For markets to function efficiently, consumers need to know how much things cost.
This is as true for eggs and milk as it is for medical care.
And it was this very insight that motivated the rule that President Donald J. Trump implemented during his first term in 2019 ordering hospitals to be transparent about their prices.
Trump 1.0's goal was to empower patients to shop around for care, thereby spurring competition throughout the hospital sector that would lower costs and improve outcomes.
Unfortunately, that hasn't exactly come to pass — in part because large numbers of hospitals have simply ignored the rules.
Thankfully, the president hasn't given up the fight.
In a new executive order signed in February, President Trump instructed his administration to "take all necessary and appropriate action to rapidly implement and enforce" his old price transparency rule by May 26, 2025.
If the administration succeeds in that aim, it could usher in a new era of dynamism and affordability in the healthcare market.
President Trump's 2019 rule required hospitals to post the prices for 300 common healthcare services and procedures — from tonsillectomies to MRI scans and laboratory tests — by the beginning of 2021.
A 2020 rule required health plans to post their negotiated rates with providers, their out-of-network rates, and the actual prices they pay for prescription drugs by the beginning of 2022.
When pricing information is widely available in a consumer-friendly format, patients can shop around for the best-value care.
This, in turn, forces hospitals to compete for patients' business -- just as actors in other sectors of the economy do.
Unfortunately, six years on, hospitals still aren't complying with President Trump's price transparency rules.
Hospitals responded to the rules in 2019 by suing to block their implementation. When that didn't work, most simply dragged their feet on following them.
The penalties for noncompliance were thin — $300 per day for small hospitals and up to $5,500 per day for larger ones.
Many hospitals surely calculated that remaining opaque about their prices was worth the potential fine.
Of the more than 5,000 hospitals examined in a 2022 study in the journal JAMA, just 5.7% were in full compliance.
The situation has improved modestly since then, but not nearly enough, according to a 2024 study from the nonprofit PatientRightsAdvocate.org. That report found that just 21.1% of hospitals surveyed were fully compliant as of last November.
Sadly, this kind of recalcitrance on the part of hospitals only got easier under the previous president. Guidance issued by the Biden administration in 2023 — which purported to strengthen the price transparency rules — allowed hospitals to avoid releasing straightforward dollars-and-cents prices and instead post percentages and algorithms.
That's obviously less useful to patients shopping for care.
Of the 2,000 hospitals examined by PatientRightsAdvocate.org last year, just 6.7% were both fully compliant with the transparency rule and posted prices in dollars and cents.
Trump 2.0 should not let them get away with it.
His latest executive order instructs the Departments of the Treasury, Labor (DOL), and Health and Human Services (HHS) to increase enforcement and improve compliance with the transparency rules.
More than that, the order seeks to undo some of the damage inflicted by Biden's updated rule — specifically by directing the agencies to "require the disclosure of the actual prices of items and services, not estimates."
One executive order isn't likely to resolve this situation.
Sadly, that much became clear after Trump's initial rule took effect. But in revisiting this particular policy, the president has kept the fight alive.
Congress can also consider codifying price transparency rules into law.
Doing so would make it a whole lot harder — and more expensive — for hospitals to keep their prices secret from the American public.
Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is "The World's Medicine Chest: How America Achieved Pharmaceutical Supremacy — and How to Keep It" (Encounter 2025). Follow her on X @sallypipes. Read Sally Pipes' Reports — More Here.
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