After re-entering the Oval Office, President Trump promptly instructed his administration to expedite enforcement of Executive Order 13877, the healthcare price transparency reform he passed near the end of his first term in 2019. Numerous analyses of hospitals around the country since then have found patients still suffering from confusion regarding costs, often having little idea what the final bill will include when they receive services.
These moves are taking place at the federal level, but some states are trying to hasten compliance within their borders, add their own rules, or streamline the process. Several states, including the following, have proposed legislation to watch in 2025.
Washington
Washington’s SB 5498 recently cleared the Senate and now awaits a House vote. It compels the state’s hospitals to finally satisfy the federal mandate to post clear prices online in both “machine-readable” and “consumer-friendly” forms. Hospitals must also submit these figures to the Washington health department by July 1, 2027 and give annual updates.
Despite the original federal mandate going into effect in 2021, the bill’s sponsor, Sen. Marcus Riccelli, says price clarity efforts in the state have not been pushed as “aggressively” as in some other areas. The final bill still lacks several provisions, including a potential $10,000 fine per violation, that the original contained. Supporters of the stricter first version expressed concern that the watered-down final wording without a penalty clause will not be sufficient, and Riccelli says he debated even moving the bill forward, but he believes the current iteration will provide some benefits.
Michigan
The Hospital Price Transparency Act, Michigan’s SB 95, passed the Senate with a 35-1 vote and now heads to the House. Although it died in committee in the House after passing in the Senate last year, the law now has another chance.
This bill gives teeth to existing legislation by preventing hospitals from collecting patient payments if they neglect to comply with the bill. Current laws have failed to garner their desired results, largely due to a lack of penalties, but preventing violators from getting paid will presumably provide some new motivation.
North Carolina
In North Carolina, HB 434 addresses some uncertainty arising from prior authorization stipulations. These requirements, enacted by insurance companies, require providers to send notice of certain non-emergency procedures, visits, or prescriptions. Without this prior approval, patients have no expectation of coverage (although authorization alone does not even guarantee payment).
On average, a physician’s office fills out 40 such forms per week. Not only is this time-consuming, but providers must also wait for a response after they complete their side of the work. HB 434 mandates that insurance companies publicize their lists of treatments requiring prior authorization, respond by a set deadline, and maintain a review board with medical practitioners providing oversight for approvals and denials. These directives will allow patients and practitioners to review likely costs more easily and quickly.
Although the resurgence of federal oversight will almost certainly push individual states to place more emphasis on medical pricing transparency, they have considerable discretion and control in managing the rollout of the laws. The three states discussed took vastly different approaches and focused on issues they deemed important where they lived, which will likely be the case across the country.