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Yahoo
2 days ago
- Health
- Yahoo
America might finally make childbirth free—and moms could be the biggest winners
'This is how much it costs to give birth in America: $44,318.41.' That was the now-viral TikTok from a mom just days postpartum, scrolling through the itemized bill at home. Her insurance only covered $20,353.62—despite paying $2,500 a month for coverage for her family of five. This mom's story isn't an outlier. According to the Peterson-KFF Health System Tracker, privately insured families in the U.S. pay an average of $3,000 out-of-pocket for childbirth on average—just for having a baby. By 'choosing' to have a baby with a midwife in a birth center, I personally had to pay a $10k fee upfront. (Wanting midwifery care in a calm setting for my super fast labors didn't feel like a choice, but in America, it is.) Moms bear so many burdens for having babies. And one devastating cost that sets so many families back financially when they're just beginning life together is the price of childbirth, even with insurance. We're talking million-dollar NICU bills. $50k c-section charges. A financial punishment for doing the most critical work in a country: bringing the next generation of citizens into the world. But that may soon change. A bipartisan group of senators has introduced a bill that could be a game-changer for millions of American families. The Supporting Healthy Moms and Babies Act (S.1834) was announced on May 21, 2025, and aims to eliminate all out-of-pocket costs related to prenatal care, childbirth, and postpartum services for those with private health insurance. The bill's sponsors—Sens. Cindy Hyde-Smith (R-MS), Tim Kaine (D-VA), Josh Hawley (R-MO), and Kirsten Gillibrand (D-NY)—say the legislation is about protecting families from being buried in medical debt at one of the most vulnerable times in life. 'Bringing a child into the world is costly enough without piling on cost-share fees that saddle many mothers and families with debt,' Sen. Hyde-Smith said in a statement announcing the legislation. 'By relieving financial stresses associated with pregnancy and childbirth, hopefully more families will be encouraged to embrace the beautiful gift and responsibility of parenthood.' A companion bill is expected in the House, led by Rep. Jared Golden (D-ME), who told Vox, 'This idea is simple and powerful: Pregnancy and childbirth are normal parts of family life. So, insurance companies should treat it like the routine care it is and cover the cost—not stick people with huge medical bills.' While the average out-of-pocket cost is around $3,000, the financial burden can be far worse for many: 17% of privately insured moms face bills over $5,000 1% are hit with bills exceeding $10,000 17.5% of women with private insurance report problems paying medical bills Nearly 9% say they couldn't pay them at all These numbers are not just statistics—they represent real parents delaying care, going into debt, or struggling to recover financially in the fragile weeks after childbirth. If passed, the bill would expand the list of 'essential health benefits' under the Affordable Care Act to include full-spectrum maternity care. Medicaid already covers these services in full, and that's how 41% of births in the U.S. are paid for. But for the 178 million people on private insurance plans? Birth is still a budget-buster. The new legislation would require private insurers to pick up the tab. That means: Prenatal care (including appointments and ultrasounds) Labor and delivery Hospital stays Postpartum recovery and mental health care Neonatal and perinatal services Lactation support The estimated premium hike to cover it all? About $30 per year, according to Lawson Mansell, policy analyst at the Niskanen Center, who conducted the cost modeling for the bill. Mansell told Vox this proposal is the simplest way, on an administrative level, to make birth free. Related: Too many U.S. moms are in debt from giving birth. They deserve better. Beyond the financial relief, this bill has the potential to improve health outcomes for moms and babies. Research backs this up: A report by the Washington State Office of the Insurance Commissioner found that eliminating cost-sharing for prenatal services is associated with improved maternal and infant outcomes, including fewer preterm births and