Will Republicans Support Transparent Hospital Prices?

Ascension Columbia St. Mary’s Hospital in Milwaukee. File photo by Coburn Dukehart / Wisconsin Watch

In June 2023, Republican State Sen. Mary Felzkowski of Tomahawk introduced a bill requiring price transparency by hospitals in Wisconsin.

The bill’s language was very specific, requiring hospitals to publish their standard charge for 300 “shoppable services” on their website that “must be available at all times to the public in a machine-readable format.” The legislation called for fines for non-compliance of $600 per day for the smallest hospitals and up to $10,000 per day for the largest hospitals.

The bill was co-sponsored by six other state senators and 18 Assembly representatives. It was backed by Wisconsin Manufacturers & Commerce, the biggest lobbyist in the state Capitol, and the conservative Wisconsin Institute for Law and Liberty, two of the most important Republican advocacy groups. And polls show Americans overwhelmingly support hospital price transparency, with 94% in favor. But after receiving a public hearing the bill died in the Senate, where Republican leaders never allowed it to be voted on.

But Felzhowski hasn’t given up. She has now won the number two position, President of the Senate, and intends to introduce a similar bill when the next Legislature convenes in January. “I very much hope we can work on a bipartisan basis,” she said in an interview with Wisconsin Public Radio.

The logic of price transparency is obvious, she noted in the interview: “I appeal to everyone: What do you purchase that you don’t know the cost before you purchase it?”

Without knowing the prices, individual consumers and employers creating health care plans for employees can’t choose the cheapest option. “One thing we have found is there is absolutely no correlation between cost and quality,” Felzhowski explained. “If employers had this data they could contract with the lowest cost and highest quality contractors. And it would eventually start driving those costs down statewide.”

The ever-rising costs are making health care unaffordable. “The saddest thing I see out there is people are not going to the doctor,” Felzhowski said. “They’re not afraid of the diagnosis. They are afraid of medical bankruptcy. They’re afraid of the costs.”

All of this, of course, is not news to legislators. So why did Republicans essentially kill the bill last year?

The Wisconsin Hospital Association (WHA) opposed the law, arguing it was unnecessary given a similar requirement that already exists at the federal level. “Wisconsin hospitals are national leaders in complying with federal transparency law” and the law’s penalties are “being rigorously enforced” by the federal government, said Eric Borgerding, president and CEO of the Wisconsin Hospital Association (WHA).

But one month after Borgerding made that claim, a report on “Hospital Price Transparency” by the nonprofit Patients Rights Advocate (PRA), “analyzed the websites of 2,000 U.S. hospitals and found only 36% of them (721) to be fully compliant with all requirements of the rule,” as Urban Milwaukee reported. The report found that just 49% of hospitals in Wisconsin were in compliance.

As for the WHA claim that the federal law is rigorously enforced, the PRA report found that “Minimal, lenient enforcement… has led most hospitals to continue to disregard the rule,” preventing consumers “from being able to compare prices, benefit from competition, and be protected from overcharges.”

The WHA has a $10 million budget funded by hospitals to make such claims as Borgerding did. He is paid $1.25 million in annual compensation to run the nonprofit organization, its federal 990 shows.

But that’s nothing compared to what executives at the big hospital chains supporting the WHA receive. As Urban Milwaukee has reported, the most recent 990s showed Ascension paid its top executive about $15 million a year and 6 executives below him $2.8 million to $8.3 million per year. Advocate Aurora paid its 16 staff members compensation that ranged from from $1.34 million to $7.7 million per year; All together the top 16 staff collected $36.75 million. The ever rising cost of medical care underwrites these salaries.

“Hospital prices are far too high,” charges Democratic state Sen. Chris Larson of Milwaukee, who co-sponsored Felzkowski’s bill in 2023. “And they keep going up while the mega-corporations posing as nonprofits that run them keep taking away services from our communities.”

Yet even while reducing services mega-hospital chains have grown in market power and political muscle, becoming ever more formidable. But one state has been willing to take them on. Colorado has passed a bipartisan law creating the Colorado Hospital Price Finder, which “lets users research and cross-reference the cost of specific medical procedures at hospitals across the state using publicly available price information,” as the NPR affiliate in Northern Colorado reported. The new system was created by Patient Rights Advocates, the same group that annually reports on hospital price transparency. Felzkowski pointed to Colorado as a possible model for Wisconsin.

Until now, her push for reform could be quietly killed in Wisconsin, as Republicans ran a gerrymandered legislature. But fair maps have brought the state Senate closer to a potential Democratic takeover and increased the number of Democrats in the Assembly by 10 members. Proposals like this, which have overwhelming public support, will be harder for representatives from both parties to oppose. Felzkowski may be able to get many more co-sponsors for her legislation this time.

And if Republican leaders do decide — once again — to bury her bill, they will hand Democratic legislators a potent issue to run on in the next election. The advent of fair maps could make this an interesting legislative battle to watch.