Missouri families shouldn’t have to suffer from hospital bill sticker shock | Opinion

It’s a dilemma all parents have faced. Our child gets some bump, bruise, or burn — or comes down with a high fever in the middle of the night. We must decide: Should I take them to the hospital and play financial roulette, or can we make due with a regular doctor’s visit the following day?

I’ve introduced a new bill in the Missouri House of Representatives to make this stressful decision easier for Missouri parents and reduce hospital costs for all state healthcare consumers, including employers. House Bill 1837 would convince Missouri hospitals to finally post their actual prices, including for admittance to the ER, and hold patients harmless from bills from hospitals that continue to hide their prices in violation of federal law.

Consider the typical story of the Bhatt family from St. Louis. Their 2-year-old son, Martand, burned his hand on the stove. After it swelled up, his mother grew concerned and took him to the SSM Health Cardinal Glennon Children’s Hospital. They registered, saw a nurse who took Martand’s vitals, and waited an hour and a half before leaving without seeing a doctor.

Martand’s burn healed on its own. Yet despite never seeing a doctor, the Bhatts received a bill in the mail for $1,012. Their health insurer’s negotiated rate was $859, which the family owed out of pocket because it was below their deductible. “It is absolutely ridiculous and unethical,” said Martand’s father to Kaiser Health News. And sadly, it’s all too common under the opaque health care status quo.

Since the beginning of 2021, a federal hospital price transparency rule has been in effect that’s supposed to prevent situations like these. It requires hospitals to publish their actual prices, including all negotiated rates by insurance plans and the discounted amounts for those paying in cash. This information can allow Americans to choose affordable care and avoid price gouging like $1,000 for merely setting foot in a hospital.

Unfortunately, most hospitals haven’t complied. According to a new report by PatientRightsAdvocate.org, only 35% of hospitals nationwide — and only 22% in Missouri — are fully following the rule. (Though the report didn’t specifically analyze SSM Children’s, I confirmed with the study’s authors that it is also noncompliant.)

Hospitals continue hiding prices because it makes it easier to overcharge patients. As a result, ordinary Missourians face runaway health care costs, including skyrocketing health insurance premiums that are a function of underlying medical costs. No wonder 4 in 5 Missourians worry about affording health care.

The U.S. Department of Health and Human Services hasn’t done enough to enforce this transparency rule. It has fined only 14 hospitals nationwide out of the thousands that aren’t complying.

My legislation would dramatically boost Missouri hospital compliance by hitting hospitals where it hurts: their revenues. It would allow patients to avoid paying bills received from hospitals that aren’t posting their prices as the federal rule requires. It follows the basic principle that you shouldn’t owe what you didn’t know. Patients would no longer be responsible for unknown hospital bills.

If actual hospital prices were known, Missouri families could choose and budget for affordable care without worrying about overbilling weeks and months later. Employer health plans could steer employees to less expensive care, reducing high monthly insurance premiums and copays. Ensuing competition would reduce astronomical health care prices.

Price transparency would help parents decide whether their child’s malady is worth a trip to the ER. In these cases, the key price families need to know is the hospital facility fee — the charge for merely entering the hospital doors. In the Bhatts’ case, this fee was 95% of their total bill. It’s outrageous that hospitals don’t post this basic information at check-in for all to see.

No more. My bill says that if hospitals don’t say, then you don’t pay. Strong legislation is needed to finally convince hospitals to reveal their real prices, so Missourians can lower their health care bills and avoid such Bhatt situations.

Aaron McMullen represents District 20 in the Missouri House of Representatives.