higher birth weights. So in addition to relieving the stress families face, covering prenatal care fully makes it more likely that moms actually get it. Another study published in BMC Public Health linked removing financial barriers under the Affordable Care Act to increased use of preventive care, such as mammography and Pap tests. While the study focused on these services, the findings suggest that eliminating financial barriers can encourage timely and consistent healthcare utilization. The bill's sponsors come from across the political spectrum—and so do its supporters. Everyone from the American Medical Association and the American College of Obstetricians and Gynecologists to anti-abortion groups like Americans United for Life and Susan B. Anthony Pro-Life America have voiced support. Even Planned Parenthood Action Fund commented they 'generally supports legislation to make the cost of maternal health care and parenting more affordable.' Related: The cost of giving birth is getting more expensive—and some families are getting hit with childbirth debt If the bill becomes law, the financial landscape of pregnancy would change dramatically—especially for those in the 'missing middle': families who earn too much for Medicaid but not enough to easily afford thousands in delivery fees. It would also offer immediate relief for parents managing multiple financial burdens at once: high rent, unpaid leave, child care costs, student loans. You know, new motherhood. Call your representatives. Especially if you have private insurance and have ever been slammed with a delivery bill. You can find contact info at and Share your story. Lawmakers have said constituent birth bill stories played a big role in shaping this legislation. Talk about it on social. If your childbirth costs shocked you, say so. Use hashtags like #MakeBirthFree and tag your reps. This moment is historic not just because it's bipartisan, but because it signals a new kind of family policy thinking: one where moms aren't expected to 'figure it out' in isolation, one giant bill at a time. As Yuval Levin of the American Enterprise Institute put it in a policy brief, 'Substantively and symbolically, bringing the out-of-pocket health care costs of childbirth to zero is an ambitious but achievable starting point for the next generation of pro-family policies.' Whether you're pregnant now or years past it, you probably remember your hospital bill—and you definitely remember how it made you feel. Exhausted. Angry. Maybe even ashamed. This new bill says: No more. And moms deserve that. Sources: Family-Friendly Policies for the 119th Congress. February 2025. AEI. Family-Friendly Policies for the 119th Congress. America might finally make childbirth free. May 2025. Vox. America might finally make childbirth free. Americans United for Life Applauds Bipartisan Innovative Policy Proposal. May 2025. America United for Life. Americans United for Life Applauds Bipartisan Innovative Policy Proposal to Make Maternal Healthcare More Affordable. AMA advocacy to improve maternal health. May 2025. AMA. AMA advocacy to improve maternal health. Impact of removing cost sharing. 2019. BMC Public Health. Impact of removing cost sharing under the affordable care act (ACA) on mammography and pap test use. New bipartisan proposal would remove childbirth costs. May 2025. Niskanen Center. New bipartisan proposal would remove childbirth costs and confusion for parents. Characteristics of Mothers by Source of Payment for the Delivery. May 2023. CDC. Characteristics of Mothers by Source of Payment for the Delivery: United States, 2021. About the Affordable Care Act. Us Department of Health an Human Services. About the Affordable Care Act. Out-of-pocket medical bills childbirth. National Library of Medicine. Out-of-pocket medical bills from first childbirth and subsequent childbearing. The Association of Childbirth with Medical Debt. National Library of Medicine. The Association of Childbirth with Medical Debt in the USA, 2019–2020. Sentators introduce bill to ease financial burden of pregnancy. Cindy Hyde-Smith. SENATORS INTRODUCE BIPARTISAN BILL TO EASE THE FINANCIAL BURDEN OF PREGNANCY, CHILDBIRTH. Women who Give Birth Incur Nearly $19,000 in Additional Health Costs. KFF. Women who Give Birth Incur Nearly $19,000 in Additional Health Costs, Including $2,854 More that They Pay Out of Pocket.
