Health Care Archives - Show-Me Institute

Healthcare Price Transparency

Wed, 12 Nov 2025 06:28:21 +0000

The Problem

The lack of transparency in healthcare pricing means that patients don’t know the price of the treatment they receive until they get the bill and that hospitals are shielded from competition.

The Solution

Arm consumers with the information they need to make healthcare decisions.

Key Facts

In Missouri, prices for the same service can differ widely depending on a patient’s insurance. For example, the price of a pelvic CT scan at a single hospital can vary by a multiple of 20.
After several years of increasing compliance rates, hospital compliance with the federal price transparency rule, which went into effect in 2021, has fallen nearly 40% in the past year.

What We Don’t Know Is Costing Us

Advocates of government-run healthcare often claim that market forces do not operate in healthcare. However, they neglect to mention that competition has been artificially suppressed by a lack of price transparency. Studies have found wide variation in prices paid for healthcare procedures across regions, among hospitals, and most alarmingly, within the same hospital based on the type of insurance or lack thereof.

With total healthcare spending rising from 16% of gross domestic product (GDP) in 2007 to 25% of GDP today—and with projections estimating it will eclipse 37% by 2050—price transparency is critical for both the insured and the uninsured because it creates several ways to control costs:

It allows patients to compare providers.
It helps insurers negotiate lower rates.
It aids employers in offering cost-effective plans to workers.
It facilitates alternatives to fee-for-service payment models.
It enables physicians to partner in cost-containment efforts.
It forces hospitals to compete with each other on price and quality.

Hospitals Are Ignoring Transparency Rules

In June 2019, the Trump administration issued an executive order requiring hospital price transparency. Since January 2021, hospitals have been required to provide not only list prices but also negotiated charges for 300 shoppable services. Hospitals must make this information available both in machine-readable and consumer-friendly formats. However, a report from PatientRightsAdvocate.org found that, as of November 2024, only 14% of hospitals in Missouri and 21.1% nationwide are fully compliant. Alarmingly, the same website’s prior-year analysis showed significantly higher compliance rates of 25% and 34.5%, respectively. Furthermore, providers are only half of the healthcare equation; not only should all providers be subject to the same price transparency requirements, payers for services such as health plans should be required to publicly post the rates they negotiate. Until patients can be informed consumers of the care they purchase, we can’t expect to keep the cost of medical services under control.

Policy Recommendations

By state law, require that hospitals and other healthcare providers publish pricing information to the public in user-friendly and machine-readable formats.
Prohibit providers from pursuing medical debt collection if they are found to be noncompliant with transparency requirements.

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Free-Market Healthcare Reform

Wed, 12 Nov 2025 06:24:58 +0000

The Problem

Healthcare supply is needlessly limited by regulations that often protect incumbent providers at the expense of patients.

The Solution

Enact free-market reforms to increase the availability of care across the state while also working to lower healthcare prices.

Key Facts

Missouri needlessly restricts many medical professionals’ scopes of practice and has complex licensing requirements that reduce healthcare access.
During the COVID-19 pandemic, Missouri was a national leader in waiving laws and regulations that placed unnecessary limits on healthcare access.

Remove Unnecessary Barriers

“Scope of practice” defines what medical professionals can do in a state, given their training. More treatment options for patients means more competition among providers, which is good for consumers in terms of service and price. This is especially true and important in rural areas where doctors may not always be available or nearby. While Missouri has made some incremental progress on broadening the scope of practice for nurses in recent years, the state still has more restrictive laws than most of the country.

“Telemedicine” is the provision of medical care over the telephone and the internet. For the sake of public health and because many patients felt more comfortable staying at home during the pandemic, Missouri temporarily loosened the regulations that govern who could see a physician online and under what circumstances. Despite the recent expansion of Missouri’s telemedicine laws to include audio-only technologies, there is still work to be done to safely expand telemedicine.

“Licensure” is the manner in which the state regulates certain professions. Unfortunately, licensure can often act as a barrier to entry, especially for qualified healthcare providers from other states. While Missouri’s passage of universal license reciprocity in 2020 was a step in the right direction, the state’s licensing laws are still unnecessarily limiting the number of qualified and willing providers who could otherwise be treating Missouri patients.

Repeal Certificate of Need

Missouri’s Certificate of Need law restricts healthcare competition by requiring many healthcare providers to get state approval before entering new markets or expanding services offered in existing facilities. This restriction hampers market newcomers and puts upward pressure on healthcare prices by restricting supply.

