Trump order aims to disclose 'real' costs for health care

President Donald Trump signed an executive order Monday that calls for upfront disclosure by hospitals of actual prices for common tests and procedures to keep costs down .

The idea is to give patients practical information that they can use to help save money. For example, if a hospital charges your insurer $3,500 for a type of echocardiogram and the same test costs $550 in a doctor's office, you might go for the lower-price procedure to save on copays.

But insurers said the idea could backfire, prompting hospitals that now give deeper discounts to try to raise their own negotiated prices to match what high-earners are getting.

President Donald Trump speaks during a ceremony where he will sign an executive order that calls for upfront disclosure by hospitals of actual prices for common tests and procedures to keep costs down, at the White House in Washington, Monday, June 24, 2019. (AP PhotoCarolyn Kaster)

Trump's order also requires that patients be told ahead of time what their out-of-pocket costs like deductibles and copays will be for many procedures.

Little will change right away. The executive order calls for a rule-making process by federal agencies, which typically takes months or even years. The details of what information will have to be disclosed and how it will be made available to patients must be worked out as part of writing the regulations. That will involve a complex give-and-take with hospitals, insurers and others affected.

Consumers will have to wait to see whether the results live up to the administration's promises.

"For too long it's been virtually impossible for Americans to know the real price and quality of health care services and the services they receive," Trump said at the White House. "As a result, patients face significant obstacles shopping for the best care at the best price, driving up health care costs for everyone. With today's historic action, we are fundamentally changing the nature of the health care marketplace."

Health and Human Services Secretary Alex Azar told reporters earlier that the order "will put patients in charge and address the drivers of high health care costs...increasing choice and competition."

Lack of information on health care prices is a widespread problem . It's confusing for patients, and experts say it's also one of the major factors that push up U.S. costs. The same test or procedure, in the same city, can cost widely different amounts depending on who is performing it and who is paying the bill. Hospital list prices, which are available, don't reflect what they actually get paid by insurers and government programs.

The health insurance industry said disclosing negotiated prices will only encourage hospitals that are now providing deeper discounts to try to raise their rates to match the top-tier facilities. "Publicly disclosing competitively negotiated proprietary rates will reduce competition and push prices higher — not lower — for consumers, patients, and taxpayers," Matt Eyles, head of the industry group America's Health Insurance Plans, said in a statement.

While the prices Medicare pays are publicly available, private insurers' negotiated rates generally are not. Industry officials say such contractual information is tantamount to trade secrets and should remain private.

Azar pushed back against that argument, saying insurers do ultimately disclose their payment rates when they send individual patients an "explanation of benefits." That's the technical term for the form that patients get after they've had a procedure or seen the doctor.

"Every time one of us goes to a hospital, within a couple of weeks there arrives an explanation of benefits that contains the list price, the negotiated price, and your out-of-pocket cost," Azar said. "This is not some great state secret out there." He said "that information is out there, it just needs to be presented to patients at the right time, in the right format, so it can help drive decision-making for them."

Trump's executive order also calls for:

—expanded uses for health savings accounts, a tax-advantaged way to pay health care bills that has long been favored by Republicans. Coupled with a lower-premium, high-deductible insurance plan, the accounts can be used to pay out-of-pocket costs for routine medical exams and procedures.

—a plan to pull together the government's various health care quality rating systems for hospitals, nursing homes, and Medicare Advantage plans, improving reporting of information to consumers.

—more access by researchers to health care information, such as claims for services covered by government programs like Medicare. The data would be stripped of details that could identify individual patients.

UNITED NATIONS (AP) — Russia has circulated a U.N. resolution calling on all countries to take urgent action to prevent putting weapons in outer space “for all time” a week after it vetoed a U.S.-Japan resolution to stop an arms race in space.

The Russian draft resolution, obtained Wednesday by The Associated Press, goes further than the U.S.-Japan proposal, not only calling for efforts to stop weapons from being deployed in outer space but for preventing “the threat or use of force in outer space,” also “for all time.”

It says this should include deploying weapons “from space against Earth, and from Earth against objects in outer space.”

Russia’s U.N. Ambassador Vassily Nebenzia told the Security Council when he vetoed the U,S.-Japan draft that it didn’t go far enough in banning all types of weapons in space.

The vetoed resolution focused solely on weapons of mass destruction including nuclear arms, and made no mention of other weapons in space.

It would have called on all countries not to develop or deploy nuclear arms or other weapons of mass destruction in space, as banned under a 1967 international treaty that the U.S. and Russia ratified, and to agree to the need to verify compliance.

Before the U.S.-Japan resolution was put to a vote on April 24, Russia and China proposed an amendment that would call on all countries, especially those with space capabilities, “to prevent for all time the placement of weapons in outer space, and the threat of use of force in outer spaces.”

The vote was 7 countries in favor, 7 against, and one abstention and the amendment was defeated because it failed to get the minimum 9 “yes” votes in the 15-member Security Council required for adoption.

U.S. Ambassador Linda Thomas-Greenfield told the council after the vote that Russian President Vladimir Putin has said Moscow has no intention of deploying nuclear weapons in space.

“Today’s veto begs the question: Why? Why, if you are following the rules, would you not support a resolution that reaffirms them? What could you possibly be hiding,” she asked. “It’s baffling. And it’s a shame.”

Putin was responding to White House confirmation in February that Russia has obtained a “troubling” anti-satellite weapon capability, although such a weapon is not operational yet.

Russia’s U.N. Ambassador Vassily Nebenzia said after casting the veto that the U.S.-Japan resolution cherry picked weapons of mass destruction.

He said much of the U.S. and Japan’s actions become clear “if we recall that the U.S. and their allies announced some time ago plans to place weapons … in outer space.”

Nebenzia also accused the U.S. of blocking a Russian-Chinese proposal since 2008 for a treaty against putting weapons in outer space.

Thomas-Greenfield accused Russia of undermining global treaties to prevent the spread of nuclear weapons, irresponsibly invoking “dangerous nuclear rhetoric,” walking away from several of its arms control obligations, and refusing to engage “in substantive discussions around arms control or risk reduction.”

Much of the Russian draft resolution is exactly the same as the U.S.-Japan draft, including the language on preventing an arms race in space.

It calls on all countries, especially those with major space capabilities, “to contribute actively to the objective of the peaceful use of outer space and of the prevention of an arms race in outer space.”

Thomas-Greenfield said the world is just beginning to understand “the catastrophic ramifications of a nuclear explosion in space.”

FILE - U.S. Ambassador to United Nations Linda Thomas-Greenfield speaks on Thursday, April 18, 2024, in Tokyo. The U.N. Security Council is set to vote Wednesday, April 24, 2024, on a resolution announced by Thomas-Greenfield, calling on all nations to prevent a dangerous nuclear arms race in outer space. It is likely to be vetoed by Russia. (AP Photo/Eugene Hoshiko, Pool, File)