PatientRightsAdvocate.org Letter to President Biden
January 26, 2021
The Honorable Joseph R. Biden, Jr.
President
1600 Pennsylvania Ave
Washington, DC 20501
CC: Ambassador Susan E. Rice, Director, Domestic Policy Council
Dear President Biden:
Thank you for your commitment to serving the American people and unifying our country at this critical time. We applaud your dedication to “increase price transparency in the healthcare system across all payers” as prominently outlined in the Biden-Sanders Unity Task Force Recommendations. The need for real price transparency in healthcare has never been greater. As we continue to fight a major health crisis and financial hardships, the ability to see prices in healthcare will give power to American patients to control both their physical health and financial savings.
Unifying and healing our country can begin with healthcare – specifically healthcare price transparency, an issue strongly supported by an overwhelming majority of Americans. A recent Marist Poll found:
Over 90 percent of Americans agree that “all organizations involved in healthcare (insurance, hospitals, doctors, etc.) should disclose all their prices – including self-pay and allowed amounts (the price providers negotiate with health plans) – in an easily accessible place online to allow for easy shopping for health care services.”
Nearly 90 percent of Americans agree that “hospitals should be required to post the actual prices of healthcare services in advance of care, not just broad estimates.”
PatientRightsAdvocate.org is a leading voice and non-profit, nonpartisan organization dedicated to protecting and expanding Americans’ rights to healthcare price transparency – patients’ right to know and compare actual prices before they get care, their right to choose fairly priced care they can afford, and their right to save their money, and their right to lower the costs of healthcare and coverage.
In November 2019, our country took a significant step towards making healthcare price transparency a reality with the Department of Health and Human Services’ (HHS) final rule requiring hospitals to provide up-front, real price information. This rule, using authority under the Affordable Care Act (ACA), has been upheld by both a federal district court and a unanimous panel of the D.C. Circuit Court of Appeals (incoming Attorney General Merrick Garland was on the panel for oral argument).
The rule’s requirements took effect on January 1, 2021, alongside the Transparency in Coverage final rule which takes effect on January 1, 2022. Together, these rules enable systemwide real healthcare price transparency and give the power to the patients when fully enforced. To protect Americans and their right to know upfront, real prices in healthcare, it is critical that HHS and the Centers for Medicare and Medicaid Services (CMS) continue to prioritize price transparency and devote the necessary resources to ensuring these rules’ successful implementation.
Thousands of patients across the nation have shared with us their horrific stories of financial ruin from a hospital visit (e.g. garnished wages, lost homes, bankruptcies) when they were never told the price of their care in advance and were later blindsided with price-gouging bills:
Wanda, a nurse's aid, was taken to court for $8,000 in medical debt after being overcharged for unnecessary ER care.
Carberry, a young school teacher, received $6,545 in surprise bills for a simple COVID test at a tent outside her hospital’s emergency room.
Martin, a self-employed handyman, was overcharged $6,000 for anesthesia beyond what his insurance would cover.
Price transparency gives patients like Wanda, Carberry, and Martin the power to prevent overcharging, price-gouging, and erroneous or fraudulent billing. It empowers them with recourse if hospitals, insurance companies, and middle players attempt to capitalize on their misfortune.
Price discovery will usher in quality transparency. The power of the well-informed consumer’s choices, benefiting from competition, will greatly drive down the cost of healthcare and coverage for our nation. Actual posted prices will help eliminate massive administrative waste in the U.S. healthcare system, with potential for savings estimated at nearly $1 trillion per year.
Yet, at a time when Americans are most vulnerable, hospitals are pushing back against this rule, citing administrative burden. While our nation’s hospitals serve a critical role in fighting the COVID-19 pandemic, HHS calculated the burden of complying with the transparency rule is de minimis – a mere 150 hours per hospital, less than one month’s worth of work for a single employee.
Fortunately for the hospitals, the data is already in digital form. Hospitals heavily use this digital pricing data to bill patients, and they use it analytically to optimize their revenues. Moreover, they often use these digital pricing files to calculate pro formas in assessing potential merger and acquisition activities.
As we recover financially, the opportunity for workers, unions, and employers to reduce their healthcare costs by 30-50%, is shown in these examples:
The Dallastown School District saved $500,000 of taxpayer dollars in less than a year by contracting directly with price transparent providers and surgical centers for its workers’ care.
Kara tells of the relief by knowing the price of her care in advance, through her employer’s price transparent model. Under a prior insurance, she was sent to collections for a bill for childbirth.
Continued support of healthcare price transparency will benefit all Americans, protect the most vulnerable, and put power into the hands of patients to be in charge of their healthcare decisions and savings. Thank you for standing strong in supporting the implementation and enforcement of the hospital price transparency rule and forthcoming Transparency in Coverage rule.
Sincerely,
Cynthia A. Fisher
Founder and Chairman, PatientRightsAdvocate.org