The Washington PostDemocracy Dies in Darkness

The Health 202: Biden says he'll enforce Trump-era rules requiring hospitals to post their prices

with Paige Winfield Cunningham

President Biden is putting his foot down on a price transparency rule that many hospitals have skirted over the past seven months.

On Friday, Biden released an executive order instructing the Secretary of Health and Human Services to “support” price transparency regulations issued by the Trump administration.

Starting on Jan. 1, hospitals were required to post the prices they charge cash-paying customers and the rates they negotiate with insurers — figures that were largely obscured from public scrutiny. Proponents of greater hospital transparency championed the change, saying it would help patients shop for better deals and drive down health care prices. Until now, it was unclear exactly how the Biden administration would approach the Trump-era rules, even as advocates and some lawmakers urged stronger enforcement amid signs of widespread noncompliance. 

Friday’s executive order still didn’t provide many details, but it signaled that the new administration views the transparency rules as valuable, even if they ultimately don’t pack as much of a punch as former president Donald Trump had claimed.

Recent studies have found that many hospitals aren’t complying with the rule.
  • A study published in the American Journal of Managed Care last month looked at 20 prominent U.S. hospitals and found that only 60 percent listed their cash prices on their websites, as of February. Only 5 percent displayed the minimum charges that they negotiated with insurers.
  • Another study published in the journal JAMA Internal Medicine found that some 83 percent of hospitals are not fully complying with the price transparency rules.

Many hospitals provided a price estimator tool for patients, the JAMA study found, but far fewer provided an easy-to-use file with the prices the hospital negotiated with different insurers.

“Because patient-oriented price estimator tools make prices visible only for a given patient and insurance plan and not to payers or the public, selective compliance may fail to expose abuses of market power, affect price negotiations, or support broad analysis of price variation to the extent intended by the transparency initiative,” the study authors write.

Biden’s executive order is sparse on details, saying that the health secretary should “support existing price transparency initiatives for hospitals” along with any future transparency requirements. But the Department of Health and Human Services began in April to send letters to hospitals that weren’t complying with the rule and indicated it plans to audit a sample of hospitals. 

Transparency advocates, who’d been disappointed by hospitals’ lack of compliance, are hoping the fresh attention from the Biden administration could signal stronger enforcement.

“Biden’s executive order hands the torch to both [Health and Human Services Secretary Xavier] Becerra and Health and Human Services to boldly enforce the rules. It gives them the power to do what they need to do even if it means they need harsher penalties and stricter enforcement,” said Cynthia Fisher, the founder of Patient Rights Advocate, a nonprofit that pushes for price transparency.

The response from hospitals themselves was muted, but Molly Smith, vice president for public policy at the American Hospital Association, told Health 202 that the organization “strongly encourage[s]” hospitals to follow federal guidelines on transparency. 

Still, even with enforcement, the effects of greater price transparency may be modest.

Experts in health care finance have said that the new transparency rules are unlikely to be a silver bullet when it comes to driving down health care costs. 

Many Americans are insulated from the direct cost of treatment because their insurance picks up the tab, and even those patients who pay directly may have a hard time wading through hundreds of pages of complex pricing documents. 

Even when hospitals do post their prices, many Americans don’t know to look for them. Fewer than 1 in 10 Americans say they are aware that hospitals are required to post their prices, according to a recent Kaiser Family Foundation poll.

“Healthcare goods are very complex. We care a lot about quality, and we in essence listen to what our doctor recommends,” said Zack Cooper, a professor of health policy and economics at Yale University. “I think the idea somebody is going to be out there with a price transparency tool figuring out where to go in this market is just not realistic.”

President Biden signed a sweeping executive order on July 9. The order outlines 72 initiatives to rein in the corporate powerhouses that control markets. (Video: Reuters, Photo: Evan Vucci/AP/Reuters)
Biden’s executive order also called for action on drug pricing and hospital consolidation. 

The health care provisions come in a sweeping executive order that has 72 initiatives aimed at scaling back monopolies and offering consumers more options in technology, finance, and health care.

The order encourages Federal Trade Commission to crack down on hospital mergers that are harmful to patients and to ban “pay-for-delay” tactics that allow brand name drug manufacturers to pay generic manufacturers to keep their products off the market.

It also directs the Food and Drug Administration to work with states on importing drugs from Canada, another initiative started during Trump’s time in office, as our colleague Amy Goldstein reports.

“Just a handful of companies control the market for many vital medicines, giving them leverage over everyone else to charge whatever they want,” the president said before a signing ceremony at the White House. “As a result, Americans pay two and a half times more for prescription drugs than any other leading country.”

Ahh, oof and ouch

AHH: The CDC announced that vaccinated children can go maskless in the fall.

“The much-awaited easing of pandemic rules for kindergarten through 12th grade follows the opening of vaccine eligibility this spring to anyone 12 and older,” The Post’s Donna St. George and Valerie Strauss report. “But it also arrives after some states and school systems have gone their own way — lifting mask mandates and forging ahead with plans for a highly anticipated school year that is just weeks away.”

Texas Gov. Greg Abbott issued an order in May ending mask mandates in public schools. The superintendent of Miami-Dade County Public Schools, the fourth largest school district in the country, has said that masks will be optional in the upcoming school year.

