President Trump is revisiting one of the signature health policies of his first administration: making health care prices public. It hasn’t gone smoothly. Now Trump is calling for new rules and more public prices to deliver on his goal of a more competitive — less costly — health care market. 

Note: This episode and article were originally published Dec. 19, 2024. The transcript was updated on Aug. 21, 2025 when the story re-aired, to reflect recent action by the Trump administration. No other episode details have been updated. The article has not been updated.

Five years ago, it was nearly impossible in the U.S. to compare prices for medical services as easily as prices for cars, televisions or sneakers.

The Trump White House saw this as a problem that prevented consumers from taking their business where they could get the best value. The administration hit on its solution: a mandate for hospitals and insurance companies to go public with all prices.

This way, the administration argued, consumers armed with information could force competition, putting pressure on prices.

That goal is now feasible, but remains elusive as President-elect Trump returns to office.

Trump required hospitals and insurers to publish entire price lists for the first time under a pair of administrative regulations issued in 2019 and 2020. To ensure patients could easily find prices, the rules required hospitals and insurers to create tools specifically designed for consumers. 

These regulations are among the most significant and lasting health policies from Trump’s first term. 

By one measure, the rules have clearly succeeded: A vast number of health care prices that were once secret are now out in the open. 

But by other measures, the rules have fallen short. Prices are still sometimes unavailable. A planned release of drug prices has stalled without guidance. The public price lists can be inaccurate and complex, rendering the information challenging for all but the most sophisticated users.

Proposals that would strengthen enforcement and expand the rules regarding price transparency cleared the Republican-controlled House this year, but the proposal stalled without Senate action. 

Changes to existing rules alone, however, likely won’t be enough to transform health care in ways that Trump envisioned, many of price transparency’s proponents say, including conservative policymakers who first put the policy forward.

Filling in blind spots

Economists, policymakers, employers and consumer advocates widely agree the prices are essential to inform decisions on how to tame health care prices, a primary driver of the nation’s high health spending. 

Researchers say the highly detailed price information can also be analyzed to help inform policy on questions about why prices are so widely different across cities, competing hospitals – and even within the same hospital. An analysis by the Health Care Cost Institute found that high prices inflate health care bills for people with private insurance by nearly 20%.

Tamping down health care inflation is a goal that has eluded policymakers for decades. Fast-rising medical prices have outpaced other prices across the economy since 2000, analysis by health policy nonprofit KFF shows. Medical prices increased 121% in that time compared with about an 86% increase economy-wide. 

Pulling off greater transparency has been even harder than many expected. 

One major obstacle was obvious from the start: Hospitals fought in court to keep their prices secret. Though eventually unsuccessful, many hospitals blew past the initial 2021 deadline to comply. As of December, approximately 95% share their data. 

Since July 2022, under Trump-era rules, insurers and many employers have been required to publish the rates they pay for medical care. But because of how many organizations must release prices, it’s been hard to track compliance.  

Release of drug prices have also stalled as regulators wrangle with making it work. 

Even without those, the price data from insurers and employers are enormous. They publish most prices for any health care company they do business with. 

It turns out, much of it is a mess.

Health care (data) is complicated 

Turquoise Health, which aggregates pricing data, estimates that companies these days must sift through as many as 1 trillion distinct prices for health care services – prices that are now publicly available and updated monthly. The average independent grocery store’s price list, by comparison, has about 12,150 items. 

Not all prices released by insurers are useful. They sometimes include prices for services that aren’t actually offered, which have earned the name “zombie” or “ghost” codes.

A consumer’s quest to get more for their money is further complicated by the complexity of health care billing. 

Patients at the same hospital getting an identical treatment often pay different prices, which depend on the contract hammered out between their insurer and the hospital. Each contract has its quirks, which makes prices across contracts hard to compare.

Federal health agencies revised criteria for publishing hospital prices as of July, which is supposed to help. As of December, about two-thirds of hospitals had adopted the new criteria.

