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President Donald Trump, in his usual superlative but vague style, promised on Friday "another big announcement" within the next two weeks that will have a "profound effect on the things that we're talking about." The president was speaking from the Rose Garden about his health care-related actions thus far, including a new, expanded use of tax-free health care accounts used by employers.
"It's going to be something really incredible," Trump said. "Nobody knows what it is. It's going to be a big surprise, but it's going to be a very pleasant one."
The White House hasn't said exactly what the president is referring to - but hospitals and insurers are worriedly eyeing a potential executive order reportedly being readied by the departments of Health and Human Services, Labor and Justice. The order, which my Washington Post colleagues Amy Goldstein and Josh Dawsey reported on a few weeks ago, could require them to publicize the discounted rates they negotiate for medical services.
Cloaked in secrecy, these rates are part of a bewildering health-care pricing system that leaves many Americans in the dark about how much their care costs and the share they'll have to pay for it. As a result, consumers have limited ability to make informed financial decisions when obtaining care or buying prescription drugs, and providers have little incentive to lower prices.
That's why the issue of transparency has emerged as a key goal for both HHS and members of Congress as they pursue a basket of initiatives to lower health-care costs. Republicans - who are hesitant about more heavy-headed measures to extract lower prices from industry - have especially embraced the goal of transparency to force more competition into the sector.
"No American should be blindsided by bills for medical services they never agreed to in advance," Trump said. "We're promoting price transparency to force competition and drive down cost."
The pending executive order probably wouldn't create policies right away. Instead, the president would direct federal agencies to pursue multiple new regulations aimed at price transparency, Amy and Josh reported.
Besides requiring disclosures from insurers and hospitals, the order could also make it easier for Medicare enrollees to find out what they would pay for treatment at various hospitals by widening the range of services for which hospitals must post their prices. It could also include an effort to promote more competition among hospitals by slowing a trend toward consolidation.
The policies are certain to engender firm resistance from hospitals and insurers, which argue that simply listing prices wouldn't necessarily help consumers make informed decisions. Because patients with insurance don't pay the full price of medications and services, requiring the disclosure of price negotiations wouldn't directly help consumers and could even cause prices to rise further, they'll argue.
That's precisely the argument hospitals have levied against a requirement under the Affordable Care Act that they publicize what's known as their "chargemaster" - their list prices for all the services they provide. Journalist Steven Brill brought additional attention to the chargemaster with his 2013 Time magazine article "Bitter Pill," in which he detailed how chargemaster prices vary dramatically between hospitals, automatically increase every year and often appear arbitrary.
Hospitals had to start complying on Jan. 1 with the ACA requirement to publish their chargemaster in a computer-friendly format, under rules finalized last year by the Centers for Medicare and Medicaid Services. Yet they've got a point - publicizing their prices doesn't necessarily mean it's easy for people to ingest.
"What's resulted - confusing, unwieldy lists of thousands of goods and services posted on thousands of individual hospital websites - is of dubious relevance to patients in its current form," says an analysis by the Commonwealth Fund.
While transparency is a worthy goal, there are a few reasons it might not help lower health-care prices in the same way it assists in other industries. Hospital patients usually have no idea what services they'll end up needing during a visit or stay. And shopping for care is incredibly difficult because it requires a huge amount of information about treatments that is hard for most patients to absorb or even obtain.
"In reality, patients receive a complex package of services during an episode of care, such as a knee replacement," the Commonwealth authors wrote. "Hospital-pricing information should be presented in the same way. In additional, patients covered by insurance rarely pay hospitals' published list prices."
Of course, industry opposes regulations it thinks will harm its bottom line or worsen its public perception. Other corners of the country's health-care complex have lobbed similar criticisms whenever the administration has tried to force transparency.
The pharmaceutical industry hates an HHS regulation finalized last month requiring drugmakers to include the list price of drugs in television advertisements. Amgen, Eli Lilly and Merck are suing HHS to block the rules, my colleague Christopher Rowland reported Friday. The drugmakers say the requirement not only violates their free speech rights, but are "entirely unnecessary, bad for patients and detrimental to healthcare."
"The lawsuit claims that the list price required to be disclosed in advertisements is not meaningful because it doesn't take into account discounts, insurance coverage, deductibles and co-payments that affect what patients actually pay for their drugs," Chris wrote.
The drug manufacturers are even arguing that disclosing high list prices could hurt health-care costs in the long run by misleading people who have insurance.
"The rule is . . . likely to cause many patients to overestimate how much they would have to pay for treatment, and indeed to cause many patients to conclude - incorrectly - that it is not worth asking their doctors about the advertised product even though the treatment might save or significantly improve the quality of their lives,'' according to the lawsuit, filed in U.S. District Court in Washington.
But that contention - that transparency is sometimes harmful - isn't one HHS Secretary Alex Azar is likely to buy, either from pharmaceutical companies or from hospitals and insurers.
"Claiming list prices don't matter is almost the same as claiming there is no problem with high drug costs at all - and I don't think many American seniors or patients with serious illnesses would say that's the case,'' Azar said while rolling out the final rule on TV ads.
Whatever Trump rolls out next, it will be with an eye to his bid for reelection next year. The president told George Stephanopoulos in an interview with ABC News that health care will be a priority for his campaign, saying he plans to release a new health plan in "about two months. Maybe less." He said it would be announced before the election.
"We already have the concept of the plan, but it'll be less expensive than Obamacare by a lot. And it'll be much better health care," he said in the interview that aired Sunday.
He acknowledged the plan's success would be conditional on Republicans "winning back the House, Senate and the presidency. You need the three."
And he lamented Republicans' failed attempt at repealing and replacing the ACA, saying "we almost had health care done. Health care's a disaster, Obamacare," he said. "We almost had it done. . . We would have had great health care. So we're going to do that if we win the House. If we win back the House, we're going to produce phenomenal health care."
At one point during the same interview, Trump - who is a self-professed "germaphobe" - asked his acting chief of staff Mick Mulvaney to leave the room because he let out a cough. "If you're going to cough, please leave the room," the president said. "You just can't, you just can't cough."
"The president was in the middle of answering a question about his financial records when he became distracted by the sharp sound of his chief of staff expelling air from his lungs," our Post colleague Isaac Stanley-Becker writes. "Trump tripped over his words, requesting to Stephanopoulos, 'Let's do that over.' Appearing to point at Mulvaney, he said, 'He's coughing in the middle of my answer.'"