After years of waiting, Missouri patients have a new protection against hospitals that fail to disclose their prices. A new law took effect in August, restricting debt collection practices by hospitals found to be “materially out of compliance” with federal price transparency requirements. The provision represents a positive step toward making healthcare prices more transparent, although questions remain about its enforcement.
I’ve been regularly writing about the new federal hospital price transparency rules since they took effect in 2021. The rules require hospitals to publicly disclose their prices, including negotiated insurance rates, so patients can compare costs before receiving care. Noncompliant hospitals can face warnings, corrective action plans, and financial penalties.
Unfortunately, as I’ve also written about, hospitals have been slow to disclose their prices, and the federal government has been reluctant to penalize noncompliance. It should go without saying that patients should have an opportunity to know what their care will cost before receiving it. And it only makes sense for hospitals that refuse to disclose their prices to not be allowed to use debt collection practices. Since 2022, my colleagues and I have recommended that Missouri establish its own price transparency requirements and penalties, including prohibiting debt collection.
While Missouri’s new law sounds similar to this recommendation, there is an important difference. The state’s new prohibition on debt collection is tied to the current federal rule and depends on federal enforcement. This means that federal regulators must either assess a financial penalty or officially determine that a hospital failed to correct material deficiencies before Missouri’s prohibition can take effect.
According to the Government Accountability Office, federal regulators initiated 1,287 enforcement actions between 2021 and 2023, but only 14 resulted in financial penalties. As of October 2026, the Centers for Medicare and Medicaid Services had publicly listed financial penalties against just 28 hospitals nationwide. Although a penalty is not the only action that can trigger Missouri’s law, the small number illustrates the limitations of relying on federal enforcement.
There is some optimism that federal enforcement could become more aggressive. The Trump administration has renewed its emphasis on hospital price transparency, with stronger disclosure requirements that took effect in January, and enforcement beginning in April. These changes are intended to address problems with hospitals publishing pricing formulas that patients cannot easily use to determine their costs.
Missouri lawmakers deserve credit for taking another step toward greater healthcare price transparency, but there is still a long way to go. Going into next year’s legislative session, policymakers should consider establishing the state’s own requirements and enforcement mechanisms rather than relying entirely on Washington to determine if hospitals should face consequences.
