Everyone will know everyone else’s business: for example, how much insurers Aetna and Humana pay the same surgery center for a knee replacement.
The requirements stem from the Affordable Care Act and a 2019 executive order by then-President Donald Trump.
“These plans are supposed to be acting on behalf of employers in negotiating good rates, and the little insight we have on that shows it has not happened,” said Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health, an affiliation of employers who offer job-based health benefits to workers. “I do believe the dynamics are going to change.”
Source: How much health insurers pay for care is about to go public : Shots – Health News : NPR
Initially, the data is expected to be available in obfuscating large databases. It is hoped that third parties will redistribute the data in human accessible formats.
From the beginning of the ACA (2008-2010), I believed price transparency would help to eventually constrain health price increases. Health care is generally billed at $10 to $50 per minute for time spent with a provider. Yet ACA architect Jonathan Gruber did not include price transparency measures, believing instead that tens of millions of people would sign up for ACA policies creating a dynamic and robust competitive market that would drive prices down; that never happened. In fact, from 2014 to 2017, our ACE Silver policy premiums tripled in cost, as did the deductibles. Today, an ACA Silver policy for two of us is $24,000 per year, and all policies but one have no coverage (not even “out of network”) for hospitalization or surgery while traveling outside the local area, within the United States. And all other services other than hospitalization and surgery are billed at “out of network” prices.
In May I had a routine, pre-scheduled colonoscopy exam. Upon sign in, I was presented with a price estimate between $4,000 and $12,000 – with a clause that “and it could be higher”. In other words, a useless price estimate.
The actual price was billed to the insurer for about $7,500 but the provider accepted a contract price of $2,400. I think. I still don’t know if the anesthesiologist was included in that, or if the outpatient surgical services center will add a “facility fee”, etc.
Ultimately, pricing remains non-transparent and providers and insurers may continue to “game the system” to keep this opaque.
