For 17 years, Michelle Arroyo did everything she could to keep her son alive after he\u2019d been diagnosed with brain cancer at 6 years old. The single mom from California moved from Orange County to Los Angeles to be closer to the best doctors and medical facilities, quit her job in real estate to care for her son around-the-clock and liquidated all her financial assets, including her retirement account.<\/p>\n\n\n\n
But despite her best efforts, Arroyo\u2019s son, Grayson Arroyo-Smiley, died in 2023 at 22 years old, leaving Arroyo distraught and saddled with\u2002mounting medical bills<\/a> that soared, she said, into the millions. She was also left with a feeling that she\u2019d been swindled by health care companies into having to pay both physically and emotionally for wanting the best for her son.<\/p>\n\n\n\n \u201cThe process is just so overwhelming,\u201d Arroyo said, describing her experience in dealing with the growing number of bills and phone calls with insurance companies. <\/p>\n\n\n\n \u201cIt was like going through this in the dark,\u201d she said. \u201cYou never knew what you were going to get. When you are trying to save a loved one\u2019s life, you are not going to ask prices.\u201d<\/p>\n\n\n\n Had she known about those prices up front, Arroyo said, she would have been better able to make more informed decisions about care.<\/p>\n\n\n\n For several years, the federal government has been pushing for more price transparency from hospitals. In 2019, during his first term, President Donald Trump signed an executive order<\/a> aimed at improving price transparency by requiring hospitals and insurers to disclose health care costs upfront. As a result, the Hospital Price Transparency rule went into effect in 2021. The rule made it mandatory for hospitals to post standard charges for their services on their websites.<\/p>\n\n\n\n Compliance, however, has been lacking: One study published in 2022 in the Journal of the American Medical Association<\/a> found that fewer than 6% of hospitals were fully compliant with the rule.<\/a> A 2024 report<\/a> from the inspector general of the Department of Health and Human Services found that just under two-thirds of hospitals sampled complied.<\/p>\n\n\n\n This came despite President Joe Biden signing his own executive<\/a> order in 2021 to tighten enforcement by fining hospitals that did not comply. When that order went into effect the following year, some hospitals continued to ignore the rules outright, while others accepted the fines, which were capped at $5,500 a day.<\/p>\n\n\n\n Trump is once again trying to increase compliance. In late February, he signed an executive order<\/a> directing the Departments of Treasury, Labor, and HHS to develop a plan in the next three months to enforce the price transparency rule.<\/p>\n\n\n\n Arroyo said that if this kind of information had been available to her, she would have been able to better financially manage her son\u2019s health care needs and ensure she was getting the value she desired.<\/p>\n\n\n\n \u201cIf the prices were posted for me,\u201d she said, \u201cI would compare the prices I got versus what others got. The fact that others get different prices, it\u2019s not right.\u201d<\/p>\n\n\n\n Arroyo estimated that in the last 10 years of her son’s life, she spent hundreds of thousands on one medical supply that cost about $500 a month and fell outside of her insurance\u2019s coverage. She recalled getting another medical bill for $1.5 million for less than 90 days of a five-month stay that her son spent in the ICU. The bills, she said, seemed to never end. Though insurance covered most of them, she says, she consistently had to negotiate the prices down<\/a>. Today, she said, she is still paying off $14,000 of medical debt.<\/p>\n\n\n\n Because of her professional experience in negotiating real estate contracts, she was able to haggle some services down, but she questions how others could manage a similar experience.<\/p>\n\n\n\n \u201cIf you don\u2019t have that information, how can you do it?\u201d<\/p>\n\n\n\n Experts are split over price transparency\u2019s effectiveness<\/strong><\/strong><\/p>\n\n\n\n Advocates of Trump\u2019s order believe that more transparency in health care prices will lead to increased competition for hospitals and insurers, which, they say, will drive down costs for consumers.<\/p>\n\n\n\n \u201cThe bad news is for hospitals who charge rates that are higher than they should be in the markets they\u2019re in \u2014 this rule change will likely increase scrutiny, and hopefully competition, for them,\u201d said James Gelfand, president and CEO of the ERISA Industry Committee, a national nonprofit organization that represents large employers that pay for their own health insurance.<\/p>\n\n\n\n \u201cIf it works the way the administration hopes it will, those outliers will reduce prices to be more competitive, potentially saving patients and employers tens of billions of dollars over the next decade,\u201d Gelfand said. The order will benefit patients and employers with \u201cmore, better data that can be used to get the best care at the best prices,\u201d he added.<\/p>\n\n\n\n There\u2019s already some evidence that\u2019s already happening.<\/p>\n\n\n\n Ge Bai, a professor of accounting and health policy at Johns Hopkins University in Baltimore, noted that the costs from some hospitals have already dropped due to the 2019 price transparency rule, pointing to a recent analysis<\/a> from Turquoise Health, a health care pricing platform.<\/p>\n\n\n\n Other public health experts, however, are wary that one executive order alone can serve as a magic bullet to the challenges in health care cost transparency<\/a> that have saddled the industry for decades.<\/p>\n\n\n\n \u201cI don\u2019t think there is any downside, but I don\u2019t think there is any upside either,\u201d said Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health, who contends that comparing prices in practice for consumers becomes both laborious and complex when it\u2019s based on averages and \u201cno one understands how it works.\u201d<\/p>\n\n\n\n Nearly 100 million Americans \u2014 or 1 in 4 adults \u2014 are hampered by more than $220 billion<\/a> of medical debt that they cannot afford, according to the Consumer Financial Protection Bureau. <\/p>\n\n\n\n If the Trump administration can effectively enforce the rule, the beneficiaries will be financially disadvantaged patients, regardless of race, who will gain the most from price competition, while higher-priced hospitals will be harmed the most, public health experts said.<\/p>\n\n\n\n \u201cThere is huge public support for this initiative,\u201d Bai said.<\/p>\n\n\n\n Some of that support comes from an unlikely source: the rapper Fat Joe.<\/p>\n\n\n\n The Bronx-born hip-hop artist is an ambassador for the nonprofit Power to the Patients<\/a>, an advocacy group that pushes for accessible health care. Through PSAs, public art installations and in-person events, the organization since 2021 has pushed for more price transparency.<\/p>\n\n\n\n Fat Joe said he got involved after learning the scale of the issue and how the lack of transparency was financially crippling people all around him. He\u2019s appeared in commercials<\/a>, spoke on Capitol Hill and advocated on social media<\/a> about the need for price transparency virtually since the organization\u2019s inception.<\/p>\n\n\n\n \u201cPeople are tired of these prices\u201d that are often inflated, said Fat Joe, adding that when people go to hospitals for a service, \u201cit\u2019s like a game of lottery, which is really more like Russian roulette.\u201d <\/p>\n\n\n\n Melissa Deitrich, a 49-year-old single woman from Ossian, Indiana, believes she would benefit greatly from greater price transparency. Deitrich, who\u2019s gotten involved with Power to the Patients, said she was overcharged by her provider by more than a thousand dollars for a routine checkup and now drives more than two hours to the closest clinic that lists their prices upfront.<\/p>\n\n\n\n \u201cIt\u2019s worth the peace of mind,\u201d she said. \u201cComplete price transparency is the only way patients will ever be able to trust their health care system.\u201d<\/p>\n\n\n\n \u2018It\u2019s just not ready for prime time\u2019 <\/strong><\/strong><\/p>\n\n\n\n