Price transparency can stop health insurers’ gain off patient pain

By | April 7, 2021

CEO pay disclosures this spring show what many patient advocates already suspected: Health insurance company executives gained from ordinary people’s 2020 pain. While patients avoided hospitals and doctors’ offices last year for fear of catching COVID-19, health insurers laughed all the way to the bank by paying out far fewer claims.

Compensation data filed so far show that the CEOs of Cigna and Centene raked in $ 79 million and $ 59 million in 2020. That’s significantly more than in 2019 and far higher than CEO pay at most other Fortune 100 companies. This inflated executive compensation mirrors health insurers’ record 2020 profits, which are partly derived from taxpayers through expanded government subsidies for health insurance. UnitedHealth Group reported its full-year 2020 profit at a record $ 15.4 billion. Cigna made $ 8.5 billion in 2020 profits, 66% more than in 2019. And Humana reported $ 4.6 billion in profits, 40% more than in 2019.

Meanwhile, ordinary workers faced generational economic upheaval. The unemployment rate peaked at 14.8% last April, the highest level since the Great Depression.

Health insurers’ stratospheric profits and executive compensation aren’t merely a function of fewer claims during the pandemic. They are a systemic result of high and hidden prices charged to policyholders. According to the Kaiser Family Foundation, average employer-sponsored family insurance premiums rose to $ 20,300 last year, a 55% increase over the last decade. In addition, average families face annual deductibles of roughly $ 8,000. Cost-shifting from insurers to consumers has increased in recent years along with insurers profits, with the share of people holding high-deductible plans growing by nearly 50% over the last five years.

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Health insurers can maintain these inflated prices because they hide their contracted rates and out-of-pocket prices from patients, preventing them from shopping for the best quality care and coverage at the lowest possible prices. Insurers generally don’t inform consumers of their “patient responsibility” until after bills arrive in the mail weeks and months later. By that time, there’s no recourse or ability to shop for a better value. This opaque dynamic allows insurers to charge far more than they could in a functional, competitive marketplace and profiteer by keeping patients in the dark.

Beginning this year, hospitals are required to disclose their real prices, including their discounted cash and secret negotiated rates. Patients can use this information to see what their insurers pay for care. Yet, patients are still generally unable to get upfront access to their out-of-pocket responsibility, which is the most important price for many covered patients. Insurers can do right by patients and immediately reveal this pricing information.

Soon, they won’t have a choice.

Beginning next year, a new Health and Human Services rule takes effect that requires health insurers to reveal patient-specific cost-sharing information so that consumers can compare coverage alternatives based on prices and quality. The economic and anecdotal evidence suggests that such price transparency will lower the price of care and coverage by 30% to 50%, helping consumers while reining in out-of-control industry profits and compensation. More than 90% of people support such price transparency, according to a recent Maris poll.

Most covered employees are part of self-insured health plans run by their employers. These businesses can immediately reveal detailed price information to empower their employees to shop for care. For instance, the Business Roundtable, which is made up of more than 200 of the nation’s biggest companies, collectively employing more than 15 million people, can revolutionize care and coverage by committing to healthcare price transparency. In 2019, the Business Roundtable made headlines advocating for “stakeholder” capitalism, which considers the interests of employees, communities, and suppliers alongside shareholders. Employers can help this broad group of stakeholders by working with their third-party administrators to post prices upfront for employees. Such a move can generate significant savings for employees and put downward pressure on the price of care and coverage for all community members.

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Such savings can provide a real economic stimulus, at no cost to taxpayers, as employees redirect dollars that formerly went to sky-high healthcare costs to spending and saving. Employee wages can rise because compensation will no longer be so largely allocated to health benefits. And employers can save money due to a reduced employee healthcare burden.

Price transparency will therefore improve personal and company bottom lines. Armed with actual prices for care and coverage, health industry profiteering will be redirected to health consumers’ pocketbooks for generations to come.

Cynthia A. Fisher is a life sciences entrepreneur, the founder and chairwoman of PatientRightsAdvocate.org, and the founder and former CEO of ViaCord Inc.

Healthcare