Straits Times
5 days ago
- Health
- Straits Times
The Trump effect on high drug prices
US President Donald Trump said on May 11 that he wants prices of drugs sold in the US to reflect the cheapest prices globally. PHOTO: AFP News analysis The Trump effect on high drug prices Salma Khalik explains why US leader Donald Trump is up in arms against high drug prices, how pharmaceutical companies have reacted, and what effect his executive order could have on the rest of the world. SINGAPORE – If US President Donald Trump had his way, the price of medication in the US would fall drastically – while the rest of the world would end up paying more, possibly a lot more. His declaration on Facebook on May 11 that he wants prices of drugs sold in the US to reflect the cheapest prices globally sent shares of large pharmaceutical companies tumbling across the world, with several losing 3 per cent or more of their stock market value within hours. But the steep plunge reversed just as abruptly once the executive order signed by Mr Trump on the morning of May 12 was made public. This was because the order lacked details, which led some observers to note that there was more bark than bite in his words . Today, the US, with 340 million people, or less than 5 per cent of the world's population, spends about US$5 trillion (S$6.5 trillion) a year on healthcare – and accounts for about 45 per cent of global pharmaceutical sales. One reason is that people in the US consume more medicine per capita than the rest of the world. Since they use more, they buy more, and hence spend more on drugs. Another reason, which is what upsets Mr Trump, is that prices of drugs, particularly those still under patent, are generally much higher in the US than anywhere else in the world. Pharmaceutical companies say the high prices paid in the US allow consumers there to be among the first to get any new treatments. Mr Trump gave the example of a 'fat drug', without naming it, that costs 10 times more in the US than in some other countries. He was likely referring to the highly popular diabetes drug Ozempic, which is also prescribed for weight loss under the trade name Wegovy. A 2023 comparison of prices by the independent Peterson-KFF Health System Tracker found 'the list price for one month of Ozempic in the US (US$936) is over five times that in Japan (US$169), and about 10 times more than in Sweden, the United Kingdom, Australia and France'. Drug companies have historically priced their products differently in different countries. Generally, richer countries tend to pay more than poorer countries with lower purchasing power. The Singapore Association of Pharmaceutical Industries (Sapi) told The Straits Times: 'Pharmaceutical companies work with local governments and healthcare systems to offer flexible and tailored pricing solutions based on each country's needs, helping make medicine and vaccines more affordable and accessible, especially in countries with fewer resources. 'Tiered pricing is one of the most effective and sustainable ways in which pharmaceutical companies help to improve and sustain access to medicine globally.' The cost of medication in Singapore, for example, is much higher than in neighbouring countries, so it is not uncommon for people to cross the Causeway, where savings could be significant, to buy their medicine. Having said that, rich countries also can get drugs more cheaply because of their buying power and ability to negotiate better prices. Australia, for example, sets a cap on the price of drugs it allows to be sold in the country. This can mean, however, that fewer drugs are available in Australia – compared with Singapore, for instance – as some pharmaceutical companies will refuse to sell at the designated prices. Even within the US, drug prices do vary. But the US does not benefit from its large purchasing power because the prices were negotiated individually between drug companies and their buyers – typically insurance companies, pharmacy chains and hospitals. Mr Trump's executive order states: 'The inflated prices in the United States fuel global innovation while foreign health systems get a free ride.' Associate Professor Wee Hwee Lin of the Saw Swee Hock School of Public Health said one of the main reasons drug prices are so high in the US is that there has been no direct price control mechanism, unlike in many other developed countries. Drugs have to prove only safety, efficacy and quality – but not cost-effectiveness, as is required in some other countries. She added that many pharmaceutical companies also choose to launch in the US first, as they can command the highest prices there, thus setting the bar for the rest. This may change with the passage of the Inflation Reduction Act (IRA) in 2022, which, for the first time, empowered Medicare to negotiate prices directly with drug companies. It had previously been legally prohibited from negotiating drug prices under a 'non-interference clause' in the Medicare Prescription Drug, Improvement and Modernisation Act 2003. Medicare, the national insurance for people over 65 and those with disabilities, is the single largest payer of healthcare in the US, and covers more than 55 million Americans for outpatient prescription drugs. Said Prof Wee, whose teaching areas include pharmacy practice: 'Prior to the IRA, Medicare was explicitly prohibited from negotiating prices directly with pharmaceutical companies. Therefore, drug prices in the US may be considered to be market-based pricing, based on supply and demand.' Even with the passing of the IRA, the cheaper negotiated prices will start to take effect only from 2026. Since the IRA was passed, Medicare has