In part 1 of this series, “The Year of Healthcare Consumerism”, we defined the current state of healthcare price transparency, a critical piece of the healthcare consumer journey. We reviewed the current regulations requirements, enforcement and oversight, and gaps and opportunities within the market.
In part 2 of this series, we’ll be reviewing the very exciting momentum gained in the past week towards ensuring transparent healthcare prices for patients.
It’s been almost a month since we published the first post in this series, and now there’s big news to share: On February 25, 2025, President Trump signed an executive order called “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information.” This new order builds on earlier price transparency efforts from his first term (particularly Executive Order 13877 from June 24, 2019, titled “Improving Price and Quality Transparency in American Healthcare to Put Patients First”). In other words, the Administration is picking up where it left off—this time, with the promise of faster, stricter enforcement.
Major Takeaways from the New Executive Order
- Rapid Enforcement of Transparency Regulations
The Departments of Treasury, Labor, and Health and Human Services are charged with rapidly implementing and rigorously enforcing existing rules that require hospitals and health plans to make prices public. Get ready for more action, less talk. And hopefully that action means savings back to the patient. - Requirement for Actual Prices (Not Estimates)
Hospitals and insurers must post actual prices—not vague estimates or broad price ranges. That means patients will finally see what they’re actually going to pay. Just like every other consumer-facing market. - Standardized Pricing Information
Ever tried comparing prices from different hospitals for the same exact procedure only to be overwhelmed by fine print and apples-to-oranges comparisons? The new order demands user-friendly, consistent formats so we can finally compare healthcare costs like we compare everything else. Just as TALON has been doing for the past 10 years - Stronger Enforcement Measures
The Administration is looking to crack down on healthcare organizations that ignore these rules. Stricter penalties and oversight mean noncompliance just got riskier for hospitals and insurers. Next on the list, pharmacy benefit managers. - Expansion to Prescription Drug Transparency
Prescription drugs often come with confusing pricing structures and unexpected costs. This order targets that issue head-on by demanding that health plans publicly post the actual prices they pay for drugs, effectively shining a light on an area long kept in the dark and long burdening healthcare consumers. - Potential Billions in Savings
An economic analysis from 2023 (cited by the Administration) projects that these price transparency rules could save up to $80 billion in healthcare costs by 2025—for consumers, employers, and insurers alike. TALON views the $80 billion not as the savings goal, but instead, the baselines target to exceed.
Why This Matters More Than Ever
The new order specifically calls out the lack of progress in enforcing price transparency since Trump’s first term. It highlights how hospitals and insurers haven’t faced much accountability for failing to post or fully disclose pricing details—especially given price transparency is one of the few, if not the only, bipartisan issues.
What’s happening on the hospital front?
So far, 18 hospitals have faced enforcement actions from the Centers for Medicare & Medicaid Services (CMS) for not following the Hospital Price Transparency Rule. According to PatientRightsAdvocate.org, a nonprofit dedicated to healthcare price transparency, only 21.1% of 2,000 hospitals reviewed are fully compliant.
What about insurers?
It’s a bit of a Wild West situation. Compliance with the Transparency in Coverage Rule (which applies to health insurers) hasn’t drawn as much scrutiny. The rule requires insurers to produce both massive, machine-readable files for public pricing data and a consumer-friendly, web-based tool for shopping and cost comparisons. If that wasn’t enough of a deterrent, the fines for noncompliance can reach up to $100 per affected member per day—which is huge.
Here are some of the key requirements for insurers’ web-based cost-comparison tools:
- Accurate pricing that is derived from the payer’s machine readable files which include actual in-network rates, out-of-network allowed amounts, and a member’s individual cost-sharing details (think deductibles and out-of-pocket limits).
- Clear breakdowns for bundled payment arrangements (where several services are grouped together).
- Notices of any prerequisites to coverage.
- Disclosure of network status, preventive care details, and more.
Looking Ahead
TALON is crossing our wings that Part 5 of this series will bring even more breakthroughs for price transparency. The new executive order certainly raises expectations. Here’s what it says government agencies need to do—fast (within 90 days!):
- Require real (not estimated) prices for items and services.
- Standardize pricing information so it’s easily comparable across hospitals and health plans.
- Update enforcement policies to ensure complete, accurate, and meaningful data actually gets posted.
TALON has been leading the frontline of this healthcare revolution, where patients finally know the real cost of their care before they set foot in a hospital. Stay tuned for the next installment in our series—we’re watching closely to see if these promises become reality.