President Trump, flanked by Health and Human Services Secretary Robert F. Kennedy Jr. (left) and Commerce Secretary Howard Lutnick (right), signs an executive order on Feb. 25, addressing requirements related to price transparency in the health care sector.
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Alex Wong/Getty Images
The pursuit of price transparency in healthcare is akin to finding a holy grail: the goal is to compel the industry to disclose the prices negotiated between health insurers and hospitals—an aspect historically treated as confidential. Among the myriad of executive orders President Trump enacted during his first five weeks back in office, a key promise was to “Make America Healthy Again” by providing patients with accurate health care pricing.
The objective is to compel hospitals and health insurance companies to facilitate easier comparisons of actual prices for medical procedures and prescription drugs for consumers. Trump tasked his administration with devising a standardized approach and a compliance mechanism by the end of May.
However, Trump’s order from 2025 also illustrates the minimal progress made since he issued a similar directive almost six years ago. Consumers often find the information partially useful, and its quality is inconsistent.
An “ambitious” initial step that fell short
The 2019 order was considered “pretty ambitious,” remarked Gary Claxton, a senior vice president at KFF, a non-profit organization focused on health information, including KFF Health News. “They took a strong stance against providers and plans, stating that the previously confidential data should no longer remain confidential.”
The aftermath was disappointing for consumer advocacy groups. Hospitals and insurers published extensive, complex, and often perplexing data regarding their prices on websites. Navigating this information proved challenging even for experts in health care pricing, let alone for consumers. Some congressional members even proposed legislation to legally enforce price transparency requirements, but those bills failed. Moreover, President Biden’s administration faced criticism for not enforcing the regulations more strictly; one advocacy group even aired a Super Bowl ad featuring rapper Fat Joe claiming that “hospitals and insurers conceal their prices.”
Trump’s new order, signed in February, stated that hospitals and health plans “were not held sufficiently accountable when their price transparency data was either incomplete or not posted at all.”
In an October report, the Government Accountability Office revealed that the Centers for Medicare & Medicaid Services was uncertain whether the prices reported by the healthcare industry were accurate or comprehensive. Nevertheless, CMS plans to “systematically monitor compliance” and assist institutions in understanding the requirements, according to a spokesperson, Catherine Howden.
Howden did not address inquiries regarding whether CMS staff overseeing price transparency compliance had been dismissed as part of Trump’s expansive initiative to reduce the federal workforce.
“Ghost” rates and other discrepancies
Meanwhile, independent researchers have identified several issues concerning the quality of the price data that hospitals and health insurers share with consumers.
A recent analysis by the Peterson-KFF Health System Tracker discovered that data provided by four health insurers in New York City often included prices for services that the health providers either do not provide or cannot provide. These erroneous figures are referred to as “ghost” or “zombie” rates. For instance, health plans reported payments to dentists, optometrists, and audiologists for procedures unrelated to their specialties, such as knee replacements and gastrointestinal examinations.
Additionally, the data sometimes reflected varying prices for the same service from the same insurer at the same hospital. For example, UnitedHealthcare disclosed it paid New York-Presbyterian/Weill Cornell Medical Center three distinct rates of $47,000, $64,000, and $70,000 for heart attack treatment.
There were also instances where insurers reported identical pricing for vastly different services. Aetna, for example, stated it paid exactly $6,292 to Mount Sinai Beth Israel hospital for treatments ranging from respiratory infections to heart attacks, several types of cancer, urinary tract infections, and psychosis.
Neither UnitedHealthcare nor Aetna provided clarifications regarding the discrepancies in the data. Cole Manbeck, a representative for UnitedHealthcare, asserted that the insurer complies with price transparency requirements and encouraged members “to utilize our cost-estimator tools for precise costs based on their specific health plan.” A spokesperson for Aetna, Shelly Bendit, referred inquiries to AHIP, a trade association for insurers.