completed negotiations on 10 drugs that alone cost it US$50.5 billion in 2022, or about 20 per cent of its gross total drug spending . The drugs, which are used to treat chronic diseases such as diabetes and cancer, will have maximum prices that are 38 per cent to 79 per cent cheaper from January 2026. The IRA allows it to negotiate prices for 10 drugs in the first year, 15 in the next two years, and 20 a year thereafter. It has embarked on negotiations for the next 15 drugs, also for chronic diseases like diabetes, cardiovascular disease and cancer, to take effect from January 2027. Ozempic is one of them. Legal challenges have been mounted against the drug negotiation programme. According to a US Congress report, 'beginning in June 2023, several pharmaceutical manufacturers and trade associations filed lawsuits in various federal district courts alleging that the programme was unconstitutional'. So far, most have failed, but some court cases are still ongoing. In contrast, some Congress members want to expand the programme to more drugs in the market. Prof Wee said most other developed countries exert some control over drug prices by government intervention that will 'thus introduce market failure'. Britain's National Institute for Health and Care Excellence is a forerunner of healthcare technology assessment, which looks at whether the benefits of new treatments justify the price asked for. If they do not, the treatment would not be recommended to the National Health Service, which pays for almost all drugs used in the country. Many other countries in Europe and Asia have similar agencies to control the cost of new and expensive treatments. Singapore recently tasked the Agency for Care Effectiveness with studying new treatments and deciding if they provide value for money – changing the nation from being a passive price taker to one that has some clout in deciding the 'correct' pricing for the benefits from a treatment. It resulted in the Cancer Drug List, a list of treatments approved for insurance coverage, which has led to across-the-board savings of about 30 per cent in the public sector. At the upper ranges, the prices of cancer drugs fell by as much as 60 per cent. Pharmaceutical companies are still free to sell their cancer drugs at any price – but unless their price to the public sector is deemed cost-effective, they cannot be covered by MediShield Life or Integrated Shield Plan insurance, which pays for the vast majority of cancer treatments here. Singapore, being a small market, continues to pay a lot more than places like Australia, Taiwan and South Korea for many other drugs. Prof Wee pointed out that another major reason for the high drug prices in the US is the use of middlemen such as pharmacy benefits managers (PBMs). She said PBMs were originally intended to streamline procurement processes and help drive down costs for insurers and employers. 'However, over time, many unintended consequences arose. For example, there is a lack of transparency as regard the amount of rebates PBMs receive from the pharmaceutical companies relative to the list price,' she said. On the day the US President's executive order was signed, Mr Stephen J. Ubl, president and chief executive of the Pharmaceutical Research and Manufacturers of America, released a statement saying: 'The US is the only country in the world that lets PBMs, insurers and hospitals take 50 per cent of every dollar spent on medicine. 'The amount going to middlemen often exceeds the price in Europe. Giving this money directly to patients will lower their medicine costs and significantly reduce the gap with European prices.' Prof Wee said the influence of PBMs goes beyond just taking a big cut from the sale of drugs: 'PBMs may purchase based on how much rebate they can obtain rather than what is the least-cost option. Many of the PBMs are also owned by insurance companies. 'It is not clear how the financial interests of the insurance companies are prioritised over cost savings or patient outcomes.' Many drug companies argue that a large drop in their revenue could affect their ability to research and develop new treatments, which would be a sad loss to the world. However, there is no evidence to suggest this would actually happen. Mr Trump, who has not mentioned the Medicare programme, nevertheless wants drugs in the US to be sold at the 'most-favoured-nation price'. If that happens, prices of drugs elsewhere could go up as a result. The order said: 'My administration will take immediate steps to end global freeloading and, should drug manufacturers fail to offer American consumers the most-favoured-nation lowest price, my administration will take additional aggressive action.' However, it did not spell out what such aggressive actions might be. Furthermore, Mr Trump had tried something similar in his first term in office, only to be blocked by the courts. Most attempts to control drug prices will need congressional approval – something that could take years to achieve, if at all possible. Mr Trump ordered his Secretary of Health and Human Services, Mr Robert F. Kennedy Jr, to establish a mechanism through which American patients can buy their drugs directly from manufacturers, bypassing middlemen. This sounds promising on paper, as it would cut the price of drugs by half. But in reality, it is far more complex. If the current intermediaries between drug company and patients are removed, some other mechanism needs to take their place to ensure drugs get to patients. It might cut the price, but there would certainly be some distribution cost. Mr Trump also suggested importing 'prescription drugs on a case-by-case basis from developed nations