Trump Rule Requires Health Plans to Disclose Costs up Front | Business News

By RICARDO ALONSO-ZALDIVAR, Associated Press

WASHINGTON (AP) — Trying to pull back the veil on health care costs to encourage competition, the Trump administration on Thursday finalized a requirement for insurers to tell consumers up front the actual prices for common tests and procedures.

The late-innings policy play comes just days ahead of Election Day as President Donald Trump has been hammered on health care by Democratic challenger Joe Biden for the administration’s handling of the coronavirus pandemic and its unrelenting efforts to overturn “Obamacare,” the 2010 law providing coverage to more than 20 million people.

A related Trump administration price disclosure requirement applying to hospitals is facing a federal lawsuit from the industry, alleging coercion and interference with business practices.

The idea behind the new regulations on insurers is to empower patients to become better consumers of health care, thereby helping to drive down costs.

But the requirements would take effect gradually over a four-year period, and patients face a considerable learning curve to make cost-versus-quality decisions about procedures like knee replacements or hernia repairs. Add to that political uncertainty about the policy’s survival if Trump doesn’t get reelected, and the whole effort is running into skepticism.

Administration officials are adamant the changes will stand, arguing the goal of price transparency transcends political partisanship.

“It will be impossible to walk backwards on this,” Health and Human Services Secretary Alex Azar said. “How do you fight transparency on prices? How do you actually articulate the argument that you should conceal what something costs from the person trying to purchase it?”

Insurance companies contend that the rules will boomerang economically, driving up costs. Hospitals and doctors now accepting discounted rates will press to get paid more once they see what their upper-end competitors are getting.

The new rules are being issued jointly by HHS, the Labor Department and the Treasury, which share jurisdiction over health insurance plans. They would:

— Starting in 2022, require insurers to make available data files on the costs of various procedures, allowing technology companies to design apps that let patients see costs not only under their own plan but other insurers’ plans as well.

— Starting in 2023, require insurers to make available to their policyholders cost-sharing details on 500 specific services, medical equipment and other items, as called for by the government.

— Starting in 2024, require insurers to make cost-sharing information available on all the services and goods they cover.

Patients would use an online shopping tool from their plan to see the negotiated rate between their doctor and the insurer, as well as an out-of-pocket cost estimate for procedures, drugs, durable medical equipment and any other item or service they may need.

The information would be available ahead of time, enabling an informed decision. Currently, most patients find out what they owe after they get back from the hospital and receive their “explanation of benefits” statement.

“We need to keep pricing on the front end, not the back end,” said Seema Verma, head

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Fact check: Trump falsely claims California requires people to wear ‘special’ and ‘complex’ mask at all times

At a campaign rally in Arizona on Wednesday — at which there was no social distancing and most attendees did not wear masks — Trump started mocking what he claimed are the mask requirements in California.

“In California, you have a special mask. You cannot, under any circumstances, take it off. You have to eat through the mask,” the President said.

He continued: “It’s a very complex mechanism. And they don’t realize, those germs, they go through it like nothing. They look at you with that contraption and they say, ‘That’s an easy one. …’ “

Moments later, Trump joked that a meal of spaghetti and meat sauce would mess up a mask someone was forced to wear while eating. The crowd laughed. But the President sounded serious enough when he made his other assertions about California’s mask rules that his claims are worth fact-checking.

Facts First: Trump’s story was false. Californians are not required to wear “complex” or “special” masks; basic face coverings, even homemade ones, are acceptable there. Though Gov. Gavin Newsom has imposed a statewide mask order, Californians are not required to wear masks at all times; they can remove them when at home, when alone in a room outside their home, when outdoors more than 6 feet from others, and when eating or drinking. And while people can transmit the coronavirus or get infected with it while wearing masks, face masks have proven effective in reducing the chances of transmission; they are much better than “nothing.”
Trump’s comments about Californians being forced to eat through their masks appeared to be a reference to an early-October tweet from Newsom’s office that told people “don’t forget to keep your mask on in between bites” when going out to eat with members of their households. The tweet was widely mocked, particularly in conservative circles.

Despite the tweet, California does not have a requirement to wear a mask in between bites at a restaurant. Newsom played down the tweet, saying at a virtual news conference that it was posted by “a staff member” and that its intent was merely to say that “if you’re just gonna read a book at a dinner table, it might be good after a while to put on a mask.”

Top health officials in the federal government, including National Institute of Allergy and Infectious Diseases director Dr. Anthony Fauci and Centers for Disease Control and Prevention director Dr. Robert Redfield, have emphasized that the widespread use of masks is critical to the fight against the virus.

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