Insurers Argue CMS Transparency Rule May Backfire

by Jane Anderson

Organizations representing health insurers are blasting the Trump administration's proposed insurer price transparency regulation, saying the rule is anti-competitive and could even force prices higher.

The proposed CMS insurer transparency rule, released Nov. 15, would require all non-grandfathered group and individual health plans to: provide consumers with personalized out-of-pocket cost information for all covered health care items and services through an "internet-based self-service tool," and in paper form upon request, and make their negotiated rates with in-network providers and historical allowed amounts to out-of-network providers available to the public in "standardized, regularly updated machine-readable files."

In written comments on the rule to CMS Administrator Seema Verma, health insurer trade groups said they agreed in principle that transparency is good, but the administration's approach is too heavy-handed and could backfire. "Individual consumers (as opposed to insured enrollees) are unlikely to access this information and those parties who do access this information — competing health plans and providers — may directly or indirectly incent increases in health care costs if lower-paid providers seek higher reimbursement rates," Association for Community Affiliated Plans CEO Margaret Murray said in her letter to CMS.

At the same time, the Alliance of Community Health Plans has unveiled what it calls an alternative to CMS's approach to price transparency. That plan would use a private certification framework for existing digital health care pricing tools in an effort to make both price and quality information "accessible, understandable and actionable" for consumers, the group says.

Dan Mendelson, Avalere founder and former CEO, says there's likely still room for compromise between insurers and the Trump administration. "I think that right now the administration is justifiably exasperated because they're trying to do the right thing, but this is always really hard because what they're doing is requiring both the hospitals and the insurers to change their business practices," he says.

The election cycle also is driving some urgency on this, since the Trump administration would like a win on health care to tout on the campaign trail, Mendelson says.

From Health Plan Weekly