with low-cost prescription drugs'. Even if the laws in the US can be amended to allow for this, the quantities imported are unlikely to be large enough to move the needle. Prof Wee said that to systematically bring down the prices at which drugs are sold, the US first needs to define the set of countries that it will refer to for international reference pricing – and whether this is based on the list price or the net amount paid after negotiations, including volume discounts. While list prices are readily available, negotiated prices are usually kept confidential. She added that the US would also need to conduct health technology assessments to decide on what drug pricing is justifiable, at a national level. Any moves in this direction will certainly be challenged as unconstitutional, as it could prevent patients from assessing treatments deemed not to provide value for money. In contrast, many countries in Europe and Asia, including Singapore, are willing to forgo access to new therapies if they are found to be too costly for the additional benefits provided. In spite of the difficulties in implementing Mr Trump's directive, his declaration of war against high drug costs in the US is likely to result in some price reduction. Most industry experts expect pharmaceutical companies to reduce prices somewhat in an effort to allay his wrath. This will be especially for drugs that are nearing the end of their patent – so that Mr Trump can declare his move a success. Prof Wee said it is 'hard to say at the moment how the pharmaceutical companies will respond'. Should there be significant cuts in drug prices in the US, she anticipates a chain effect, which will lead to a new equilibrium in pricing globally, including in Singapore. US Secretary of Health and Human Services Robert F. Kennedy Jr at a news conference about prescription drug prices at the White House on May 12. PHOTO: AFP Going forward, exactly what will happen remains anybody's guess. But should the US government try to impose severe price cuts, the drug companies will likely take legal action to block such moves, given that billions of dollars are at stake. And pharmaceutical companies have deep pockets – with the top handful each raking in revenues in excess of US$50 billion in 2024. Mr Trump's diatribe on high drug prices in the US appears to target Europe. Referring to how countries there 'force' pharmaceutical companies to cut the cost of drugs, he said 'the European Union has been brutal, brutal. And the drug companies actually told me stories, it was just brutal'. So, rather than going after the pharmaceutical industry directly, he just might penalise countries that he feels are 'suppressing' drug prices to the detriment of the US. Mr Trump is known for doing the unexpected, such as linking a 20 per cent tariff on goods from China to the inflow of fentanyl to the US. So, the penalty could be anything, including higher tariffs on totally unrelated goods to something no one has even thought about. Any changes, big or small, in drug prices in the US will likely have some spillover effect for Singapore. Ms Poh Hwee Tee, president of Sapi, told ST: 'While it is too early to determine the full extent of the impact of the US government's most-favoured-nation executive order, Sapi and its members are closely monitoring the developments and remain committed to working in close partnership with the Ministry of Health and other stakeholders to identify and address any potential challenges. 'Our focus remains on supporting Singapore's healthcare ecosystem and working collaboratively with stakeholders to ensure sustainable access to innovative medicine and vaccines for patients in Singapore.' Singapore spends about $1 billion a year on medicine. If prices were to go up by, say, 20 per cent across the board, that would be an additional $200 million a year. While this might not amount to much for government coffers and much of the price increase for subsidised patients might be cushioned by higher subsidies, the increase may be significant for private patients. A reassuring thought is that any increase in prices will affect only drugs that are still under patent. A lot of commonly used drugs here for conditions like diabetes, high cholesterol and blood pressure, are generic, and hence cheap. There is unlikely to be any impact on these. Join ST's Telegram channel and get the latest breaking news delivered to you.
Yahoo
29-04-2025
- Business
- Yahoo
This Florida woman's insurer didn't pay a $150K bill for ‘necessary' surgery — after telling her they would
After undergoing a medically necessary surgery on her colon, Madeline Rogers of Zephyrhills, northeast of Tampa, was shocked to discover that she was stuck with a $150,000 bill due to a denied insurance claim. I'm 49 years old and have nothing saved for retirement — what should I do? Don't panic. Here are 5 of the easiest ways you can catch up (and fast) Thanks to Jeff Bezos, you can now become a landlord for as little as $100 — and no, you don't have to deal with tenants or fix freezers. Here's how Nervous about the stock market in 2025? Find out how you can access this $1B private real estate fund (with as little as $10) 'I was told every time: denied. Denied. Denied," Rogers told the ABC Action News I-Team. 