Bill now heads to Senate floor for final passage

WASHINGTON - Today, U.S. Senators John Hickenlooper and Roger Marshall celebrated passage of their bipartisan Patients Deserve Price Tags Act, which would make health care costs transparent, out of the Senate Committee on Health, Education, Labor and Pensions. The bill requires providers to publish the costs of services so Americans understand what a specific visit or procedure will cost, and have the opportunity to compare prices and get the best deal. The bill now heads to the Senate floor for a final vote.

"Right now, Americans walk into a hospital blind and walk out with a bill nobody could have predicted. That's not a health care system - it's a gamble," said Hickenlooper, who sits on the Senate Health, Education, Labor, and Pensions Committee. "Our bill makes hospitals and insurers publish their prices and backs it up with real fines, not empty threats. If we're serious about getting universal coverage and lowering costs, we start by following the money."

"Patients deserve price tags, not surprise bills. This is the only bipartisan healthcare reform before Congress today that can begin lowering the cost of living immediately by bringing real competition to our healthcare system," said Marshall. "Americans have waited far too long to know what their care will cost before they receive it, and I'm proud this commonsense legislation passed out of the HELP Committee today with overwhelming bipartisan support. It's time to put patients back in charge - not the big hospital systems and insurance companies."

"The Patients Deserve Price Tags Act would replace healthcare's blank checks with actual prices, empowering patients and employers to compare options, avoid the risk of surprise bills and reap the benefits of competition found elsewhere across the economy," said Cynthia Fisher, founder and chair of PatientRightsAdvocate.org. "At a time when health insurers are planning massive premium increases, this bipartisan legislation will expose for the first time how exactly they set their prices."

Americans are being crushed by the high cost of health care. Most Americans go to the hospital with no idea what services will cost beforehand. As a result, 41% of Americans, more than 100 million people, owe a staggering $220 billion in medical debt. And in Colorado, 700,000 people are at risk of losing their wages or their homes due to unpaid medical bills. In addition, the historic cuts the Trump administration made to Medicaid and the Affordable Care Act have only increased the cost of health care and forced millions of Americans off their insurance.

The Patients Deserve Price Tags Act would create true transparency for health care pricing by requiring all negotiated rates and cash prices between plans and providers to be accessible.

Specifically, the bill would require providers and insurers to:

• Publish machine-readable files of all negotiated rates and cash prices between plans and providers, not estimates.
  
• Publish actual prices for 300 shoppable services in a readable, consumer-friendly format.
  
• Provide the right to a detailed itemized bill with plain-language descriptions and billing codes of each distinct item or service, or an all-in total price for bundled items if offered to the patient as an option.
  
• Provide each patient with an Explanation of Benefits statement.
  
• Hold the patient harmless for medical claims that are substantially in excess of the initially quoted cost, absent documented and unforeseen medical circumstances.

Previous efforts to enact price transparency in the Trump and Biden administrations fell short because enforcement was limited. The PatientsDeserve Price Tags Act goes further by codifying price transparency into law and strengthening enforcement mechanisms. Specifically, the bill:

Expands transparency to corporate ownership: the bill requires hospitals, insurers, labs, imaging centers, ambulatory surgical centers, and health plan service providers like Pharmacy Benefit Managers (PBMs) to publish information on provider ownership or investment interest in the entity. This helps shine a light on corporate structures and financial interests that can influence health care costs.

Puts real teeth into penalties: The bill requires hospital executives to formally verify that all prices are accurate and complete. A hospital that has failed to comply will be subject to civil monetary penalties. Fines become steeper the longer the provider is not in compliance.

Strengthens patient billing protections: if a hospital isn't following the pricetransparency rules, it's barred from going after patients with aggressive debt collection tactics for bills tied to the period when the hospital was out of compliance.

Protects against add-on charges: The bill requires providers to publish facility fees or add-on charges that'll be tacked onto the final bill, plus a plain-language explanation of when that fee applies and how to avoid it.

For full text of the legislation, click HERE.

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