Talking Points: 18 November 2024

A quick roundup of the issues driving the healthcare reform conversation.

Week in Review

HOSPITAL TRANSPARENCY Hospitals still aren’t compliant with federal price transparency rules.

Quick takeaway: Just under half of hospitals fail to comply with rules requiring them to make their standard charges available to consumers.

Digging deeper: Since 2021, hospitals have been required to post negotiated rates for common medical services and procedures online in a push to make healthcare prices more transparent. 

But, according to a new report from the Department of Health and Human Services Office of Inspector General, about 46 percent remain noncompliant with the rules.

What it means: It’s still unclear how the rules affect market dynamics, since the data has yet to translate into lower patient costs. But, researchers point to signs of progress.

NONPROFIT HOSPITALS Physicians call for greater oversight of nonprofit hospitals.

Quick takeaway: Last week the American Medical Association (AMA) voted to hold nonprofit hospitals accountable for the level of charitable care they provide.

Digging deeper: Nonprofit hospitals enjoy broad tax exemptions in exchange for providing charity care and investing in their communities. However, tax codes and state laws allow these systems significant flexibility in how they measure the level of charity care they provide.

This inconsistency has resulted in 80 percent of hospitals giving back less to the communities they serve than they receive in tax breaks. In fact, these combined “fair share” deficits are estimated to be as high as $25.7 billion.

What it means: The AMA is now pushing for stronger government oversight of community benefit requirements for nonprofit hospitals, including penalties or the loss of tax-exempt status for noncompliance.

HEALTHCARE DOLLAR Hospital costs make up a disproportionate share of overall healthcare spending.

Quick takeaway: More than 40 cents of every healthcare dollar spent goes to hospitals.

Digging deeper: According to a newly updated analysis:

• 19.9 cents of every healthcare dollar goes to outpatient hospital costs (not including emergency care)
• 17.6 cents of every healthcare dollar goes to inpatient hospital costs
• 3.2 cents of every healthcare dollar goes to emergency room costs

In terms of overall provider spending:

• 11.6 cents of every healthcare dollar goes to doctor visits
• 7.1 cents of every healthcare dollar goes to other outpatient care, such as that delivered outside of hospitals or doctor offices

(Not to be discounted – prescription drugs account for nearly a quarter of total spending at 24.2 percent.)

What it means: When totaled up, nearly 60 cents of every healthcare dollar spent in the U.S. goes to providers.

CONSUMER CHOICE Open enrollment on the health insurance exchange Marketplace is underway.

Quick takeaway: Consumers have until 15 December to choose a health plan for themselves and their families for coverage to begin at the start of the New Year. (Anyone enrolling after that, but before 15 January, would have to wait till 1 February for the benefits to kick in.)

Digging deeper: Marketplace enrollment began at the start of November, giving Americans just over six weeks to select affordable, high-quality health coverage:

• More than 21 million Americans choose to enroll through the Marketplace
• Eight out of ten shoppers can select a plan for less than $10 a month after tax credits
• 97 percent of enrollees have more than seven plans to choose from

What it means: The Marketplace remains highly competitive, providing a record number of Americans access to stable, affordable, and good quality health coverage. That’s why it’s so important that lawmakers protect this option.

The Health Action Network includes everyday Americans—families, workers, businesses, patients, providers, neighbors, and friends. We are working together because we support market-based solutions that offer better healthcare choices and help build a stronger economy. The Health Action Network is an Elevance Health, Inc., initiative.