3 steps that could stop fraud and make healthcare more affordable for all Americans
Americans know something is broken in healthcare. Premiums keep rising, deductibles keep climbing and medical bills often arrive with charges no one can explain. Behind those frustrations is the fact that we operate within a healthcare system built around secrecy.
On May 18, President Donald Trump took on drug pricing with the expansion of TrumpRX, a first-of-its kind platform designed to allow Americans to find their drugs for less in a system styled to work like Airbnb or Priceline.com. Next, he should set his sights on hospitals and insurance companies.
Healthcare remains one of the most expensive and least transparent sectors of the American economy. Hidden prices, opaque billing systems and layers of middlemen cost taxpayers and working families hundreds of billions of dollars each year through fraud, waste and abuse.
The good news is that the Trump administration has the authority needed to begin to provide relief to the American people right now. What is missing is the enforcement.
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There are three practical steps that could be taken immediately to lower costs, expose fraud and restore public trust in the healthcare system.
First, give patients prices before care and empower them to join the fight against fraud, waste and abuse.
Americans cannot fight fraud if they cannot see it. Today, most patients learn the true cost of care only after treatment is complete, and the bills start arriving. By then, it is too late to compare costs or challenge suspicious prices.
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Congress and Trump already addressed this problem in the No Surprises Act by authorizing an Advanced Explanation of Benefits, or AEOB, at the end of Trump’s first term. Patients are supposed to receive itemized charges before scheduled care showing expected services, prices, and out-of-pocket costs. That protection sat on the shelf for four years under President Joe Biden and is yet to be fully implemented.
Completing it would create immediate accountability. Patients could compare prices, identify inflated charges before treatment occurs, and keep a documented record if billing disputes with insurers or providers arise later. Every other major purchase in the economy comes with an upfront price. Healthcare should too.
Second, clean up the federal employee health program.
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The Federal Employees Health Benefits Program is one of the largest healthcare purchasers in the country, yet taxpayers and government alike still lack basic visibility into where much of the money goes.
Under existing law, the Office of Personnel Management already has authority to demand standardized claims and pricing data, conduct aggressive audits and verify dependent eligibility. Those are basic financial controls that would be expected in any competently managed organization.
Audits can uncover duplicate billing, inflated charges and improper payments. Eligibility verification can eliminate fraudulent or outdated enrollments that continue draining taxpayer dollars long after they should have ended.
Stronger oversight alone could save billions without cutting benefits or passing a single new law.
Third, force transparency across employer health plans.
Most Americans receive coverage through employers or union-sponsored plans, yet many employers are denied access to the data needed to identify fraud and control costs. That must change.
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The Department of Labor is already moving toward stronger compensation disclosure requirements for Pharmacy Benefit Managers under ERISA. Those transparency requirements should extend to third-party administrators, insurers, stop-loss carriers and any entity receiving compensation from plan assets.
Employers and plan fiduciaries need direct access to claims data, payment records and fee structures without interference from middlemen.
Right now, many employers are effectively writing blank checks while intermediaries operate behind layers of secrecy. Transparency would shift employers from passive payers to active purchasers capable of negotiating better value for workers and businesses alike.
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These tools already exist, but they’re not being used. That is not a policy failure. It is an enforcement failure. Transparency rules without enforcement are meaningless.
Federal transparency rules are in place for hospitals and insurers, but many organizations continue filing incomplete or unusable pricing data with little to no consequence.
Americans are tired of hidden prices, surprise bills and unexplained costs. They want accountability. And unlike many healthcare debates, this is not fundamentally about ideology. It is about whether patients, employers, and taxpayers deserve to know where their money is going.
The authority already exists. The laws are already on the books. What is needed now is the will to enforce them. Maximum price transparency enforcement is the fastest way to empower Americans and make healthcare affordable again, and the Trump administration can get it done.