Retake a Top Spot

At the start of the COVID-19 pandemic, Missouri quickly became a national leader in expanding healthcare access. Governor Parson waived numerous laws and regulations regarding scope of practice, license reciprocity, telemedicine, and even Certificate of Need requirements. But in the years since, the waivers were allowed to expire, and Missouri’s legislature has taken minimal action to address the issue.

Missouri’s laws and regulations that specify what the state’s providers are allowed to do and where they can practice play a key role in the recruitment of new state residents and workers. Greater freedom for providers makes job opportunities in a state more desirable for prospective employees. If Missouri’s elected officials are serious about addressing the state’s healthcare access issues, making healthcare employment in Missouri more competitive is required.

Policy Recommendations

Remove the unnecessary barriers to healthcare access that were previously waived during the COVID-19 pandemic, such as expanded providers’ scope of practice.
Remove the statutory delays to reciprocity licensure and create additional pathways for licensed healthcare providers in other states to treat patients in Missouri.
Repeal Missouri’s Certificate of Need laws.

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Missouri’s Free-Market Policy Guide

Tue, 17 Dec 2024 04:16:19 +0000

Missouri’s Free-Market Policy Guide outlines key areas where targeted, well-researched reforms can make a meaningful difference in the lives of Missourians. From expanding educational opportunities and empowering parents to choose their children’s schools to fostering greater economic freedom and accountability in government spending, the policies here can help create a more prosperous and dynamic Missouri. Each section offers a clear analysis of current challenges, explores solutions grounded in research and facts, and presents actionable recommendations for policymakers.

Click here to download the guide.

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Model Policy: Healthcare Price Transparency

Mon, 01 Apr 2024 20:37:37 +0000

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House Bill 1837: Hospital Price Transparency

Tue, 30 Jan 2024 04:28:05 +0000

On January 30, Show-Me Institute Director of State Budget and Fiscal Policy Elias Tsapelas submits testimony to the Missouri House General Laws Committee regarding hospital price transparency. Click here to read the full testimony.

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Senate Bill 789 / Sale of Hospitals

Tue, 30 Jan 2024 00:30:17 +0000

On January 30, Show-Me Institute Director of Municipal Policy David Stokes submits testimony to the Missouri Senate Commerce, Consumer Protection, Energy and the Environment Committee regarding Senate Bill 789. Click here to read the full testimony.

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House Bill 777: Certificate of Need

Tue, 31 Jan 2023 03:38:05 +0000

On January 31, Show-Me Institute Director of Government Accountability Patrick Ishmael submits testimony to the Missouri House Healthcare Reform Committee regarding House Bill 777 and Certificate of Need abolishment. Click here to read the full testimony.

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Fiscal Implications of Medicaid Expansion

Tue, 30 Jun 2020 10:00:00 +0000

On June 30, 2020, Show-Me Institute Senior Analyst Elias Tsapelas submits testimony to the Missouri House Budget Committee regarding the fiscal implications of Medicaid expansion. Click on the link below to read the full testimony.

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Missouri Must Declare a Policy War on Coronavirus and Win

Thu, 02 Apr 2020 10:00:00 +0000

Thus far, most Missourians have experienced the coronavirus epidemic as a shutting down—schools are closed, many businesses are shuttered as employees work from home, and sports stadiums and concert venues are deserted.

But while the emotional and economic costs of social distancing are necessary during the current crisis, it is just as urgent that our state’s health care policies move in the opposite direction—toward more openness and accessibility. If legal and bureaucratic obstacles to care have been harmful in the past (and they have), they will be catastrophic in the coming months.

Policies that have made it harder for doctors from other states to work here, harder for patients to take advantage of telemedicine, and harder for health care providers to open new facilities have been harming Missourians for years. As this report explains, addressing these problems now will not only help us minimize suffering during the current epidemic, but will maximize the availability of health care in the future.

Note: Between the formal release of our five reform proposals last week and the release of this brief, the Governor issued temporary waivers granting interstate licensing reciprocity for physicians, allowing those physicians to provide telehealth services, and allowing advanced practice registered nurses to practice beyond the 75 mile radius from their collaborating physician, as currently required under the law. These are important advancements that, as we argue in the brief, should be made permanent.

Click on the link below to read the full report.

