The affordability of well being care–or lack thereof–has develop into an pressing problem for state policymakers. The price of care persistently ranks as a high concern for sufferers, households, and employers. Premiums and deductibles proceed to rise, inserting stress on family budgets, whereas wage progress lags. On the identical time, aggressive hospital billing and debt assortment practices can expose even insured sufferers to vital monetary threat. State policymakers who need to present reduction to residents and cut back well being care prices can contemplate a number of forms of reforms.
With significant federal motion unlikely this 12 months, states are positioned to guide on well being care affordability. Fortunately, state policymakers have already got a toolkit at their disposal, and plenty of states have been working to promote affordability for fairly a while. Through the years, they’ve constructed a roadmap of sensible methods, together with worth and billing regulation, competitors and possession reforms, and transparency and reporting necessities. These efforts present that state-level interventions could be efficient, providing fashions policymakers can construct on to enhance well being care affordability for customers.
Value & Billing Regulation
States are utilizing billing regulation to form how sure hospital costs are structured and handed on to sufferers, notably billing practices that improve shopper out-of-pocket prices with out medical justification. A number of states, reminiscent of Maine, Connecticut, and Washington, have targeted on limiting facility charge billing and advancing site-neutral fee insurance policies to stop larger costs when routine providers are delivered in hospital-owned outpatient settings relatively than impartial places of work.
Different states are pursuing broader worth regulation methods to include general hospital spending. Rhode Island caps annual hospital reimbursement progress and enforces affordability requirements, which have contributed to a 9.1 % discount in costs and vital financial savings for commercially insured residents. Oregon established reference-based pricing for its state worker well being plans, which caps reimbursement for in-network hospitals at 200 % of Medicare, and out-of-network hospitals at 185 % of the Medicare fee. This has generated an estimated $107.5 million in financial savings in its first two years. In 2025, Indiana and Vermont enacted reference-based worth ceilings for sure hospitals, representing the primary state efforts to use this method throughout the business market.
Competitors & Possession
States are additionally leveraging their authority to supervise market transactions and entity possession to guard affordability. Analysis persistently hyperlinks hospital consolidation to larger costs with none significant improve in high quality, with some research discovering affected person experiences worsened following hospital acquisition. By slowing or reshaping consolidation, policymakers intention to restrict worth progress, protect competitors, and preserve prices down for customers.
Throughout the nation, at the very least 35 states require hospitals to submit detailed studies of mergers, acquisitions, or affiliations, and at the very least 15 states give regulators authority to approve, modify, or block transactions that would cut back competitors or increase costs. In New Mexico for instance, the legislature created a proper transaction evaluation course of, requiring hospitals to submit detailed possession and monetary info, permitting regulators to evaluate the potential results on costs, market focus, and affected person entry.
In Massachusetts, the decline and eventual collapse of the non-public fairness–backed Steward Well being Care system uncovered gaps in oversight, substandard high quality, and unchecked profiteering on the expense of sufferers and well being system workers. In response, the legislature expanded transaction reporting to incorporate non-public fairness, actual property funding trusts, and administration providers, subjected extra transactions to state evaluation, and strengthened regulatory authority over possession adjustments that would have an effect on price, entry, or high quality.
Transparency & Disclosure
Transparency initiatives present a basis for evidence-based policymaking and assist stakeholders make knowledgeable choices about well being care spending. State policymakers are bolstering federal worth transparency mandates by requiring hospitals and well being plans to reveal detailed worth and claims info, standardize reporting codecs, and keep compliance. Colorado for instance has been a pacesetter in strengthening transparency; the state has codified and enhanced each hospital and insurer worth transparency necessities, and the Colorado Division of Insurance coverage has the authority to challenge penalties, fines, and different enforcement actions on insurers who’re noncompliant.
States are additionally advancing possession transparency and broader monetary disclosures to light up who controls hospitals and supplier networks. In 2025, a number of states together with Massachusetts, Indiana, New Mexico, and Washington enacted or launched legal guidelines requiring hospitals and different well being care suppliers to reveal possession constructions, together with non-public fairness and complicated company affiliations, serving to regulators and customers perceive how possession influences billing, market conduct, and prices. Colorado’s statutory hospital monetary transparency reporting system requires audited financials and utilization information and produces annual state studies on hospital prices, revenues, income, and uncompensated care that inform coverage discussions and spotlight affordability traits at each the state and particular person hospital degree. Equally, Delaware enacted laws in 2026 requiring hospitals to submit detailed monetary and operational information to a state evaluation board that evaluates compliance with price benchmarks, points written findings, and will impose vital penalties for reporting violations.
By combining worth, possession, and monetary transparency, states can illuminate the drivers of well being care prices, empower purchasers and regulators, and assist coverage actions that immediately enhance affordability for sufferers.
Conclusion
Policymakers can act now to make well being care extra reasonably priced. States have a variety of instruments at their disposal – strengthening transparency, increasing merger oversight, implementing antitrust protections, and implementing worth caps – that may ship significant enhancements for sufferers and customers. Whereas no single measure is a silver bullet, these steps lay the groundwork for broader, systemic reforms that confront the complete vary of price drivers, from pricing and billing practices to market consolidation and possession constructions.