HA520 Unit 9 Assignment Trump Executive Order

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UNIT 9 ASSIGNMENT 1 Unit 9 Assignment Karen Morehead HA250: Healthcare Financial Management Purdue Global University Sunday, May 21, 2023

UNIT 9 ASSIGNMENT 2 Unit 9 Assignment PART A President Trump’s Executive Order on Improving Price and Quality Transparency in American Healthcare promised transparency and competition. According to Marano and Noussia (2021), the directive was much anticipated in calling for the “development and publication of proposed rules to combat opaque pricing structures that benefit powerful interest groups” (p. 577). The aim, based on the Executive Order, was to push more transparency and afford consumers the capacity to make informed decisions. Pricing models in the care space are observed as convoluted and disruptive to the consumer mentality. The consumers, above all, are patients paying for health care. At face value, the decision indicates that consumers have more awareness over their costs, care, and coverage. The American Hospital Association (AHA), representing those in the hospital industry argued that the new rule would pose a challenge. Stempel (2020) cites the AHA arguing that it would "require them to divert scarce resources to the herculean and inordinately costly task of compiling health care costs” (para 2). The AHA argued that this would reduce competition and increase costs. A federal appeals court disagreed. The 2-0 decision by the U.S. Court of Appeals for the District of Columbia Circuit claimed that the appeal missed the mark, where consumers are likely to pay fewer, not more, costs (Stempel, 2020). The Court agreed with Trump that transparency will ease the process for consumers. The hospital industry will have to compile and expose more data based on the Executive Order and subsequent ruling. The new rule “goes much farther than prior rules by requiring a disclosure of prices based on payer-specific negotiated rates” (Marano & Noussia, 2020, p. 577).

UNIT 9 ASSIGNMENT 3 The aim is to make care costs shoppable and categorical. Many believe this was the plan with Obamacare, where the objective was to establish a free market where one is able to shop for healthcare services based on specificity and income level (Marano & Noussia, 2020). The AHA fought against the new rule proclaiming it was unnecessary and would subsequently lead to higher consumer costs. The legal authorities made the decision that the AHA claim did not hold merit. At face value, Trump’s order prompts the industry to show transparency. An argument can be made that either side has a hidden or non-disclosed agenda. Trump’s agenda on the surface is to reduce pricing for consumers and align the AHA and care industry with transparency and liability. By comparison, a surface level view argues that the AHA uses complication and confusion as a means of trying to block the rule, arguing that more work for the agencies requires more money and added consumer costs. The legal authorities sided with the White House, alleviating any potential issues of illegitimacy in Trump’s push for lower consumer costs and added communication between the providers and patients. PART B California law enacted on July 1, 2017, protects consumers from surprise medical bills when they receive non-emergency services. Ricardo Lara, on behalf of the California Department of Insurance (n.d.) argues that before 2017 consumers would sometimes receive unexpected bills from out-of-network providers when they were seeking services at an in- network facility. The bills were “a result of a billing disagreement between insurers and out-of- network providers” (Lara, n.d., para 1). For example, a consumer had surgery at an in-network hospital but the anesthesiologist providing care was not in the health insurer network. While the consumer did not have a choice in who the anesthesiologist was, the provider sends a bill

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