Trump Health Transparency Order Sparks Hope of Enforcement Boost

Employers and consumer advocates are hoping President Donald Trump will tighten requirements of price transparency measures and boost enforcement against the health care industry following his executive order this week.

The rules, finalized under President Donald Trump’s first administration and tweaked under former President Joe Biden, require hospitals and health plans to post detailed pricing information online, with consumer-friendly elements to help patients shop for care. But lawsuits and regulatory rollbacks have stalled progress, and industry compliance may even be declining.

The executive order may also help jump-start efforts in Congress to codify the rules, after Trump and billionaire adviser Elon Musk in December tanked a bipartisan spending deal that included the language.

The hospital rule was finalized in 2019, while the insurance rule was finalized in 2020. The Biden administration later increased penalties and strengthened disclosure requirements in a 2023 rule, but also allowed hospitals to use estimates and algorithms in place of some specific prices.

But hospital compliance with the rules has been “fairly spotty, and, frankly not really enforced that well,” said Christopher Whaley, associate professor of health policy at Brown University.

Low Compliance

Just 21% of hospitals fully complied with the rules in 2024, according to Patient Rights Advocate. That’s down from a high of 36% in 2023.

“We do think there has to be more pointed and aggressive enforcement,” said Rob Andrews, CEO of the Health Transformation Alliance. “I have every reason to think the administration will do that. So we’re very happy to see this.”

But hospital and other provider groups caution against an increase in burdensome compliance requirements and call for better assessment of the pricing information.

In a statement, Ariel Levin, director of policy at the American Hospital Association, took issue with the poor compliance narrative about hospitals. “We have long pointed out the inaccuracies of certain reports that suggest low levels of compliance among hospitals and therefore welcome HHS further validating hospitals’ compliance,” he said.

Levin cautioned against “stripping patients of the option to review both the rates negotiated between their health plan and providers and a more comprehensive estimate that in many cases will more accurately reflect how services are bundled and the cost-sharing imposed by their health plan.”

Beth Feldpush, senior vice president of policy and advocacy at America’s Essential Hospitals, also said hospitals were doing a “pretty good” job of compliance. She said she hoped the order wouldn’t result in “new onerous” reporting requirements.

“Any increase in compliance and administrative activities that would either drastically expand the type of information that hospitals need to provide,” or add granularity, or “hours and hours of staff time that would, by default, take staff away from providing patient care, that would be a concern to us,” Feldpush said.

Chip Kahn, president and CEO of the Federation of American Hospitals, was also leery. “We support transparency, but the devil is in the details of how the executive order would impact the regulations,” Kahn in a statement.

Enforcement Efforts

The Centers for Medicare & Medicaid Services took action against nearly 1,300 hospitals between 2021 and 2023, according to the Government Accountability Office. Enforcement peaked sharply at 851 hospitals in 2023, when the Biden administration hired an outside contractor and implemented new software to better track compliance.

More than $4 million in civil monetary penalties were levied against 14 of the hospitals that didn’t correct the violations, the GAO found.

But the CMS still doesn’t have insight into the accuracy or completeness of the data that hospitals are posting, and critics say the agency needs to go after more big health systems, and faster.

Hospital pricing disclosures have never reached a sufficient threshold, although the insurance data has been better, said Ben Chartock, assistant economics professor at Bentley University.

“It never really reached the hospital price transparency level that was to me, as a researcher, strong enough for me to use that data,” he said.

Insurers, on the other hand, are frequently flooding the zone with too much information, like “ghost rates” that might be on file for a service that a particular doctor doesn’t perform. The result can effectively block patients, researchers, and tech developers from accessing the real contracted rates, said Cynthia Fisher, founder of Patient Rights Advocate.

“That could all be easily parsed if they didn’t scramble it with junk data,” she said.

Trump and Musk are currently taking a chainsaw to the federal workforce, however, raising concerns about how CMS could improve compliance.

“If the goal of DOGE is to make government more efficient and streamline processes, etc., the irony is you need people to do that,” said Shawn Gremminger, president and CEO of employer group National Alliance of Healthcare Purchaser Coalitions. “You need actual bodies to write regs and implement regs that may be deregulatory in the long run.”

But the government could be more efficient if it employed better tech tools, Fisher argued. Hospitals should submit data files to the CMS, and the CMS should deploy an algorithm to assess compliance.

“They don’t even need to outsource that,” Fisher said. “They could easily do that in-house.”