{"id":7239,"date":"2023-05-15T10:54:57","date_gmt":"2023-05-15T14:54:57","guid":{"rendered":"https:\/\/chirblog.org\/?p=7239"},"modified":"2023-05-15T12:41:21","modified_gmt":"2023-05-15T16:41:21","slug":"the-health-plan-price-transparency-data-files-are-a-mess-states-can-help-make-them-better","status":"publish","type":"post","link":"https:\/\/chirblog.org\/the-health-plan-price-transparency-data-files-are-a-mess-states-can-help-make-them-better\/","title":{"rendered":"The Health Plan Price Transparency Data Files Are a Mess – States Can Help Make Them Better"},"content":{"rendered":"\n

Spring heralds the start of rate review season: that time of year when state departments of insurance assess health insurers\u2019 proposed rates for the next year and determine whether their plans comply with federal and state laws. Many state insurance departments now have a new responsibility as part of that process: determining whether state-regulated health insurers are complying with federal\u00a0Transparency in Coverage<\/a>\u00a0(TiC) requirements.<\/p>\n\n\n\n

Although these are federal rules, state departments of insurance have the primary enforcement role with respect to state-regulated insurers. Insurance regulators can do more than just confirm that insurers are posting these data\u2014they can also help ensure that the data files, currently\u00a0difficult to access and use<\/a>, fulfill their potential to help constrain health care cost growth and improve affordability for state residents.*<\/p>\n\n\n\n

Why Price Transparency? A Tool To Help Identify System Costs And Target Solutions<\/h2>\n\n\n\n

Health insurance has become increasingly unaffordable for employers and workers alike. Employees\u2019 contributions to premiums have increased<\/a> by 300 percent since 1999, and the average deductible has grown from $303 in 2006 to $1,562 in 2022. The enhanced federal subsidies that protect most individual Marketplace consumers from high premiums are slated to expire by 2026, and many consumers face significant deductibles<\/a>. The growth in health insurance premiums and cost sharing is largely driven by growth in the underlying cost of health care services\u2014particularly the prices<\/a> that hospitals, physicians, and drug companies charge to commercial insurers.<\/p>\n\n\n\n

A range of policies<\/a> could reduce the prices that insurers pay for health care goods and services, from direct government regulation, to market-based approaches that require greater transparency of the prices negotiated between providers and commercial payers. While price transparency, by itself, is unlikely<\/a> to move the needle much on health care costs, better price data can help policy makers, employers, insurance regulators, and researchers identify the drivers of higher costs and target solutions. For example, on average private insurers pay hospital prices that are 224 percent<\/a> to 240 percent<\/a> of Medicare prices for the same services, but prices vary widely across the country, with insurers in some states paying more than 300 percent of Medicare prices for hospital services.<\/p>\n\n\n\n

The promise of price transparency prompted the federal government to require<\/a> insurance companies to publicly post the prices they pay for all health care services. These new requirements, along with other data sources, have the potential to be powerful resources that support state-level efforts to improve insurance affordability. But this potential may be largely unrealized without a state-federal partnership to improve data access and quality.<\/p>\n\n\n\n

Greater Price Transparency Can Inform State-Level Strategies To Improve Affordability<\/h2>\n\n\n\n

Multiple states have embarked on efforts to constrain health care cost growth and improve the affordability of coverage for local employers and residents. Many of these efforts could benefit from access to more robust, real-time, and provider-specific information about the prices that insurers are paying. For example, price data could be used to support:<\/p>\n\n\n\n