But so far, this morass has made it difficult for H.R. executive Ginger Miller to use these prices in the way that they were intended: to help her and her co-workers shop.

“What are they supposed to do?” 

Miller oversees health benefits for Pennsylvania-based snack food company Utz Brands. The company has about 4,200 people covered by its insurance. 

Utz wants its employees to shop smartly for medical care, Miller said, hoping to save workers and the company money. That’s why the business has contracted directly with hospitals and doctors to get good deals for mammograms and hip or knee replacement surgery, for example. 

Published health care prices should be an effective new tool for Utz and its employees to find the best value for their money. But Miller says it hasn’t worked out that way.

The lists are just too unwieldy and complex for Utz to use to negotiate better deals. And there are flaws, she says. One Utz employee was recently quoted a zombie code.

Another employee tried to compare price estimates for mammograms, in this case by calling hospitals. The cheaper option, the worker assumed, seemed to be the best choice. But Miller discovered, following up, that the lower price omitted necessary physician services. 

Miller likens it to ordering pie at a restaurant. The waitress may bring pie or pie with whipped cream or pie a la mode, but each is priced differently.

Miller could use public prices to help her co-worker, in theory, but she says she’s hamstrung by how complex the data is.

“It’s very disheartening that you just can’t take this into your own hands and be able to make good decisions about how to take care of your health and how to spend,” Miller said.

Competition or collusion?

Studies suggest making prices more transparent can actually backfire for consumers. Rivals may informally collude, forgoing competition to inflate prices, as appears to have happened after prices for concrete in Denmark became public. 

Doctors and hospitals with reimbursement at the low end of the market may also raise their rates once they discover what a competitor is charging, as one recent study found. 

Published analysis of how prices have changed since the Trump-era rules took effect is limited.

Employers beyond Utz have struggled to use prices to lower their spending, but some have made headway. The 32 BJ Health Fund, which covers about 200,000 people across 5,000 employers, is using the pricing data to press for lower prices for its health plans for some services next year, said Misha Sharp, assistant health policy director for the fund. 

A study of New Hampshire’s price transparency law suggests employers could help lower prices at the top of the market. Consumers’ out-of-pocket spending on medical imaging, for example, dropped by 5% in the first five years that prices were public. The study also found prices for medical imaging visits fell by 2%. 

The health care industry is wielding the newly public prices to their advantage. Hospitals and health insurance companies are analyzing their competitors’ prices, looking for an edge as they negotiate rates. 

“We see it as kind of like this arms race,” said Julie Yoo, who heads up the health care investing practice at venture capital firm Andreessen Horowitz, an investor in Turquoise Health. The company’s customers, for now, are largely hospitals and insurers.

Mount Sinai Health System in New York renegotiated its contract with UnitedHealthcare this year after seeing what its competitors got paid, The Wall Street Journal reported. Mount Sinai said it cannot comment on its contract prices.

Transparency 2.0 

As Republicans sweep back into Washington, the party has support for proposals to strengthen and extend price transparency policies. 

Legislation that passed the Republican-controlled House this session would have increased the penalties for hospitals that refuse to release prices. Hospital compliance did improve after the Biden administration increased fines, researchers reported in JAMA in 2023. 

The same bill called for new regulation to make huge price files more accessible and useful, a move widely supported by employers and consumer advocates. 

Even with improvements, transparency isn’t the end goal of Republican health care market proposals.

Some conservatives consider price transparency rules to be part of an unfinished Republican agenda to remake the nation’s private health insurance market. The Trump administration first introduced price transparency as one of several intertwined policies that put consumers on the hook for more of their health spending. 

Republicans say the problem with health insurance is that it protects patients from the financial pain of high prices. That lessens patients’ willingness to shop around, they argue. Hospitals would then have to compete for their business on price. 