'Somebody has got to intervene and stop what's going on with this healthcare system.' Receiving a bill of this magnitude could completely derail anyone's financial future. While recovering from surgery, managing the stress of this unexpected bill is the last thing that a patient wants to deal with. Unfortunately, medical debt isn't a rare occurrence in America. About 20 million adults owe some level of medical debt, according to the Peterson-KFF Health System Tracker. The day before heading into surgery, the hospital called to cancel because they hadn't received the approval from the insurance company. Rogers called the insurance company for more information about the late approval. She said, 'I had spoken to the insurance company about the approval, and I was told on a recorded line, do not worry if you don't have the authorization ahead of time. As long as the doctor deems it medically necessary, you won't have any problems.' Since her condition was life-threatening, Rogers decided to move forward with the surgery anyway. She paid $26,000 upfront to receive the care. After the surgery, Rogers received a bill from the insurer indicating that they had denied the claim, and she owed $150,000 for her care. Immediately, Rogers started the appeals process. She went through two rounds of appeals and a peer-to-peer review by medical professionals without getting anywhere. Finally, she reached out to the I-Team at ABC Action News to share her story. The I-Team reached out to the insurance company, Oscar, about the issue. The next day, Rogers received news that her claim was approved. 'I was floored to hear from them so quickly," Rogers told the I-Team. Read more: This hedge fund legend warns US stock market will crash a stunning 80% — claims 'Armageddon' is coming. Don't believe him? He earned 4,144% during COVID. Here's 3 ways to protect yourself People in the U.S. owe a total of at least $220 billion in medical debt. Most of that burden is on individuals who owe more than $10,000 in medical debt. If you find yourself facing a mountain of medical debt after a denied claim, start by appealing your insurance company's decision. Patients with denied claims have the right to appeal the decision both internally and externally. Generally, you'll start with an internal appeal, which involves your insurance company conducting a full review of the situation. Without a resolution, you can move to an external appeal, which involves an independent third party reviewing the situation. Another option is to negotiate the medical debt with the provider. In some cases, they might allow you to pay a lower amount to clear the debt. Many hospitals offer some level of financial aid. If you qualify for financial aid, this could relieve your medical debt burden. When possible, start with the hospital's billing department for guidance on your options. But if you need additional help, consider working with a medical bill advocate. Medical bill advocates can help you navigate the billing system. In the best-case scenario, the insurer will cover the claim. But even if your insurer foots most of the bill, you'll likely face some out-of-pocket costs surrounding a major medical event. With that, it's helpful to build up savings in a Health Savings Account or a Flexible Spending Account to cover medical costs. Finally, building a solid emergency fund to lean on during unexpected medical events can take some of your financial stress out of the equation. Want an extra $1,300,000 when you retire? Dave Ramsey says this 7-step plan 'works every single time' to kill debt, get rich in America — and that 'anyone' can do it Rich, young Americans are ditching the stormy stock market — here are the alternative assets they're banking on instead Here are 5 'must have' items that Americans (almost) always overpay for — and very quickly regret. How many are hurting you? This article provides information only and should not be construed as advice. It is provided without warranty of any kind.
Daily Mail
23-04-2025
- Politics
- Daily Mail
The View's Alyssa Farah Griffin and Sunny Hostin duke it out over 'racism' claims
Sunny Hostin of The View hurled a not-so-subtle accusation of racism at President Donald Trump for his administration's fledgling plan to give a $5,000 'baby bonus' to every American mother after they give birth. The policy, which he told reporters Tuesday 'sounds like a good idea,' would act as an incentive to boost the birth rate in the United States, which has been declining since 2007. In 2024, the US finally reversed the years-long trend with a one percent increase in births when compared to 2023, according to provisional data from the Centers for Disease Control (CDC). Talking about Trump's baby bonus plan, Hostin referenced the CDC data and examined which racial groups had the most babies last year. 'That [one percent] increase was with Hispanic mothers and Asian mothers. Aha! So, they don't seem to be concerned about that increase. They seem to be more concerned about a decrease in other populations,' Hostin said. Hispanic women gave birth to nearly 4 percent more children, while the number of Asian babies increased by more than 5 percent, according to the CDC. Joy Behar urged Hostin to say what she was implying, that Trump is only concerned that the birth rates among white people are declining. In 2024, there was a modest 0.37 percent yearly decrease in the number white babies that were born. Hostin was reluctant to go all the way with her point, but Alyssa Farah Griffin, the resident conservative on the panel pressed her liberal co-hosts, asking them when Trump had ever said his baby subsidy would only be for white families. 'Have they said that anywhere? I feel like, just to be fair,' said Griffin, who was briefly Trump's presidential assistant in 2020. 'Have they said that this is to target only white families?' Hostin then backed off, saying, 'Oh, I didn't say that. You have to read the stats.' Behar, more willing to cast aspersions, jumped in: 'It's in between the lines. They're not going to say it.' Earlier in the segment, Whoopi Goldberg also made her feelings known on Trump's proposal. 