White House Targets Health Costs


Many believe consumers could benefit from better price transparency.

 President Trump is expected to release an executive order as early as next week to mandate the disclosure of prices in the health-care industry, according to people familiar with the discussion.
 The order could direct federal agencies to pursue actions to force a host of players in the industry to divulge cost data, the people said. The administration is also looking at using agencies such as the Justice Department to tackle regional monopolies of hospitals and health-insurance plans over concerns they are driving up the cost of care, according to two people familiar with the discussions.
 The White House declined to comment on its plans. Industry groups said the initiatives under consideration are an executive overreach and legal challenges are possible. While the administration has been discussing various initiatives to increase price transparency in the healthcare industry, the executive order is a presidential directive with the force of law. If the concepts are acted upon, that could upend an industry long used to transacting in private.
 The White House has been working for months on a strategy officials believe will lower health-care costs by giving consumers and employers data for the first time on the discounted and negotiated rates between insurers, hospitals, doctors and other providers.
 Internal administrative disputes over how aggressively to mandate price disclosure have delayed earlier plans to issue an executive order, two people said, and some details of the current order are still being completed.
 The Trump administration is considering a number of administrative tools that officials believe could force price disclosure as part of the executive order. They include the 21st Century Cures Act, the Affordable Care Act, Health Insurance Portability and Accountability Act and Employee Retirement Income Security Act, two people said.
 The action would represent a new front in an attack on high health-care costs. Both the White House and a growing number of members of Congress are targeting the industry, saying consumers and employers will benefit if the secrecy around prices is peeled back.
 On Thursday, Sens. Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.) released a plan aimed at lowering health-care costs that included a number of proposals to push price disclosure. It would require providers and health plans to give patients good-faith estimates of their expected out-of-pocket costs for health services within 48 hours of a request.
 The administration is also likely to use a coming hospital outpatient rule to require hospitals to disclose their negotiated rates with insurers, two people said. The rule is expected this summer. Industry groups are mobilizing to derail the efforts that could extend to hospitals, doctors and insurers in the private- employer market. The Wall Street Journal has reported that the administration has been considering issuing a Labor Department rule to force insurers to publicize the negotiated rates they pay for services.
 The Department of Health and Human Services has also sought public comment on whether patients have a right to see the discounted prices in advance of obtaining care. The first-of-a-kind proposal could force doctors and hospitals to publicly share the negotiated and often discounted amounts they charge insurers.
 Disputes have erupted within the administration over health-care policy, according to several people outside the administration who are familiar with internal discussions. Joe Grogan, a key adviser to Mr. Trump who heads the White House Domestic Policy Council, has opposed more aggressive HHS proposals on drug-price transparency and competition, five people said.
 Hospitals have argued that patients need to know their out-of-pocket costs rather than negotiated rates. Others have said disclosure of average rates rather than total price of all negotiated charges would be a more useful measure. They also argue that disclosing rates could backfire by driving costs up if competitors see other providers are getting paid more for the same services.
 “Transparency for transparency's sake, and forced disclosure of thousands upon thousands of competitively negotiated rates, will not help consumers,” said Matt Eyles, president of America's Health Insurance Plans, an association of health insurers. “Instead, it will cause health-care costs to go up for every American. To improve access and affordability, we need to work together to improve competition, choice and collaboration.”
 Critics also say the administration could be overreaching if it believes the Labor Department has the authority to mandate the disclosure of insurers' negotiated rates with providers.
 About 158 million people get their health insurance in the private-employer market. Price disclosure is rapidly emerging as a major issue on Capitol Hill. A May 21 bill sponsored by Sens. Bill Cassidy (R., La.) and Michael Bennet (D., Colo.) would end contractual gag clauses between providers such as hospitals and insurers that can restrict the ability of patients to get cost information.
 Sen. Ron Wyden (D., Ore.) introduced legislation this month that would make insurers tell consumers what their out-of-pocket costs would be for drugs or in-network procedures. “In a grocery store, you can get a price check for a can of peas on Aisle 2,” Mr. Wyden said. “Health care is much more difficult, but it ought to be a lot easier for Americans to find out what they will have to pay before they get to a doctor.”  
—Brent Kendall contributed to this article.

BY STEPHANIE ARMOUR

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