President Donald Trump signed an Executive Order focused on increasing transparency around the cost and quality of health care. Included in the order is a five-part plan to help patients better understand the costs associated with their medical care – prior to receiving services – and expand flexibility for saving and paying for health expenses.
At the outset of the executive order, President Trump notes, “My administration seeks to enhance the ability of patients to choose the healthcare that is best for them. To make fully informed decisions about their healthcare, patients must know the price and quality of a good or service in advance….Opaque pricing structures may benefit powerful special interest groups, such as large hospital systems and insurance companies, but they generally leave patients and taxpayers worse off than would a more transparent system.” Five areas of focus in the executive order are: hospital price transparency; out-of-pocket cost transparency; health quality reporting; health care data; and health savings accounts.
Informing Patients About Prices
The first directive directs the Department of Health and Human Services (HHS) to require hospitals disclose information about their negotiated rate in a format that can be easily understood and used by patients. This information shall be in an “easy-to-understand, consumer-friendly, and machine-readable format” that will allow patients to compare prices across hospitals. The information will need to be updated “regularly” and the HHS Secretary shall also establish a monitoring mechanism to ensure compliance with the posting requirement. The executive order notes that within 60 days of the date of the order, the HHS Secretary shall propose a regulation to meet this end.
A second directive instructs HHS, the Department of Labor and the Treasury to work together to require insurance companies provide patients with information on the cost of services before they receive care. The three agencies shall issue an advance notice of proposed rulemaking within 90 days of the date of this order.
A third directive asks the Secretary of HHS to work with the Attorney General and the Federal Trade Commission to put together a report “describing the manners in which the Federal Government or the private sector are impeding healthcare price and quality transparency for patients,” and provide recommendations to eliminate those “impediments in a way that promotes competition.” This report shall be completed within 180 days of the order.
Health Quality Roadmap
This directive directs several government agencies to work in concert to develop a comprehensive roadmap for consolidating quality metrics across all federal health care programs. The roadmap shall align and improve reporting on data and quality measures across Medicare, Medicaid, the Children’s Health Insurance Program, the Health Insurance Marketplace, the Military Health System, and the Veterans Affairs Health System. The Roadmap shall be developed within 180 days of the date of the order.
Healthcare Data
This directive directs several government agencies to work together to expand access to deidentified health care claims data from taxpayer-funded healthcare programs and group health plans for researchers, innovators, providers, and entrepreneurs, to enable the development of tools and analytics that empower patients. This shall be done within 180 days of the date of the order.
Healthcare Resources
This directive instructs the Treasury to expand the availability and flexibility of health savings accounts with high-deductible health plans that cover low-cost preventive care before the deductible. This is to be done within 120 days of the order.
Another directive asks the Treasury to propose regulations to treat expenses related to certain types of arrangements, potentially including direct primary care arrangements and healthcare sharing ministries, as eligible medical expenses under section 213(d) of title 26 of the United States Code.
The third directive under this umbrella directs the Treasury to issue guidance to increase the amount of funds that can carry over without penalty at the end of the year for flexible spending accounts. The last two directives shall be done within 180 days of the date of this order.
While many of the policy actions outlined in the executive order must be completed within 180 days of President Trump signing the executive order, and some as soon as 60 days, it is likely that at least some of the directives under the order will be delayed, as hospital and insurer trade groups are expected to challenge the policies in court.
Health and Human Services Secretary Alex Azar expressed pride in the executive order, noting that it would be “one of the most significant steps in the long history of American health care reform.”