JUNE 21, 2026

Hospital Price Transparency Rule Has Not Lowered Costs, Research Finds

Five years after the federal government required hospitals to post their prices publicly, researchers found no evidence that a competitive market formed or that prices fell as a result. The disclosed data are now extensive, but no single hospital was found to be paid by all four major insurers on a common, fixed-price basis across both inpatient and outpatient care. In nearly half of U.S. metropolitan areas, one or two hospital systems control inpatient care, with commercial prices running roughly 2.5 times Medicare rates.

The federal hospital price transparency mandate, which required hospitals to publicly post their negotiated rates, was premised on the idea that public disclosure would activate competitive market pressure and drive prices down. According to a Washington Examiner opinion piece by Adam Cunningham and David Introcaso, founders of Sylk Health, that premise has not been borne out over the five years since the rule took effect.

The authors, who include a former evaluation officer at the Agency for Healthcare Research and Quality and a former adviser to the House majority leader, argue the core problem is structural rather than one of enforcement. In markets where one or two systems control inpatient care, disclosed prices reflect bargaining power, not underlying costs. They noted that taxpayers in public plans are also exposed to the same inflated benchmarks because public plan rates are pegged to those captured commercial rates.

The piece described how legislative or regulatory remedies drawn from the same distorted data tend to ratify rather than correct existing prices. A cap set as a multiple of Medicare rates, the authors wrote, is still derived from captured figures; a price ceiling above current rates can become a floor that lower-cost hospitals rise toward. As an example, they described Indiana's largest hospital systems as sitting under that state's pricing benchmark in full compliance without reducing costs by any amount.