March 16, 2022

Smith Op-Ed: The Right to Know: Shining a Light on Health Care Costs

By Rep. Jason Smith Washington Times

Imagine going to the grocery store and shopping for food and goods without knowing how much your bill will total until you are in the checkout line or back at home preparing to eat. When it comes to pricing in our current health care system, this is how patients feel. When patients walk into a hospital for surgery, their fear is walking out with a bill that is hundreds or thousands more than they were expecting to pay.

In 2020, total health care spending reached $4.1 trillion. Roughly speaking, one out of every four dollars the federal government spends is on health care, and that figure is projected to rise to at least 35 percent over the next decade. Premiums and deductibles in private plans are rising more than wage growth, Medicaid spending has ballooned more than 360 percent in the past 20 years, and Medicare is projected to be insolvent in 2026. So, it’s not just an imperative for patients it’s critically important for the federal budget as well that we empower consumers with information about how to obtain care at an affordable cost.

The American people have the right to know how much their care will cost before they get a bill. Yet, somehow, we have almost no idea how much that colonoscopy or mammogram or routine checkup actually costs. Even after you are finished receiving care, you still may not find out for weeks or even months. This leaves patients feeling disempowered and confused, stuck in a complex system that is nearly impossible to navigate themselves.

Part of the solution, that President Trump championed, is price transparency. Thanks to President Trump, hospitals and insurers are now required to publicly disclose the prices they charge and pay for hundreds of shoppable services. Nearly 60 percent of health care is considered shoppable, according to health care experts. Polling data shows that 56 percent of Americans have tried to find out the cost of their health care in advance, including 67 percent of those with high-deductible plans. Yet, roughly 40 percent of Americans have reported not seeking medical treatment due to cost.

A recent study found that employers incentivizing price shopping led to a modest reduction in prices. While additional studies found that insurers providing advanced price information to consumers led to a nearly 19 percent reduction in MRI prices and promoted competition in the market. These incentives are extremely beneficial to patients, as the prices of imaging services, such as a MRI, can vary as little as $300 to as much as $3,000.

Congress must pursue solutions to unleash transparency in health care built on the foundation laid by the Trump administration. Congress must also help address several potential results from transparency rules. One is that employers are more likely to be equipped with the tools to help them take advantage of this wealth of data, but individual patients may need further assistance to make informed choices, whether through price comparison tools or some other form of comparison shopping. Another is that compliance may be expensive, and hospitals in rural areas may be in a precarious position to absorb a new cost. Congress must help manage these potential realities.

A key driver of health care costs are the price of prescription drugs and the expense of administering medications. We need to inject more transparency into this market by, for instance, providing for disclosure of drug discounts and excessive price hikes while also promoting real time benefits that allow you to know what the cost of a drug will be when discussing care with your physician, before you head to the pharmacy. Or encouraging greater innovation in the drug development space so drug companies are not able to carve out a monopoly for themselves in the treatment of certain conditions. Ideas like these and others are already in legislation, H.R. 19, the Lower Costs, More Cures Act, introduced by Representative Cathy McMorris Rodgers (WA-05), the Republican Leader of the House Energy and Commerce Committee, that I and over 100 of my colleagues in Congress have co-sponsored.

We can amplify savings for patients under a truly transparent system by pairing it with patient-centric solutions such as expanding access to Health Savings Accounts (HSAs) and Health Reimbursement Arrangements (HRAs). These policies grant people the freedom to pay for additional health care services with tax-free dollars.

If Washington wants to get serious about lowering health care costs, we need to start by recognizing that all patients have a right to know. Targeted reforms can unleash transparency in the health care market and transform patients into empowered consumers.

Read the op-ed here.