How much health insurers pay for almost everything is about to go public

[Greenbeard]

Twelve years on, new policies from the ACA continue to kick in. This week it’s price transparency requirements for insurers. These requirements go further than the recently-implemented requirements for hospitals to publicly disclose their negotiated prices (for which compliance continues to be spotty, with hospitals in uncompetitive markets more likely to comply: ”Competition Correlates with Hospital Price Transparency Compliance): insurers face steeper fines for noncompliance and have to disclose their negotiated prices for more than just hospitals.

How much health insurers pay for almost everything is about to go public

Consumers, employers and just about everyone else interested in health care prices will soon get an unprecedented look at what insurers pay for care, perhaps helping answer a question that has long dogged those who buy insurance: Are we getting the best deal we can?

The federally required data release could affect future prices or even how employers contract for health care. Many will see for the first time how well their insurers are doing compared with others.

"What we're learning from the hospital data is that insurers are really bad at negotiating," said Gerard Anderson, a professor in the department of health policy at the Johns Hopkins Bloomberg School of Public Health. . .

"For the first time, an employer will be able to go to an insurance company and say, 'You have not negotiated a good-enough deal, and we know that because we can see the same provider has negotiated a better deal with another company,'" said James Gelfand, president of the ERISA Industry Committee, a trade group of self-insured employers.

The focus in that article is on how seeing what a bad deal they’re getting may spur employers-as-purchasers to put pressure on insurers to negotiate more favorable deals and lower prices. But that will run smack dab into providers, freshly emerging from the COVID shock and dealing with economy-wide inflationary pressures, demanding more generous prices increases going forward.

As inflation grows, providers and insurers to face 'a terrible bloody renewal cycle'

According to Jeff Goldsmith, founder and president of Health Futures, these current contract negotiations between providers and insurers are likely the start of "a terrible bloody renewal cycle."

"There unquestionably will be more pressure from our health systems to drive higher rate increases from the commercial payers. We've already started to hear this," said Kevin Holloran, senior director for Fitch Ratings. "Commercial payers are also facing labor inflation pressures themselves, so getting them to increase rates materially is going to be a tough sell."

In addition, providers who renegotiated their contracts within the last two years will likely have to absorb more of the costs of inflation into their bottom lines before they are able to renegotiate their prices since contracts typically last three years.

All this as even red-state legislators are getting fed up enough with health care—particularly hospital—prices to threaten direct intervention if something doesn’t give (e.g., ”Indiana legislative leaders take aim at ‘out-of-control’ health care prices”).

The next few years will be interesting.

 

[aociswundumho]

"If you're going to get an X-ray, you will be able to see that you can do it for $250 at this hospital, $75 at the imaging center down the road, or your specialist can do it in office for $25," he said.

This is of course how every market works. Only in the highly regulated healthcare market do you need a law to force it to happen.

Twelve years on, new policies from the ACA continue to kick in. This week it’s price transparency requirements for insurers.

Not only the ACA:

The requirements stem from the Affordable Care Act and a 2019 executive order by then-President Donald Trump.

We can also thank Trump for this.

All this as even red-state legislators are getting fed up enough with health care—particularly hospital—prices to threaten direct intervention if something doesn’t give (e.g., ”Indiana legislative leaders take aim at ‘out-of-control’ health care prices”).

The next few years will be interesting.

Yeah, price controls. That's the next step in this idiotic clown show called "regulated capitalism", which is actually just socialism-lite.

 

[Greenbeard]

This is of course how every market works. Only in the highly regulated healthcare market do you need a law to force it to happen.

Thankfully we have such a law.

Not only the ACA:

Yes, only due to the ACA. That’s the law that gives
HHS the authority to require price disclosures. No ACA, no price transparency. If you want to thank Trump, thank him for utterly failing in his quest to dislodge the ACA.

 

[molten_dragon]

This is of course how every market works. Only in the highly regulated healthcare market do you need a law to force it to happen.



Not only the ACA:



We can also thank Trump for this.



Yeah, price controls. That's the next step in this idiotic clown show called "regulated capitalism", which is actually just socialism-lite.

The problem is that healthcare isn't a free market. It's not controlled solely by supply and demand. And then it's complicated further by the fact that you have a middle-man (i.e. the insurance company) involved in every transaction. Those two things are why regulation is needed for healthcare.

 

[Deuce]

This is of course how every market works. Only in the highly regulated healthcare market do you need a law to force it to happen.

How much does Samsung pay for each Galaxy phone circuitboard?

 

[bave]

How much does Samsung pay for each Galaxy phone circuitboard?

Not really an apt comparison. The consumer can absolutely measure a Samsung phone vs an Apple competitor, see the features and the costs. The consumer can't do that in healthcare.

It would be like asking what Hospital A pays for suture, it doesn't matter, you are interested in what the consumer packaged product costs (ie: surgery).

 

[CaughtInThe]

This is of course how every market works. Only in the highly regulated healthcare market do you need a law to force it to happen.

Yes, because deciding to buy a printer on Amazon versus HP's website is exactly like getting an x-ray at a hospital.

 

[aociswundumho]

Yes, because deciding to buy a printer on Amazon versus HP's website is exactly like getting an x-ray at a hospital.

A better example would be an MRI.

 

[CaughtInThe]

A better example would be an MRI.

i know when people are told that they have cancer or heart disease or their lungs aren't working the first thing they should do is start price shopping.

 

[aociswundumho]

i know when people are told that they have cancer or heart disease or their lungs aren't working the first thing they should do is start price shopping.

You are simply ignoring reality. Even on your deathbed, it's in your interest not to throw your money away, in order to benefit your heirs.

 

[CaughtInThe]

You are simply ignoring reality. Even on your deathbed, it's in your interest not to throw your money away, in order to benefit your heirs.

yes, price shopping when a person is told they have non-Hodgkin's lymphoma is all the rage.

 

[jaeger19]

A better example would be an MRI.

Well except if all people shopped for tge cheapest mri..they would find fewer services available at their local hospital. Since the mri..is one of the things that pay for say an icu bed.