On November 15, 2019, the Trump Administration released a proposed rule that would require health plans to disclose cost-sharing estimates to enrollees and to publicly release negotiated rates for in-network providers and historical allowed amounts for out-of-network providers. The proposed rule was designed to increase transparency among health plans and to equip consumers with more information about the costs of health care services. Aimed Alliance supports the proposed rule because it increases transparency in the U.S. health care system and could lower overall health care costs. Stakeholder comments on the proposed rule closed on January 29, 2020, and insurer groups uniformly attacked the rule for being too burdensome to implement.
In opposing the rule, the Blue Cross Blue Shield Association (BCBSA) cited an economic analysis that found the total setup and maintenance costs to comply with the proposed rule were $13.63 million, which is 26 times higher than the Administration’s estimate of $510,000. BCBSA also called attention to the large amount of data that health plans would be required to disclose, which they argue would not be very helpful to consumers due to the sheer volume of the data.
Both insurers and employers requested that the Administration delay the implementation of the final rule by one year or more, which would give health plans enough time to properly test all of the tools and processes required to comply with the rule.
Conversely, the American Hospital Association (AHA) supported the Administration’s efforts to improve consumer access to cost-sharing information but disagreed with the proposed requirement for health plans to disclose their negotiated rates. AHA argued that the Administration cannot implement the proposed requirement for health plans to disclose their negotiated rates because the First Amendment of the Constitution prohibits the government from compelling public disclosure of pricing information. This is identical to the AHA’s legal argument in The American Hospital Association, et al. v. Azar, which is a lawsuit challenging the Administration’s recently finalized rule that would require hospitals to publish the rates they negotiate with private insurers. While that case has not yet been decided, its outcome will be influential on the legality of the insurer price transparency rule.
Last Updated on May 18, 2020 by Aimed Alliance
