While the underlying cost of health care services remains an under-reported issue, there are signs that this may be changing (see California and Wisconsin summaries below). The California legislature, for example, is beginning to turn its attention to rising hospital and provider costs, and not just the rising cost of premiums. Just in time, the U.S. Justice Department announced last week that California's largest health care purchasers can proceed with an extensive study  of the costs of care at more than 300 hospitals statewide. The California Hospital Association tried to block the project claiming antitrust concerns, but the Justice Department  rejected the claim. Only by addressing costs throughout the health care system will the nation begin to slow the overall cost of health care and truly deliver on the promise of health care reform. Transparency remains a very important part of the equation.

CALIFORNIA: Democrats on the Senate Health Committee passed legislation addressing greater premium rate transparency. The bill contains numerous problematic provisions that would require detailed actuarial justification for premium increases. However, the bill would also require health insurers to provide hospital and physician price increase information and anticipated trends in reimbursement ratesfor hospitals and other health care providers. With federal reform implementation underway, some legislators are beginning to think about costs in the system and are seeking answers from other stakeholders, rather than just health insurers. The last provision has caught the attention of the state medical society and hospital association.

WISCONSIN: The Governor has signed a transparency bill that requires a health care provider to specify charge information for diagnosing and treating 25 presenting conditions: the provider's median billed charges; the reimbursement amount under Medical Assistance; the reimbursement amount under Medicare; and the average allowable payment from private, third-party payers. This applies to health care facilities including hospitals, ambulatory surgical centers or nursing homes, and to associations of providers that include four or more practitioners.  The law also requires a self-insured health plan of the state, county, city, village, town, or school district, and insurers providing coverage under a health insurance policy to provide, upon request, to an insured a good faith estimate of the enrollee’s total out-of-pocket cost for a specified health care service in the geographic region in which the service will be provided. The estimate is not legally binding.