When the charge for Tylenol is $4,000, it’s clear the U.S. health system is failing us | Opinion [Miami Herald]

Across the country, higher co-pays and deductibles are making healthcare unaffordable even for patients with insurance. But for Hispanics, who are statistically less insured than the general population and suffer from preventable chronic illnesses such as heart disease, obesity, mental health, HIV/AIDS, diabetes and strokes, the crisis is even worse. This leads many to take risks and make tradeoffs when managing their health.

According to the Pew Research Center, half of Hispanic adults without health insurance say they have not seen a medical provider within the past year, and 63% say they would be unable to cover an unexpected $1,000 medical bill within 30 days.

The causes are many and complex, but there is one seemingly simple solution to immediately address the lack of affordability in America’s medical system: transparency in the price of healthcare products and services.

Nearly 60% of Americans reported having sticker shock at the outrageous cost of basic medical goods they thought were covered by insurance: $8 for a grocery bag to hold your personal items; $23 for a single alcohol swab; $10 for the little plastic cup used to administer medicine; $53 for non-sterile gloves — sterile ones are higher. These seemingly minor charges often amount to outrageous, unpredictable, and unaffordable medical bills.

Take the case of Amanda Partee-Manders, a young mother who was dismayed by the $47,091.01 hospital bill she received for having a C-section. What shocked her most was the itemized breakdown of her bill, which she received only after demanding it from the hospital system. The fees included $12,000 for her recovery room, nearly $4,000 for IV Tylenol and a $522 outpatient charge — despite never having been treated as an outpatient at that hospital. Partee-Manders, outraged, took to TikTok to share her story and advocate for greater transparency in healthcare.

Luckily, she had the help of a friend who worked in hospital billing to decipher the medical coding for each line item.

But, again, when it comes to navigating the healthcare system, the Hispanic community in this country is at a major disadvantage. Access, language and cultural barriers contribute to disparate outcomes for Hispanics, who are more likely than any other racial or ethnic group to be uninsured.

Unfortunately, the uninsured rate for Hispanic children is up 8.1% compared to 5.2% for all children, according to the Georgetown University Health Policy Institute. This is catastrophic, considering Hispanics make up the largest ethnic minority in the United States and are expected to grow to more than 30% of the population by 2050.

For so many who can’t afford the costs of basic healthcare — including Hispanics — the 2021 Trump-era Hospital Price Transparency Rule is a game-changer. By requiring healthcare providers to disclose their costs upfront, patients can shop for competitive prices and advocate for lower co-pays and deductibles. More than 6,000 hospitals in the nation are required to disclose rates online for common services, including X-rays, lab tests and C-sections. Hospitals that don’t comply are supposed to face costly civil penalties.

However, hospital lobbyists and special-interest groups have fought to keep patients confused and in the dark when it comes to pricing, leading to inconsistent and incomplete information. After two years of the rule taking effect, an analysis by the nonprofit Patient Rights Advocate found that only a quarter of the hospitals have complied with the policy, claiming it’s “too expensive to implement.” Only four hospitals have faced fines from the Centers for Medicare and Medicaid Services thus far.

Healthcare price transparency is a rare bipartisan issue, with almost 90% public support. But to make it a reality for patients, Congress and the Biden administration must do more. House lawmakers are taking swift action to standardize the process across states to get hospitals to comply, and CMS recently raised the fee for noncompliance from $100,000 a year to over $2 million per hospital. But that’s still not enough to ensure patients get the transparency and relief they need.

Underserved Hispanic communities already face limited access to quality medical care, which leads to more expensive prices and poor health. Fair pricing and greater access to billing information — provided to patients upfront, before they receive care — is a crucial, consequential step in addressing these disparities. It’s time for lawmakers to lift the veil of secrecy that protects the healthcare industry and genuinely address the crisis of expensive medical care to ensure health equity for all.

Judy Pino is a spokesperson for the Independent Women’s Forum. Kelsey Bolar is the director of storytelling and a senior policy analyst at Independent Women’s Forum.

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