Senate Bill Pushes for Hospital Price Transparency

Getting clear pricing information from hospitals has long been a challenge in healthcare. Executive orders from both the Biden and Trump administrations have tried, but so far failed, to get providers to share how much different types of care costs. That’s because hospitals have repeatedly dodged these orders, according to the Department of Health and Human Services. And while some fines have been doled out, the cost of care is still unclear. A new bipartisan Senate bill, introduced by Senators Roger Marshall and John Hickenlooper, aims to enforce hospital price transparency by requiring providers to publicly share negotiated insurance rates and cash prices. This addresses the challenge of unclear healthcare costs, which can vary widely even within the same hospital. The bill also mandates itemized bills for patients and could save up to $1 trillion by reducing administrative waste and fraud.

Trump Admin Launches Pilot Program for Weight-Loss Drug Coverage

The Trump administration is set to launch a five-year pilot program starting in April 2026 for Medicaid and January 2027 for Medicare, allowing voluntary coverage of weight-loss drugs like Ozempic, Wegovy, Mounjaro, and Zepbound for obesity management. These GLP-1 receptor agonists, originally for Type 2 diabetes, can help patients lose up to 20% of their body weight, addressing obesity as a serious health condition. However, the high cost ($5,000 to $7,000 annually) raises concerns about affordability, with estimates suggesting a $35 billion impact on Medicare by 2034.

Expanding Access to Outpatient Procedures

Medicare wants to allow about 1,730 procedures currently only reimbursed in inpatient settings to also be reimbursed in outpatient settings. A July 17 proposed rule suggests getting rid of the inpatient-only (IPO) list, established in 2000, which dictates a list of procedures Medicare will only reimburse if performed in inpatient settings.The list would be phased out over three years starting in 2026 with 285 mostly musculoskeletal procedures. These services have already started to shift from inpatient to outpatient setting, thanks to advancements in technology and medicine, the rule notes. CMS says in the rule it has received public comments over the years that physicians should be trusted to decide where to perform each procedure for their patients, but others, like the American Hospital Association (AHA), have defended its importance.