I recently attended a panel discussion about the future of healthcare reform and specifically the American Health Care Act that the Republicans unveiled (review coming up soon). When I asked the panelists about the importance of price transparency for the effective functioning of a free market, I was told that New York State passed a law requiring the top providers in the state to post prices for their procedures. This surprised me because I had never heard of this law, what great news!
A quick search of “New York price transparency law” reveals several unrelated articles about price transparency in general, a few links about a new pharmaceutical price transparency effort being pushed and then finally a link to New York Senate Bill S77 which seeks to “enact the transparency in health care fees act”. That sounds great so far, what does this thing do?
S 2999-L. HEALTH CARE BILLS. 1. FOR PURPOSES OF THIS TITL "HEALTH CARE PROVIDER" SHALL MEAN A PRACTITIONER IN AN INDIVIDUAL PRACTICE, GROUP PRACTICE, PARTNERSHIP, PROFESSIONAL CORPORATION OR OTHER AUTHOR- IZED FORM OF ASSOCIATION, A HOSPITAL OR OTHER HEALTH CARE INSTITUTION ISSUED AN OPERATING CERTIFICATE PURSUANT TO THIS CHAPTER OR THE MENTAL HYGIENE LAW, A CERTIFIED HOME HEALTH AGENCY OR A LICENSED HOME CARE SERVICES AGENCY, AND ANY OTHER PURVEYOR OF HEALTH OR HEALTH RELATED ITEMS OR SERVICES INCLUDING BUT NOT LIMITED TO A CLINICAL LABORATORY, A PHYSIOLOGICAL LABORATORY, A PHARMACY, A PURVEYOR OF X-RAY OR IMAGING SERVICES, A PURVEYOR OF PHYSICAL THERAPY SERVICES, A PURVEYOR OF HEALTH OR HEALTH RELATED SUPPLIES, APPLIANCES OR EQUIPMENT, OR AN AMBULANCE SERVICE. 2. PRIOR TO PERFORMING ANY HEALTH CARE SERVICES, ALL HEALTH CARE PROVIDERS SHALL ADVISE PATIENTS IN WRITING OF THE FEE TO BE CHARGED TO THE PATIENT FOR THE SERVICES TO BE RENDERED IN THE EVENT SUCH FEE IS NOT PAID FOR BY INSURANCE. S 3. This act shall take effect immediately.
Beautiful! This is exactly the bill that our healthcare system needs. When does this go live?
Oh…it hasn’t passed into law yet, it’s still a proposal. That must be why I never heard of this bill. But it’s in the health committee, so that’s good news, right? It’s a good cost control mechanism that also has the benefit of protecting consumers from surprise billing, surely it will pass, right?
LEGISLATIVE HISTORY : S.344 of 2015-2016 (Hoylman): Died in Health A.250 of 2015-2016 (Rozic): Died in Health S.7124 of 2014 (Hoylman): Died in Health A.3518 of 2013-2014 (Rozic): Died in Health
Of course it won’t pass. This is yet another incarnation of a bill that gets brought up every year (thank you state senators Hoylman and Rozic), gets sent to the health committee, and dies there. Well, I wonder why it keeps dying there? It’s most likely not so different from what happened to the price transparency law that was passed in Ohio:
The hubris of the healthcare lobby, as displayed by its actions after the law passed unanimously in June, 2015, is unfortunately telling. The lobbyists who are ostensibly representing Ohio providers failed to even inform their members that this legislation passed, leaving the vast majority in the dark and unprepared to comply with the law. This failure to inform provider members of legislation that would affect their practices is not surprising given the confidence of the lobby in its ability to reverse the will of the people. According to the healthcare lobby, it “had the votes” (meaning had enough “friends” in the legislature) to repeal the law.
So if we don’t get to have true price transparency, as I was misinformed by the panelist, what do we have instead? In 2015 New York State passed a bill establishing FAIR Health as a benchmark pricing tool to protect consumers. FAIR Health claims that law offered “comprehensive healthcare cost transparency”, which is a very loose definition of comprehensive, since it does no such thing. What FAIR Health does do is provide an award winning consumer website that tells me that in my area my estimated out of pocket cost for a hemodialysis procedure with one physician evaluation is $85.50…
… which means absolutely nothing! What theoretical provider matches this estimate? What theoretical plan matches this coverage setup? What if the provider is out of my network? Of course they don’t even provide a recommendation of a provider that most matches this estimate. And as a consumer that magical word “estimate” is really unsettling, because if I walk into the wrong facility, that cost could easily be much higher. So do I feel like I am protected from surprise fees? Am I able to shop around for a hemodialysis at the price best for me? Absolutely not, because we don’t have “comprehensive price transparency,” we have alternative price transparency.
And as long as we allow lobbies to hijack the legislative process to protect entrenched monopolies, that’s the price transparency we deserve.