The new mask guidance may be hard to implement. The Centers for Disease Control and Prevention did not spell out how schools should determine which students are vaccinated. Erin Sauber-Schatz, a CDC official who oversaw the school guidance, said that if schools are unable to verify vaccine status, the safest option to protect unvaccinated students is to require universal masking. 

CDC data shows that 24 percent of children ages 12 to 15 are fully vaccinated, along with 36 percent of those 16 and 17 years old. Vaccines are not yet approved in the U.S. for children under 12.

OOF: Pfizer is planning to brief federal officials about the need for booster shots.

The move comes after the pharmaceutical giant and federal officials had an unusually public spat about the need for a third shot, The Post reports. Pfizer and the German firm BioNTech announced Thursday that they planned to seek emergency authorization for a third dose of their coronavirus vaccine. 

But the Department of Health and Human Services quickly rebuked the notion that fully vaccinated Americans needed another shot, saying “Americans who have been fully vaccinated do not need a booster shot at this time.”

Pfizer has said its data shows that the effectiveness of vaccines wanes over time, especially for the elderly. Health officials and scientists have yet to see the data, which the company will share with the FDA.

“The debate about a booster shot comes as global anxiety rises about the spread of the highly transmissible delta variant, which has become the most prevalent strain in the United States. It also reflects ongoing concerns about vaccine hesitancy and the fairness of potentially giving Americans a third shot when much of the world lacks access to vaccines,” our colleagues Yasmeen Abutaleb, Tyler Pager, Laurie McGinley and Lena H. Sun report.

OUCH: Fauci called for more local vaccine mandates.

Anthony Fauci, the White House’s chief coronavirus medical adviser, advocated for more local vaccine mandates when asked by CNN’s Jake Tapper whether he supported vaccine requirements in businesses and schools.

“I have been of this opinion, and I remain of that opinion, that I do believe at the local level, Jake, there should be more mandates," Fauci said on CNN’s “State of the Union.” "There really should be. We're talking about life-and-death situation. We have lost 600,000 Americans already.”

The nation’s top infectious disease expressed concern about vaccine hesitancy and alluded to polling showing a large partisan divide in vaccine uptake.

“Why are we having red states and places in the South that are very highly ideological in one way not wanting to get vaccinations? Vaccinations have nothing to do with politics,” Fauci said.

Fauci said that he believed some of the hesitancy around the vaccines stems from the fact that they have not been fully authorized by the FDA, and are instead only authorized for emergency use. Speaking to ABC’s George Stephanopoulos on “This Week,” Fauci expressed confidence that the vaccines would receive full approval, calling it a “technical issue” and emphasizing that there is already enough data to show the vaccines are extremely safe and effective.

More in coronavirus news

A new study highlights the importance of receiving both vaccine shots.

A report published in the journal Nature finds that a single shot of a two-dose vaccine offers “barely” any protection against the delta variant of the coronavirus, although people fully vaccinated with the AstraZeneca or Pfizer vaccine should retain significant protection. That finding echoes a report published Wednesday in the New England Journal of Medicine.

Scientists assume that the findings from Pfizer would apply to the similar Moderna vaccine. Earlier clinical trial data suggests that the one-shot Johnson & Johnson vaccine offers similar protection to the other vaccines against severe disease but is less effective at preventing mild to moderate cases.

“The bottom line is that, in a time when the delta variant is rapidly gaining traction — it now accounts for a majority of new infections in the United States, according to the latest estimate from the Centers for Disease Control and Prevention — full vaccination offers a much better firewall against infection than partial vaccination,” The Post’s Joel Achenbach reports.

Studies from the U.K. underscore the low risk kids face of death or severe illness from covid.

One study found that some 99.995% of the 469,982 children in England who were infected with the coronavirus survived, the Wall Street Journal’s Denise Roland reports. The study also found that of 61 deaths in children linked to a positive covid-19 tests, only 25 were caused by the illness.

The studies, which reviewed medical records from the country’s national health system, provide some of the most comprehensive data to date on the impact of coronavirus in children. They confirm previous findings that children are at low risk for severe illness or death from the virus. The studies were published on preprint servers and have yet to be peer reviewed.  

The ongoing Alzheimer's drug controversy

The head of the FDA has urged a probe into the agency's dealings with the maker of a controversial Alzheimer's drug.

FDA acting commissioner Janet Woodcock has asked for a federal investigation to determine whether the agency's interactions with the drugmaker Biogen “were inconsistent with FDA policies and procedures.”

The request is the latest twist in an ongoing controversy over the agency's decision to approve a new Alzheimer's drug, known as Aduhelm, which is manufactured by Biogen, The Post's Laurie McGinley writes. Some critics claim that there was not enough evidence of clinical benefit to support the approval of the drug. The medical news site Stat reported last month that a top FDA official and a Biogen executive held an informal meeting that raised concerns among some experts.

Earlier last week, the FDA narrowed the use of Aduhelm, limiting it to patients with early-stage Alzheimer’s — the population that participated in clinical trials of the drug. The original label included all patients with Alzheimer’s. The label change means that the drug might be offered to 1 or 2 million patients, rather than the 6 million people with Alzheimer’s in the U.S.

Sugar rush