'I am incredibly insulted by this because clearly they don't how women's bodies work and they don't know what it costs to raise a child or just have a child,' Goldberg said. 'And $5,000? I don't know what $5,000 is supposed to do.' The average cost associated with pregnancy, childbirth and post-partum care was $18,865 in 2022, according to the Peterson-KFF Health System Tracker. If a mother is enrolled in a large group healthcare plan with her employer, however, out-of-pocket costs average out to $2,854. As early as March 2023, Trump has been supportive of financially compensating women who give birth. 'We will support baby bonuses for a new baby boom. How does that sound? That sounds pretty good. I want a baby boom,' he said at the Conservative Political Action Conference that year. This graphic shows the steadily declining birth rate in the United States since 2007. In 2024, there was a less than one percent increase in the birth rate, reversing a 16-year trend The White House has been hearing a plethora of proposals on measures to reverse declining birthrates in recent days. One is the $5,000 baby bonus. Another policy would reserve 30 percent of scholarships for the prestigious Fulbright fellowship for applicants who are married or have children. A third proposal calls for government funded programs to educate women on their menstrual cycles so they can better understand when they are ovulating and able to conceive. It's not yet clear which of these three is going to win out in the end, or if the administration seeks to pursue some or all these policies in some form. Trump, who referred to himself as the 'father of IVF' on the campaign trial in October 2024, signed an executive order that seeks to make in-vitro fertilization more accessible in February. The order tasks the assistant to the President for Domestic Policy with looking into recommendations on how to make IVF 'drastically more affordable.' His press secretary Karoline Leavitt said that the order will 'aggressively' reduce out-of-pocket costs for the procedure that costs generally costs between $12,000 to $25,000 per cycle, according to the text of the order.
Miami Herald
03-04-2025
- Health
- Miami Herald
How much will that surgery cost? Hospital prices remain largely unhelpful
It's a holy grail of health care: forcing the industry to reveal prices negotiated between health plans and hospitals — information that had long been treated as a trade secret. And among the flurry of executive orders President Donald Trump signed during his first five weeks back in office was a promise to 'Make America Healthy Again' by giving patients accurate healthcare prices. The goal is to force hospitals and health insurance companies to make it easier for consumers to compare the actual prices of medical procedures and prescription drugs. Trump gave his administration until the end of May to come up with a standard and a mechanism to make sure the healthcare industry complies. But Trump's 2025 order is also a symbol of how little progress the country has made since he issued a similar directive nearly six years ago. Consumers find it only partially useful, and the quality of the information is spotty. A 'bold' first step in pricing that fizzled The 2019 order was 'pretty bold,' said Gary Claxton, a senior vice president at KFF, a health information nonprofit that includes KFF Health News. 'They basically went at the providers and the plans and said, 'All this data you think is confidential we're not going to make confidential anymore.'' What followed was, to consumer advocacy groups, a disappointment. Hospitals and insurers posted on websites voluminous, complex, and confusing data about their prices. The information has been a challenge for even experts in health care pricing to navigate, let alone consumers. Some members of Congress filed legislation to put the force of law behind price transparency requirements; those bills died. And President Joe Biden's administration was criticized for not more stringently enforcing the regulations, with one consumer advocacy group even buying a Super Bowl ad featuring the rapper Fat Joe alleging that 'hospitals and insurers hide their prices.' Trump's new order, signed in February, said that hospitals and health plans 'were not adequately held to account when their price transparency data was incomplete or not even posted at all.' The Government Accountability Office reported in October that the Centers for Medicare & Medicaid Services didn't know whether prices reported by the healthcare industry were correct or complete. But CMS, which regulates hospitals, now plans to 'systematically monitor compliance' and help institutions understand the requirements, said Catherine Howden, an agency spokesperson. Howden did not answer questions about whether CMS staffers overseeing price transparency compliance have been fired as part of the Trump administration's wide-ranging effort to cut the federal workforce. 