Health insurers have shown “strong support” for price transparency, commented Chris Bond, a spokesperson for AHIP. The organization aims to collaborate with the Trump administration to ensure that transparency is “meaningful for the end user while concurrently fostering a competitive private market,” Bond stated.
What can consumers do?
Estimates and total prices often fall short of consumer needs, as they are primarily concerned with what their ultimate out-of-pocket costs will be, said David Cutler, an applied economics professor at Harvard University. This can fluctuate based on health plans due to deductibles, copayments, and other fees.
“Most of the price transparency data does not provide that information,” he explained.
Additionally, it fails to inform consumers about the quality of care, Cutler noted, leading to biases. “It’s comparable to selecting wine at a restaurant,” he elaborated. “People often presume that the pricier wine is better.”
Cutler expressed doubt that price transparency will reduce patient costs. However, he suggested it may offer insights to hospitals and health plans regarding competitors’ pricing, which could inadvertently result in price hikes for those hospitals that currently receive lower reimbursement rates demanding higher payments from insurers.
Trump’s latest executive order asserts that the highest quarter of pricing for health services has seen a decline of 6.3% annually since his 2019 order.
Conversely, the same study cited in the executive order indicated that costs for the lowest quarter of services have increased at a rate of roughly 3.4% annually, according to an analysis by Turquoise Health, a firm specializing in healthcare price data that examined rates at over 200 hospitals across the 10 largest markets in the U.S.
Some patients report that, with adequate research and tenacity, they have been able to utilize price transparency to their benefit.
Theresa Schmotzer, 50, from Goodyear, Ariz., shared that she leveraged hospital price information to save nearly $3,000 on outpatient surgery to remove a fibroid last year.
Schmotzer, who is insured, recounted that the hospital initially quoted her $3,700 for the procedure and requested upfront payment. However, she remained wary.
Her health insurer was unable to provide a quote or detail how much she would be responsible for. On the day of surgery, Schmotzer found a spreadsheet online at PatientRightsAdvocate.org listing various prices paid by insurers, including hers. According to her research, the procedure’s estimated cost was closer to $700.
Schmotzer brought a printed version of the spreadsheet to the hospital during her pre-admission appointment. She paid her $300 deductible and instructed the hospital to bill her for the remaining amount.
Months later, she received a bill for $400, which she promptly paid.
She emphasized that when individuals prepare for surgery without a clear idea of the costs involved, it generates anxiety. “Because they’re entering the process blind.”
Future actions
Hospitals express a desire to collaborate with federal regulators to meet reporting requirements, stated Ariel Levin, coverage policy director for the American Hospital Association, which represents around 5,000 institutions. Levin emphasized that consumers should be provided with service prices and “a more thorough estimate” that reflects the total episode of care and their out-of-pocket expenses, tailored to their health plan.
Following Trump’s 2019 order, CMS has developed regulations intended to simplify the pricing information submitted by hospitals and health plans, and has imposed penalties on over a dozen hospitals for non-compliance.
Federal regulations permit hospitals to disclose estimates, price ranges, or historical rates for their offerings, while health plans retain the ability to modify prices based on case severity, treatment duration, and patient age.
Claxton from KFF remarked that the available flexibility hinders “apples-to-apples comparisons” and emphasized that the data must be trustworthy for researchers to effectively analyze healthcare costs. “Currently, it does not seem to meet that standard,” he concluded.
Significant work remains before price transparency fulfills expectations of fostering competition and reducing costs, stated Katie Martin, CEO of the Health Care Cost Institute, a non-profit research organization.
Martin noted that price transparency by itself is not a panacea. It represents “an important initial step” for stakeholders such as employers, lawmakers, and regulators to better comprehend the financial mechanisms within the healthcare system and identify pathways to enhance efficiency, she affirmed. “However, it is not the entire solution.”
KFF Health News is a national newsroom producing in-depth journalism about health issues and is a core program at KFF, the independent source for health policy research, polling, and journalism.