Boosting price transparency will not be a big deal unless consumers feel the pinch, a 2018 Trump administration report said.

In his first term, the Trump administration sought more ways for consumers to set aside money and pay directly for health care, such as health savings accounts.

The administration also expanded options for skinny health insurance plans.  

The Biden administration reversed some of these policies.

Current GOP proposals would look to resurrect these ideas in some form and advance others that bring a more free-market approach to the sector. 

“There are enormous other problems with government policies that need to be addressed,” said Brian Blase, a former advisor to Trump who helped draft health policy during the president’s first term.

For Blase, one of the most compelling examples that markets can work in health care can be found in California. 

He points to the California Public Employees’ Retirement System, which capped what its health plan would pay for hip and knee replacement surgeries in 2011. Patients could go to more expensive hospitals, but would pay for anything over the cap. Instead, researchers found, patients sought surgery with prices below the cap. And pricey hospitals lowered their rates. 

The CalPERS’ success is an exception, said Sherry Glied, dean of New York University’s Wagner School of Public Service. Studies of other attempts to get patients to use price information have found it largely hasn’t worked, she said.

Patients with sticker shock stop seeking medical care, research shows, which can be harmful or even deadly.

Glied is among the economists who are skeptical that top hospital prices can be addressed without regulatory price controls in some circumstances. 

In many places, hospitals have merged and have little competition. In these communities, prices are higher, but the hospitals don’t deliver higher quality care, Glied said. And it’s in these markets that regulators should step in. 

“We call for price regulation in circumstances where competition is not going to do the job,” Glied said.

This coverage is supported in part by West Health.

Episode Transcript and Resources

Episode Transcript

Note: This transcript has been created with a combination of machine ears and human eyes. There may be small differences between this document and the audio version, which is one of many reasons we encourage you to listen to the episode above!

Dan Gorenstein (DG): Hey, it’s Dan. 

Within weeks of returning to the White House earlier this year, President Trump took new action on price transparency in health care. 

This push for hospitals and insurers to make their prices public was a policy priority of Trump’s first term but his work has hit some big snags.

So the president ordered fixes. Fast.

This week, we revisit an episode from last winter about why this effort to empower consumers with better pricing data has proved so vexing.

Stay tuned for an update at the end of the episode.

ORIGINAL STORY:

DG: The high cost of medical care seems to be a defining feature of American life. 

The price we pay for treatment is a big reason why spending is expected to top $5 trillion next year – and why health care spending continues to rise. 

During President Donald Trump’s first term, he took on prices as a problem for markets to solve.

He made prices for medical care public, by law, with the hope consumers would shop and competition would tame health care inflation.

But four years later, the data is incomplete, sometimes inaccurate and pretty tough to use. 

Today, what happened after prices became public and where Trump and Republicans might look to go as the party sweeps into power in January. 

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein. This is Tradeoffs.

*****

DG: Tradeoffs reporter/producer Melanie Evans is here today to dive into the state of public prices in health care with us. Melanie, hello and welcome. This is your first story. Welcome. 

Melanie Evans (ME): Dan, thank you. I am so excited to be here and I’m thrilled that price transparency is the first subject I get to tackle at Tradeoffs. 

DG: Before we get into what Trump did, let’s talk about who transparent prices were designed to help. Give people a little context.

ME: Absolutely. The Trump administration wanted to make it easier for both employers and consumers.

Employers pay most of workers’ health insurance premiums.

When hospitals and doctors and drugmakers raise their prices, health insurance premiums usually go up.

This is relevant for consumers because – obviously – they pay premiums, too. And consumers also get hit by high prices when bills fall under the deductible. 

Americans spent an estimated $508 billion out of their own pockets on health care last year. It’s a lot of money. 

DG: Ok. So Trump said he wanted these two groups – employers and consumers – to be able to see prices, so they could be smart shoppers. 

What did he do, exactly? 

