Year in Review: Trump administration makes big push for transparency

The Trump administration made a full-court press to bring down healthcare spending in 2019 through increased price transparency and other cost-cutting measures, even when it meant flouting the courts.

In year two of Alex Azar’s reign as HHS secretary, the department doubled down on its efforts to bring the power of market forces to bear on the historically murky world of healthcare prices. Azar and CMS Administrator Seema Verma fervently argued that exposing prices would increase competition in the healthcare delivery system. They theorized that patients would become more aggressive shoppers, just as they have in virtually every other sector of the economy. Providers would ultimately be forced to win over patients by focusing on quality, patient experience and value.

But hospitals and insurance companies fought back, claiming that the administration’s price transparency rules would be difficult and expensive to implement without providing any benefit to consumers.

The administration didn’t buy their arguments and used its regulatory hammer to increase price transparency through executive order, as well as several proposals and requests for information from the CMS. Almost all significant proposed rules in 2019 included some reference to price transparency. The administration made a big statement last month in a final rule that will require hospitals starting January 2021 to publish their standard charges online in a machine-readable format. They will need to create at least 300 “shoppable” services, including 70 selected by the CMS. The agency is also pursuing rules that would force providers and insurers to disclose negotiated rates.

Drugmakers were caught up in the push for transparency as well when the administration pushed a policy that would require them to list prices in TV ads, but that was thrown out by a federal court.

HHS also sought to slash healthcare spending through brute force. The agency continued its cuts to hospitals through its site-neutral payment and 340B drug payment policies. But the courts ruled against HHS on both regulations, saying that HHS overstepped its authority when it approved the payment changes. The administration pushed ahead anyway because it thinks it will win on appeal.