'Zombie' rates and other inconsistencies Meanwhile, independent researchers have found numerous problems with the quality of price data both hospitals and health insurers do share with consumers. A recent report from the Peterson-KFF Health System Tracker found that data reported by four health insurers in New York City often included prices that they say they pay hospitals for services that those health providers don't — or can't — provide. These are called 'ghost' or 'zombie' rates. For example, the health plans reported dentists, optometrists and audiologists receiving payments for knee replacements, gastrointestinal exams, and other procedures unrelated to their specialties. In other cases, the data included different prices for the same service paid for by the same insurer at the same hospital. UnitedHealthcare, for example, reported paying New York-Presbyterian/Weill Cornell Medical Center three rates — $47,000, $64,000, and $70,000 — to treat a heart attack. Or, the insurers reported paying the same price for vastly different services. Aetna, for example, said it paid exactly $6,292 to Mount Sinai Beth Israel hospital for the treatment of respiratory infections, heart attacks, cancers of the digestive tract, kidney and urinary tract infections, and psychosis. Neither UnitedHealthcare nor Aetna addressed the discrepancies in the data. Cole Manbeck, a spokesperson for UnitedHealthcare, said the insurer has met price transparency requirements and urged members 'to use our cost-estimator tools for exact costs based on their specific health plan.' Aetna spokesperson Shelly Bendit referred questions to AHIP, a lobbying and trade association for insurers. Health insurers have 'strongly supported' price transparency, said Chris Bond, a spokesperson for AHIP. The group will work with the Trump administration to provide transparency 'in a way that is meaningful for the end user, while also promoting a competitive private market,' Bond said. What's a health consumer to do? Estimates and total prices aren't very useful for consumers, who are mainly interested in what they'll ultimately have to pay out-of-pocket, said David Cutler, a professor of applied economics at Harvard University. That can vary by health plan, depending on deductibles, co-payments, and other fees. 'Most of the price transparency information doesn't have that,' he said. It also doesn't give consumers information about the quality of care, Cutler added, which can lead to an old bias. 'It's kind of like wine when you go to the restaurant,' he said. 'People assume that the more expensive wine is better.' Cutler said he's skeptical that price transparency will lower costs for patients. But he said it may offer insight to hospitals and health plans about what their competitors are charging and paying for services — knowledge that could inadvertently lead to price increases if hospitals that receive a lower rate than a competitor demand higher reimbursement from health plans. Trump's recent executive order notes that the top quarter of the most expensive health service prices have dropped by 6.3% a year since his 2019 order. However, the same research referenced in the executive order showed that the bottom quarter of services got more expensive, at a rate of about 3.4% per year, according to the analysis by Turquoise Health, a health care price data firm that examined rates at more than 200 hospitals in the 10 largest U.S. markets. Some patients say that with research and persistence, they've been able to make price transparency work for them. Theresa Schmotzer, 50, of Goodyear, Arizona, said she used hospital price data to save nearly $3,000 on outpatient surgery to have a fibroid removed last year. Schmotzer, who has health insurance, said the hospital first told her she would owe $3,700 for the procedure and wanted the payment upfront. But she was skeptical. She said her health insurer was unable to quote a price for the procedure or specify how much she would owe. The morning of the surgery, Schmotzer said, she found a spreadsheet online at that included different prices paid by insurers, including hers. The reported price for the procedure was closer to $700, she said. Schmotzer said she took a printout of the spreadsheet to the hospital and presented it during preadmission. She paid her $300 deductible and told the hospital to bill her for the rest. A few months later, she said, the bill arrived in the mail for the remaining $400, which she paid. When people go for surgery and aren't clear upfront what the cost will be, it stokes fear, she said. 'Because they're going in blind.' Next steps for hospital and health plan pricing Hospitals say they want to work with federal regulators and comply with reporting requirements, said Ariel Levin, director of coverage policy for the American Hospital Association, which represents about 5,000 institutions. Levin said consumers should be given the price of services and 'a more comprehensive estimate' that represents an entire episode of care and the amount they'll owe out-of-pocket, based on their health plan. CMS has developed rules since Trump's 2019 order to make price information reported by hospitals and health plans easier to understand, and the agency has fined more than a dozen hospitals for failing to comply. Federal rules allow hospitals to report an estimate, a price range, or a historical rate for their services, while health plans can adjust prices based on factors like the severity of the case, the length of treatment, and a patient's age. KFF's Claxton said that such flexibility doesn't allow for 'apples-to-apples comparisons' and that the data must be reliable before researchers can use it to better understand health care costs. 'It doesn't seem to be that yet,' he said. Much remains to be done before price transparency lives up to expectations that it will increase competition and lower costs, said Katie Martin, chief executive of the Health Care Cost Institute, a nonprofit research group. Price transparency alone is not a silver bullet, Martin said. It's 'a critical first step' for employers, lawmakers, regulators, and others to better understand how money flows through the health care system and how to make it more efficient, she said. 'It's not the whole thing.' KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