20200325 – State Must Declare a Policy – Ishmael.pdf

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Short-Term Medical Insurance: A Step Forward for Health Choice

Mon, 10 Feb 2020 12:00:00 +0000

Today I am proud to announce the release of my latest essay, Short-Term Medical Insurance: Opportunities and Trade-Offs. As the title suggests, the paper focuses on the potential upsides and downsides of short-term health insurance products, also known as “STM.” Like most health care reforms taken in isolation, the expansion of STM plans won’t fix the entire health care system on its own, but along with expanding choice in insurance products for Missourians, STM reforms would also set the stage for a broader reconsideration of the mandates and burdens placed by the state on more fully-featured health insurance plans—burdens that raise the cost of those products. Click on the link below to read the entire report.

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Medicaid in Missouri and Its Budgetary Impact

Thu, 06 Feb 2020 12:00:00 +0000

Medicaid is Missouri’s single largest government-run program, and its costs have grown substantially over the past decade. Without reform, the program will continue to consume more and more of the state’s budget, which means less money will be available for other public policy priorities such as education.

Despite growing concern about Medicaid in Missouri, the issues plaguing the program are not widely understood. This report explains how Missouri’s program works and what has driven costs to where they are today.

Additionally, the report charts a path for Medicaid reform that would rein in the program’s seemingly endless growth. Through free-market reforms, Missouri’s program could empower recipients of Medicaid services and improve health outcomes, all while preserving the state’s financial future.

Click the link below to read the entire report.

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Medicaid Expansion Costs

Wed, 09 Oct 2019 10:00:00 +0000

On October 9, the Show-Me Institute’s Elias Tsapelas and Patrick Ishmael submitted testimony on the costs of Medicaid Expansion to the Missouri House Subcommittee on Health Care Reform. Click on the link below to read the entire testimony.

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Testimony: The Importance of Empowering Patients

Tue, 10 Sep 2019 10:00:00 +0000

On Wednesday, September 11, Show-Me Institute Director of Government Accountability Patrick Ishmael testifies on free-market health care reforms before the Missouri House Subcommittee on Health Care Reform. Click on the link below to read the full testimony.

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End Certificate of Need in Missouri

Mon, 29 Apr 2019 10:00:00 +0000

Does the idea that the government can reduce costs and improve quality in an industry (in this case health care) by restricting supply seem dubious to you? If it does, you aren’t alone. Asking the government rather than the free market to determine whether a new entrant into a given health care market would benefit consumers makes little sense from an economic perspective, and can artificially limit the choices available to the public regarding one of the most important commodities—medical care—that some of us will ever purchase.

This essay presents the original rationale behind Missouri’s certificate of need law, explains how the law is implemented, and marshals both theoretical argument and empirical evidence to show that certificate of need law has, unfortunately, achieved the opposite of its intended effect in the Show-Me state. To read the entire essay, click on the link below.

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House Bill 83 and Short-term Medical Insurance

Tue, 23 Apr 2019 10:00:00 +0000

On April 24, 2019, Show-Me Institute director of government accountability Patrick Ishmael will submit testimony to the Missouri Senate Insurance and Banking Committee regarding House Bill 83 and short-term medical insurance. Click on the link below to read the full testimony.

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Demand Supply: Why Licensing Reform Matters to Improving American Health Care

Fri, 07 Oct 2016 10:00:00 +0000

Is a narrow focus on health care policy as experienced by patients—and mediated through private and public health insurance—leading us to overlook reasonable reforms that could improve access to care and reduce costs?

Patrick Ishmael’s essay, “Demand Supply: Why Licensing Reform Matters to Improving American Health Care,” addresses this question, exploring the regulatory barriers that define—often too narrowly—where health care providers can practice and what services they can offer.

Click on the link below to read the essay.

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Where Obamacare Leaves Questions, Direct Primary Care May Offer Answers

Fri, 02 Oct 2015 10:00:00 +0000

With its passage in 2010, the Affordable Care Act (ACA) set out to remake American health care, but in many respects the ACA didn’t change the health care paradigm at all; it simply doubled-down on a broken, decades-old status quo that placed health “coverage” as a national priority above both limiting health care costs and enhancing health care access. After establishing the problem with maintaining an insurancecentered care mindset, this paper explores a promising medical practice model, direct primary care (DPC), which could deliver on the cost and access promises broken by the ACA.

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