President Donald Trump signed an executive order Tuesday reinforcing federal price transparency requirements for hospitals and insurers, marking a renewed push to ensure patients have access to clear, upfront pricing for medical services. The directive calls for swift implementation and stricter enforcement of the Trump-era price transparency regulations originally established in 2019.
Under the order, the Departments of the Treasury, Labor, and Health and Human Services must ensure that hospitals and insurers “disclose actual prices, not estimates,” allowing patients to compare costs for medical procedures across different providers. The directive also mandates updated enforcement policies to bring noncompliant hospitals and insurers in line with federal transparency rules.
“When healthcare prices are hidden, large corporate entities like hospitals and insurance companies benefit at the expense of American patients. Price transparency will lower healthcare prices and help patients and employers get the best deal on healthcare,” the White House said in a fact sheet.
The push for transparency comes amid reports that hospital pricing remains inconsistent, even within the same region. “One patient in Wisconsin saved $1,095 by shopping for two tests between two hospitals located within 30 minutes of one another,” the White House wrote in a fact sheet.
Trump, who initially introduced the transparency rules during his first term, reiterated the policy’s intent. “Our goal was to give patients the knowledge they need about the real price of healthcare services. They’ll be able to check them, compare them, go to different locations, so they can shop for the highest-quality care at the lowest cost. And this is about high-quality care. You’re also looking at that. You’re looking at comparisons between talents, which is very important. And then, you’re also looking at cost. And, in some cases, you get the best doctor for the lowest cost. That’s a good thing,” he said.
The Trump administration had previously implemented the hospital price transparency rule in January 2021, requiring hospitals to post machine-readable standard charge files for all items and services and provide an online price estimator for at least 300 shoppable services. The initiative extended to insurers, who were mandated to post real-time cost-sharing information online under the No Surprises Act, enforceable from July 2022. By January 2023, insurers had to provide cost estimates for 500 shoppable services, with further requirements expanding in 2024.
Despite these mandates, compliance has remained a challenge. A report from Patient Rights Advocate found that in 2023, only 24.5% of 2,000 hospitals fully adhered to transparency regulations. Noncompliance prompted the Biden administration to impose stricter penalties on hospitals failing to meet the standards. Beginning in January 2022, the Department of Health and Human Services increased fines, setting a minimum daily penalty of $300 for hospitals with 30 or fewer beds and $10 per bed per day for larger hospitals, with a cap at $5,500 per day.
Further updates to the rules last year required hospitals to provide additional pricing data while CMS enhanced its enforcement strategies, reducing the time hospitals had to correct deficiencies. Recent industry reports indicate progress, with a Turquoise Health study showing that by 2023, 90% of 6,357 hospitals had posted machine-readable files containing at least partial service rate information. This represented an improvement of 562 hospitals compared to the previous year.
Compliance among hospitals has reached approximately 70%, according to the American Hospital Association. Commercial insurers have demonstrated even greater adherence, with a 94% compliance rate in making cost estimates available to enrollees, based on a 2023 report from accounting firm EY.
However, a recent analysis (PDF) from Patient Rights Advocate revealed a stark contrast, reporting that only 21.1% of hospitals fully comply with all transparency requirements—a decline from 34.5% the prior year. “The widespread noncompliance of 78.9% of hospitals is due to files not having prices clearly associated with payer and plan names and not following required formats,” Patient Rights Advocate wrote in its 2024 report. “All of the hospitals reviewed for this report posted a machine-readable file, though 532 hospitals’ files failed the Centers for Medicare & Medicaid Services (CMS) Validator Tool.”
In response to violations, CMS has issued civil monetary penalties against 18 hospitals since enforcement began in 2022, with fines ranging from $44,000 to $979,000.
Trump’s renewed order is expected to amplify scrutiny on hospitals and insurers that continue to lag in compliance. The administration argues that improved transparency will drive competition, lower costs, and ultimately benefit consumers who often face unpredictable medical bills.
The effectiveness of price transparency efforts remains a point of debate. While proponents argue that open pricing can empower patients to make informed healthcare decisions, critics contend that pricing alone does not necessarily equate to better affordability, especially given the complexity of insurance coverage and provider negotiations.
As the enforcement landscape evolves, hospitals and insurers will need to adapt quickly to avoid financial penalties and reputational risks. Whether the renewed push will achieve meaningful cost reductions for patients remains to be seen, but the order underscores the continued focus on healthcare transparency as a key policy issue.
