Virginia Leads the Way on Medical Price Transparency

Fairfax, Va.

If you need to visit a hospital in Virginia, first go online and check the prices. Legislation I championed took effect this month requiring hospitals to post on their websites what they actually charge for services. This is a meaningful step toward making quality healthcare affordable for all Virginians.

Price disclosures will protect patients from widespread hospital overcharges and allow consumers to more easily fight overbilling. Price transparency empowers people to identify the care they need without the delay associated with fear of unknown, inflated hospital bills.

Legislators passed this law with overwhelming bipartisan support after hearing countless hospital billing horror stories. Wanda Brooks of Fredericksburg was charged $8,000 for nausea and exhaustion. Carilyn Davis of Halifax County was charged $7,448 for nerve injections. And Wayne Williams of Charlottesville was charged $6,931 for a CT scan.

Like tens of thousands of other Virginians in recent years, these patients were sued by their hospitals for failure to pay. They faced asset seizures, home liens and wage garnishments. No one should have to decide between facing financial ruin from predatory medical bills and forgoing life-saving care.

Hidden prices have allowed hospitals to bill patients essentially whatever they want. An analysis by National Nurses United found that Virginia’s big hospitals charge patients 10 to 13 times their cost of care. In one case, a Virginia hospital charged a patient $2,000 for a $20 feeding tube.

It’s no wonder that more than half of Virginians struggle to afford healthcare, and around a third delay or avoid care for fear of the financial consequences. The problem is especially acute for blacks and Latinos. Virginia’s new law flips this unfair pricing power imbalance on its head. When patients can spot vast differences in prices for the same medical services, they can choose affordable alternatives, improving healthcare access and equity. Hospitals will have a market incentive to compete for consumers by decreasing their prices and increasing their quality of care.

Virginians and all Americans already have the right to upfront healthcare prices due to a federal hospital price transparency rule that took effect in January 2021. Unfortunately, most hospitals haven’t followed that rule. According to one recent study, only a quarter of hospitals nationwide—and only 28% in Virginia—are fully compliant, including posting discounted cash prices and all health insurance plan rates.

In Virginia, these federal rules are now codified in state law. This adds an important layer of enforcement to ensure hospitals comply with all pricing requirements. The U.S. Department of Health and Human Services has only fined four hospitals nationwide for violating the rule. We hope that Virginia’s regulators will do a much better enforcement job.

Patients aren’t the only ones who benefit from price transparency. Employers and unions do too. They can survey price disclosures to help workers find fairly priced care and use the proceeds to lower health premiums and increase wages. Employees and small businesses have been among the biggest victims of annual double-digit premium increases driven in part by out-of-control hospital prices.

Innovative young app designers will make hospital comparisons easy for patients by bringing prices together in a consumer-friendly online marketplace. Choosing where to have a medical procedure done will be as easy as shopping from home on your phone.

Price transparency will dramatically reduce the number of hospital billing horror stories in Virginia. This new law takes a giant leap toward the affordable and accessible healthcare system we all deserve.

Mr. Helmer, a Democrat, is a member of Virginia’s House of Delegates.