ME: Two things, really. The Trump administration issued regulations that said hospitals and insurance companies had to publish their prices in two formats. 

The first format is an enormous file with all the prices, which can be downloaded off the internet. 

These giant price files – in theory – could be super helpful for employers as they shop for competitively priced networks of hospitals and doctors for workers.

These files are too big for consumers like you and me, Dan. 

So the second format is an online tool where consumers can look up prices or estimated out-of-pocket costs. 

DG: So, Trump’s plan: make it easier for consumers and employers to shop that, in turn, puts pressure on the hospitals and everybody else to make their prices more competitive. 

And voila, you slow the growth in health care spending. 

ME: Yes, Dan, that was the thinking, but pulling it off has been harder than a lot of people expected.

For consumers to shop around and put pressure on prices, they need complete, accurate and comparable public prices. That is not what we have today. 

Instead, it’s a patchwork of incomplete, sometimes inaccurate data that makes serious shopping super tough. 

And, remember, this is a list of prices for nearly all the goods and services across most of healthcare.

One company that tracks these public prices – Turquoise Health, told me, there are as many as 1 trillion distinct prices. And get this Dan, they are updated every month.

To give you a sense of just how massive that really is – the average independent grocery store has about 12,000 items listed.

DG: My lord. 

ME: I know!

And look, I interviewed employers and employer groups for this story, Dan, and this data can be pretty hairy to use.

I spoke with Ginger Miller. She oversees health benefits for Pennsylvania-based snack food company Utz Brands. 

DG: They’ve got these incredible voodoo chips, Melanie, that are amazing. I love Utz’s voodoo chips. 

ME: It’s funny you’re talking about voodoo chips. Because Ginger told me about one employee who was shopping for care was quoted what’s called a zombie code, or ghost code.

Basically prices for medical care no one actually provides.

Another worker had two price quotes from competing hospitals. The worker assumed the cheaper price would be best.

DG: Makes sense.

ME: But Miller dug into it – and noticed the cheaper price was cheaper because it was an incomplete list of all the services the employee needed. 

She compared that experience to ordering one of my favorite foods: apple pie. What you may get could be pie, or pie with whipped cream, or pie a la mode, and the price for each is different. 

What really bothers Ginger is that, in theory, the public prices should be able to help Ginger help her co-worker.

But the data is such a mess that she usually can’t.

She said, quote: “It’s very disheartening that you just can’t take this into your own hands and be able to make good decisions about how to take care of your health and how to spend.”

DG: Obviously this is no way to shop, Melanie. So is this a wash? Is anyone using it?

ME: Well as bleak as it sounds – and it’s pretty tricky – I want to give you a full picture here, Dan.

There are companies out there – like Turquoise – that are cleaning up the data, which tells me that in the future this data could be really meaningful.

And even right now, as rough as it currently is, here are a determined few who are finding ways to use the prices.

One is the 32BJ Health Fund, a union fund that provides insurance for more than 200,000 people across a bunch of employers. 

And the fund turned their analysts loose on the data. 

They realized they could do better on prices.

As cumbersome and incomplete as it is , the public prices are helping 32BJ negotiate its next contract and get a better bargain.  

DG: When we come back, Melanie walks through the potential unintended consequences of price transparency, and what Republicans doubling down on their work may look like. 

MIDROLL

DG: Welcome back.

Before the break, Melanie, you shared a ray of sunlight.  We’re seeing a shifting landscape where consumers and employers now expect more transparency. I mean, this is unprecedented. There’s just a lot more we know about prices than we used to.

ME: Yes, and remember the prices are out there for everyone to see. 

The most revealing thing here, Dan, is that Turquoise Health, the price-aggregation company I talked about a few minutes ago, well, their primary customers are the hospitals and insurers. 

Julie Yoo is head of health care investing for the venture capital firm Andreessen Horowitz, one of Turquoise’s investors.

And she told me, quote: “We see it as kind of like this arms race.” 

