As the House of Representatives prepares for its January 22 hearings on healthcare affordability, in the House Committee on Energy and Commerce and the House Committee on Ways and Means, lawmakers have a real opportunity to address concerns surrounding the rise in healthcare costs.
While half of Americans receive health coverage through employers or private plans, AFFORDABILITY discussions in Washington often default to narrow debates about subsidies, government price controls, or ACA marketplaces. But that framing misses a larger problem of high and unpredictable hospital prices that remain hidden until the bill arrives.
If Congress is serious about lowering healthcare costs for all Americans (and not just those in government-run programs), then HOSPITAL PRICE TRANSPARENCY should be a central focus of these hearings.
Insured Patients Are Still Flying Blind
Commercial insurance does not shield patients from high costs.
Both deductibles and coinsurance costs have risen sharply, exposing insured families to thousands of dollars in out-of-pocket expenses every year. When patients ask what a procedure will cost or try to compare prices across different hospitals, they can still hit a wall.
Hospitals routinely fail to provide clear, upfront pricing, even for common or shoppable services like imaging, outpatient procedures, or routine surgeries. Instead, patients are asked to CONSENT to care without knowing if they agreed to a $1,500 bill or a $15,000 one.
This is not a failure of just insurance design alone, but also a FAILURE OF TRANSPARENCY in hospital markets.
Transparency Drives Competition
Federal hospital price transparency rules were intended to fix this problem by requiring hospitals to disclose negotiated rates with insurers. In theory, this empowers patients, employers, and health plans to compare prices, REWARD efficient providers, and push down costs through competition.
But in practice, enforcement has been weak and compliance remains questionable. Many hospitals continue to bury pricing files in inaccessible formats, post incomplete data, or ignore the rules entirely. As a result, commercially insured patients remain stuck in opaque markets where PRICE COMPETITION barely exists. The lack of transparency ultimately benefits the hospitals, not the patients.
The Nonprofit Disconnect
One of the most concerning aspects of this issue is that nonprofit hospitals are among the WORST OFFENDERS. These institutions enjoy a tax-exempt status, preferential regulatory treatment, and access to public funding, all justified by their supposed commitment to community benefit. Yet many nonprofit systems operate like protected monopolies by expanding administrative overhead, consolidating regional markets, and resisting transparency.
For families with commercial insurance, that lack of accountability translates directly into higher premiums and surprise medical bills with no means of recourse.
A Consumer-First Path Forward
As lawmakers examine healthcare affordability next week, they should resist calls for heavy-handed price controls or one-size-fits-all mandates that risk reducing access or innovation. Instead, Congress should focus on making markets work for patients by strengthening and actually enforcing transparency rules.
Some meaningful actions could include:
- Standardizing price disclosures in formats that patients and employers can actually understand and use, not dense spreadsheets that are designed to obscure information.
- Removing regulatory barriers that protect hospital monopolies, including Certificate-of-Need laws that limit competition.
- Empowering employers and consumers to shop for care and reward efficient and high-value providers.
Transparency is not a silver bullet, but it is a prerequisite for affordability. Without clear prices, competition cannot function, and patients cannot make informed decisions.
The upcoming House hearings should reflect the reality facing most Americans that healthcare affordability is a commercial insurance problem as well. Addressing this issue requires more than expanding government programs; we need to fix the broken pricing dynamics that inflate costs across the entire system. Hospital price transparency is a commonsense, market-oriented reform that promotes consumer choice, competition, and accountability. If Congress wants to deliver real relief to insured families, ensuring transparency is a prudent place to start.
