Trump Outlines Goals for Healthcare Price Transparency

Kerry Dooley Young

June 24, 2019

WASHINGTON — President Donald J. Trump on Monday signed an executive order that outlines goals for federal agencies to carry out actions to make the costs of healthcare more transparent to consumers.

The executive order signals to industry groups that healthcare costs remain a chief domestic concern for Trump. Democrats seeking to challenge him in 2020 will hold their first debates later this week, during which they may hash out their competing ideas for lowering Americans' medical costs. Healthcare is expected to be a dominant theme in the 2020 presidential contest.

The White House posted the text of the executive order online Monday afternoon after holding press events earlier in the day.

The executive order sets a number of deadlines for federal agencies to act or issue reports:

  • 60-day deadline for HHS to propose a regulation to require hospitals to publicly post standard charge information, including information based on negotiated rates, in an easy-to-understand, consumer-friendly, and machine-readable format. This is intended to allow patients to compare prices across hospitals, the White House said in the order.

This regulation also should require the posting of standard charge information for services, supplies, or fees billed by the hospital or provided by employees of the hospital. The White House wants hospitals to regularly update the posted information and establish a monitoring mechanism.

  • 90-day deadline for a joint action by the HHS, Treasury, and the Labor Department. They are to issue an advance notice of proposed rulemaking to seek feedback for a future proposal to require clinicians, health insurers, and self-insured group health plans to provide access to information about expected out-of-pocket costs for items or services to patients before they receive care.

  • 180-day deadline for HHS, the Justice Department and the Federal Trade Commission. They are to work together to issue a report describing the ways in which the federal government and the private sector may be impeding the flow of information about healthcare prices and quality to patients.

  • 180-day deadline for HHS, the Defense Department, and the Department of Veterans Affairs. They are to develop a so-called roadmap to align and improve reporting on data and quality measures across Medicare, Medicaid, the Children's Health Insurance Program, the Health Insurance Marketplace, the Military Health System, and the Veterans Affairs Health System. 

  • 180-day deadline for HHS, the VA, the Treasury, and the Defense and Labor departments and the Office of Personnel Management. They are to look for ways to increase access to de-identified claims data from “taxpayer-funded healthcare programs and group health plans for researchers, innovators, providers, and entrepreneurs.”

“Access to this data will also enable researchers and entrepreneurs to locate inefficiencies and opportunities for improvement, such as patterns of performance of medical procedures that are outside the recommended standards of care,” the White House said in the executive order.  The order also directs HHS to make a list of priority datasets that, if de-identified, could advance the policies set forth by Trump, the order said.

  • 120-day deadline for Treasury. It is to issue guidance to expand the ability of patients to select high-deductible health plans that can be used alongside a health savings accounts (HSAs).

  • 180-day deadline for Treasury. It is to propose regulations to treat expenses related to certain types of arrangements, potentially including direct primary care arrangements and healthcare sharing ministries, as eligible medical expenses.

  • 180-day deadline for Treasury. It is to issue guidance to increase the amount of funds that can carry over without penalty at the end of the year for flexible spending arrangements.

  • 180-day deadline for HHS. The department is to submit a report about additional steps the administration may take to take to address surprise medical billing announced on May 9.

"Just the Beginning"

On Capitol Hill, members of congressional committees have been working on bipartisan legislation to end surprise medical billing.

The Senate Health, Education, Labor, and Pensions Committee has been working on a package that is intended to end the practice of surprise billing and create more transparency. Senate HELP Chairman Lamar Alexander (R-Tenn.) said he and Sen. Patty Murray of Washington, the committee's ranking Democrat, have been working in parallel with their counterparts on the Finance Committee.

In the House of Representatives, the Energy and Commerce; Ways and Means; and Judiciary committees have recently put forward bipartisan bills to lower the cost of prescription drugs, Alexander said in a statement.

Industry trade groups already have raised questions about how the Trump administration will proceed with its plan for greater transparency about healthcare costs. In a statement Monday, Matt Eyles, president and CEO of America's Health Insurance Plans (AHIP), described Trump's executive order as "just the beginning of an extended process" for reining in healthcare costs.

"We also agree that patients should have accurate, real-time information about costs so they can make the best, most informed decisions about their care," Eyles said. "But publicly disclosing competitively negotiated, proprietary rates will reduce competition and push prices higher — not lower — for consumers, patients, and taxpayers."

Disclosing privately negotiated rates would reduce incentives to offer lower rates, "creating a floor — not a ceiling — for the prices that hospitals would be willing to accept," Eyles said.

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