ANALYSES FIND HOSPITALS 'DRIVING UP HEALTH COSTS' WITH 'OPAQUE' BILLING PRACTICES, ANTI-COMPETITIVE CONSOLIDATION

The following information was released by the America's Health Insurance Plans (AHIP):

by AHIP

In case you missed it, three new analyses underscore the ways in which hospital systems are "driving up health costs" by overcharging patients and using "opaque" billing practices to skirt transparency rules.

'The quiet billing shift driving up health costs': "Hospitals are increasingly billing health plans for more complex care than they actually provide, according to a new analysis of Blue Cross Blue Shield claims from 2022 to 2025 ... The so-called coding intensity balloons health care spending, and it corresponds with an increase in hospital use of AI to help document patient visits ... 'If this dynamic extends more broadly, it will further accelerate hospital spending and erode affordability for employers, families and health plans,' the analysis says." (Axios, 3/3/2026)

'Wide disparities found in hospitals' drug prices': "Prices of common drugs for cancer, multiple sclerosis and other conditions can vary widely depending on the hospital where they're administered, research firm 3 Axis Advisors said in a new report ... Hospital pricing remains opaque, and it's possible for the same drug at the same hospital to have a dozen different prices on the same day ... That's despite federal rules requiring hospitals to provide comprehensive files with all of their offered items and services, as well as consumer-friendly lists of services that would let patients compare prices ... The analysis found many hospitals are not providing usable data or complying with the spirit of transparency rules when they do post prices." (Axios, 3/5/2026)

'The states where hospitals are most concentrated': As rising health care costs put more financial strain on Americans, 'one major and underappreciated factor driving price increases is rising consolidation among U.S. hospitals,'" an analysis by Yale University's Health Care Affordability Lab finds. "It notes that over the past 20 years, there have been around 1,300 mergers among the nation's approximately 5,000 hospitals ... Hospitals accounted for 40% of the growth in national health spending between 2022 and 2024 a much larger share than any other health spending category, per a recent KFF analysis." (Axios, 3/9/2026)

New CMS data show that spending nationwide on hospital care reached $1.6 trillion in 2024. American families and employers pay for these rising costs through their health insurance premiums, which directly reflect the cost of medical care. As one prominent lawmaker noted in POLITICO, "Insurance companies are dependent on what hospitals charge ... I used to run the largest hospital company so I can tell you, insurance can't charge a whole bunch less if the hospitals charge more."

AHIP's Take: "Hospital costs account for more than 40 cents of every premium dollar more than any other category and many hospital systems continue to raise their prices at rates that dwarf inflation while also sticking patients with layers of opaque fees. Instead of looking around for someone else to blame, the hospital industry should stop the anticompetitive consolidation, opaque billing practices and unaffordable price hikes that continue to drive Americans' premium costs higher," said AHIP spokesman Chris Bond.