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Week 4 Assignment: Legislation Grid and Testimony/Advocacy Statement Walden University NURS-605N- Ruth E. Politi, PhD, MSN, RN, CNE March 24, 2024

Legislation Grid Template

Health-related

Bill Name Health Care Prices Revealed and Information to

Consumers Explained Transparency Act

Bill Number S.

Description A bill to amend the Public Health Service Act to provide for hospital and insurer price transparency. Federal or State? Federal Legislative Intent The Health Care PRICE Transparency Act would require public disclosure of all negotiated rates and cash prices. It also would mandate the reporting of actual prices for 300 shoppable services. Proponents/ Opponents Proponents: Sen. Sanders, Bernard [I-VT] Sen. Smith, Tina [D-MN Sen. Hickenlooper, John W. [D-CO] Sen. Grassley, Chuck [R-IA] Sen. Coons, Christopher A. [D-DE] Sen. Hassan, Margaret Wood [D-NH] Sen. Ernst, Joni [R-IA] Sen. Baldwin, Tammy [D-WI] Opponents: Target Population General Population with healthcare needs Status of the bill (Is it in hearings or committees?) This bill has be referred to the committee of Senate Health, Education, Labor, and Pensions on 12/14/2023. General Notes/Comments S.3548 - 118th Congress (2023-2024): Health Care Prices Revealed and Information to Consumers Explained Transparency Act. (2023, December 14). https://www.congress.gov/bill/118th-congress/senate-bill/3548/all-info

Legislation Grid

Template

healthcare costs relative to income can lead to delayed or forgone care, impacting health outcomes negatively (Han et al., 2022). Different age groups have varying healthcare needs. Elderly individuals, for instance, may require more frequent medical visits and prescription medications, leading to higher healthcare expenses. Younger individuals, especially those without comprehensive insurance coverage, may prioritize affordability over transparency when seeking healthcare services (Pollack 2022). Education level correlates with health literacy, affecting individuals' ability to understand and utilize price transparency information effectively. Higher education levels may empower individuals to make more informed healthcare decisions and navigate complex healthcare systems, potentially mitigating the impact of high healthcare costs (Christensen et al., 2020). Gender disparities in income and employment may influence individuals' ability to afford healthcare services, with women often facing lower wages and higher out-of-pocket healthcare costs. Additionally, gender-specific healthcare needs, such as reproductive health services, may disproportionately affect women's healthcare expenses (Christensen et al., 2020). How these social determinants interact with the Health Care Prices Revealed and Information to Consumers Explained Transparency Act depends on various factors, including individuals' socioeconomic status, access to healthcare coverage, and health literacy (Pollack 2022). While transparency in healthcare pricing can empower consumers to make more informed decisions, addressing underlying socioeconomic disparities is crucial to ensure equitable access to affordable healthcare for all individuals, regardless of income, age, education, or gender. I would address my opponent to my position by explaining all the good this bill will provide to the American people. Americans will better understand the upfront cost of health care

services while having the opportunity to compare prices and get the best transaction (Barlas, 2018). Specifically, the bill will impose data sharing standards. Require machine-readable files of all negotiated rates and cash prices between plans and providers, not estimates. Expand price transparency requirements to clinical diagnostic labs, imaging centers, and ambulatory surgical centers. Require pricing data standards including all billing codes for services. Require actual prices for 300 shoppable services with all services by 2025 (Senator John Hickenlooper. (n.d.). Plus, the legislation would require uniform pricing data standards and attestation by executives that all estimates are “accurate and complete. This bill will even require attestation by executives that all prices are accurate and complete. It will also increase maximum annual penalties to $10,000,000 (includes specific minimum and maximum penalties according to number of hospital beds in the facility). Provide group health plans with the right to access, audit, and review claims encounter data (congress.gov). Conclusion When Americans go to the hospital, they often do not know the cost of services beforehand. Patients must rely on their insurance to pay as much as possible and negotiate rates with providers, and they cannot shop around for a better deal (Senator John Hickenlooper. (n.d.). Additionally, there needs to be more transparency in agreements between insurance companies and providers. Many examples exist of employer-sponsored insurance plans reviewing employee claims data and discovering significant payment disparities and wasteful practices (Pollack 2022). Hospitals and imaging locations should disclose what a stay or medical care will cost. Patients should be able to know and compare prices with other nearby facilities. This bill also provides quality metrics that provide information on the healthcare services offered by different providers, such as patient outcomes, complication rates, infection rates, and patient satisfaction

References Barlas S. (2018). Health Care Price Transparency Initiatives Are All the Rage: But Burgeoning Efforts Suffer from Myriad Shortcomings. P & T : a peer-reviewed journal for formulary management , 43 (12), 744–768. Christensen, H. B., Floyd, E., & Maffett, M. G. (2020). The only prescription is transparency: the effect of Charge-Price-Transparency regulation on healthcare prices. Management Science , 66 (7), 2861–2882. https://doi.org/10.1287/mnsc.2019. Han, A. L., Lee, K., & Park, J. (2022). The impact of price transparency and competition on hospital costs: a research on all-payer claims databases. BMC Health Services Research , 22 (1). https://doi.org/10.1186/s12913-022-08711-x Hickenlooper, Braun, Sanders, Grassley, Smith introduce landmark bill to make health care costs transparent | Senator John Hickenlooper. (n.d.). https://www.hickenlooper.senate.gov/press_releases/hickenlooper-braun-sanders- grassley-smith-introduce-landmark-bill-to-make-health-care-costs-transparent/ Pollack H. A. (2022). Necessity for and Limitations of Price Transparency in American Health Care. AMA journal of ethics, 24(11), E1069–E1074. https://doi.org/10.1001/amajethics.2022. S.3548 - 118th Congress (2023-2024): Health Care Prices Revealed and Information to Consumers Explained Transparency Act. (2023, December 14). https://www.congress.gov/bill/118th- congress/senate-bill/3548/all-info