This isn’t a surprise. This could go badly for consumers, like hospitals could informally collude to keep prices high. 

DG: Sure, I talked about this with Margot Sanger-Katz at the New York Times. Margot reported on a study of what happened when the government in Denmark mandated prices for concrete be made public. Prices did not go down. They went way up. 

ME: Yes. It’s a solid example of how this could go sideways. Hospitals could just tacitly agree to avoid competition. 

Here’s another scenario: Hospitals and doctors at the low end of the market might start to demand – and get – higher prices.

For now, there isn’t much public analysis that can tell us how markets are responding to public prices. 

DG: Ok. Let’s take stock. We are about four years into what is, really, a national experiment. It’s been complex and messy. There’s been some progress, but we have yet to see some sort of market transformation. 

ME: That’s about right. Let me make one other point: As frustrated as employers and consumer groups and researchers are, almost everyone I spoke to said price information is essential to inform decisions on how to tame health care prices. 

They also agreed public prices alone aren’t enough to do the job. 

DG: Ok, Melanie. I guess the question is what’s next. As Trump returns to the White House and Republicans take control of Congress next year, how does price transparency – again one of Trump’s most lasting health care moves – fit into Republicans’ plans. 

ME: Well, based on my reporting – some conservatives consider price transparency rules as part of an unfinished Republican agenda to remake private insurance.

President Trump first introduced price transparency as one of several intertwined policies that put patients on the hook for a greater share of their health spending. 

DG: Right, I remember in his first term the administration expanded options for people to set aside money for health care. 

ME: Exactly. 

The goal here was to get health care to look more like other markets, and, again, slow rising health care costs.

The Trump administration also expanded options for health insurance with fewer benefits and less financial protection, but also came at a lower cost less for consumers, so-called skinny health plans. 

Now, the Biden administration reversed some of these Trump-era policies.

But current GOP proposals would look to resurrect these ideas in some form and advance others that bring a more free-market approach. 

DG: It sounds like you are telling me that as Republicans return to Washington they think the insurance market has insulated consumers too much. 

Consumers need to face more exposure, but they need tools – like bigger health savings accounts, less expensive insurance plans, skinny plans and real price transparency to navigate this greater exposure. 

ME: I think that’s right, Dan. 

And, of course, it’s unclear if this approach can work. 

There are two real challenges, though, that I think are worth mentioning. 

One – research shows that when consumers have more ‘skin-in-the-game’ they tend to cut back on care indiscriminately, for unnecessary services AND services they need to stay healthy. 

Two – there’s been a ton of consolidation over the last few decades.

As much as Republicans may want consumers to shop, there are some markets – many of them rural and red – where there’s only one game in town.

DG: Melanie, thanks so much for your story.

ME: Thank you, Dan.

UPDATE:

DG: The second Trump administration has taken several actions that health policy experts say could make public health prices more useful. 

One federal health agency recently released new guidance and proposed rules to force hospitals to publish more robust pricing data. 

And the agency asked for ideas about how to better enforce the rules for hospitals. 

The administration is also plowing ahead with ways to slim down the massive, messy pricing files from health insurers.

One more thing. Those drug prices that have never been published — the ones that have been held up without guidance — now the Trump administration is asking for ideas about the best way to collect and release the data. 

I’m Dan Gorenstein. This is Tradeoffs. 

Episode Resources

Additional Reporting and Research:

Episode Credits

Guest:

  • Melanie Evans, Reporter/Producer, Tradeoffs

The Tradeoffs theme song was composed by Ty Citerman. Additional music this episode from Blue Dot Sessions and Epidemic Sound.  

This episode was produced by Melanie Evans, edited by Dan Gorenstein and mixed by Andrew Parrella.

Melanie is a reporter and producer for Tradeoffs. She spent eight years at The Wall Street Journal, where she reported on hospital costs, health care quality and the Covid-19 pandemic. Before the Journal,...