Behind Your Rising Health-Care Bills: Secret Hospital Deals That Squelch Competition (#GotBitcoin?)
Contracts with insurers allow hospitals to hide prices from consumers, add fees and discourage use of less-expensive rivals. Behind Your Rising Health-Care Bills: Secret Hospital Deals That Squelch Competition (#GotBitcoin?)
Last year, Cigna Corp. and the New York hospital system Northwell Health discussed developing an insurance plan that would offer low-cost coverage by excluding some other health-care providers, according to people with knowledge of the matter. It never happened.
The problem was a separate contract between Cigna and NewYork-Presbyterian, the powerful hospital operator that is a Northwell rival. Cigna couldn’t find a way to work around restrictive language that blocked it from selling any plans that didn’t include NewYork-Presbyterian, according to the people.
Dominant hospital systems use an array of secret contract terms to protect their turf and block efforts to curb health-care costs. As part of these deals, hospitals can demand insurers include them in every plan and discourage use of less-expensive rivals. Other terms allow hospitals to mask prices from consumers, limit audits of claims, add extra fees and block efforts to exclude health-care providers based on quality or cost.
Journalist and reporters have identified dozens of contracts with terms that limit how insurers design plans, involving operators such as Johns Hopkins Medicine in Maryland, the 10-hospital OhioHealth system and Aurora Health Care, a major system in the Milwaukee market. National hospital operator HCA Healthcare Inc. also has restrictions in insurer contracts in certain markets.
The U.S. spends more per capita on health care than any other developed nation and will soon spend close to 20% of its GDP on health. Americans aren’t buying more health care overall than other countries. What they are buying is increasingly expensive. Among the factors driving spending is the opaque way the price of health care is set, a problem exacerbated by the hidden details in agreements between insurers and health-care providers.
“No hospital system should be able to exercise market power to demand contract agreements that prevent more competitively priced networks,” said Cigna’s chief medical officer, Alan Muney, in a written statement provided by the company.
A health plan that excludes a costly system can be more than 10% less expensive for consumers and employers, according to insurance-industry officials. A plan that includes all providers but steers patients away from the costlier ones can save 3% to 7% or more, these people said.
Restrictive hospital-insurer contracts have helped prevent even big employers, including Walmart Inc. and Home Depot Inc., from moving forward with plans they were exploring to try to lower costs and improve quality for their workers.
A Northwell spokesman said “negotiations and other conversations with our insurers are confidential.” Aurora, which is now part of a larger system called Advocate Aurora Health, said in a statement from Carrie Nelson, a vice president, that it approaches “all of our contracts through the same lens that guides all of our clinical and operational decisions: what will ensure the highest quality of care at the lowest cost for our patients.” HCA said it “provides patient access to health care in a variety of settings and contracts with health-care payers for all of its services and sites of care in the communities it serves.”
NewYork-Presbyterian, Johns Hopkins and OhioHealth declined to comment on their contracts.
Hospital-industry officials said patients should be able to choose their health-care provider without financial pressure from their insurers or employers. Insurers are focused on their bottom lines, not necessarily the best care for patients, they said. “Allowing the patient to make the best decisions for them and their family and their health is the central goal,” said Matt Gove, chief consumer officer at Piedmont Healthcare, a large system in the Atlanta area.
This article is based on dozens of interviews with current and former health-insurance executives, employer executives, hospital officials, researchers and other experts.
Certain hospital systems are able to command advantageous terms because they have grown through years of deal-making, shifting the balance of power between hospitals and insurers. In 2010, the year the Affordable Care Act passed, the annual number of hospital mergers shot up 40% to 59, and the number of deals has remained above 60 every year since, according to Irving Levin Associates, a research firm that tracks health-care transactions.
About 77% of Americans living in metropolitan areas are in hospital markets considered highly concentrated, ranging from Modesto, Calif., to Trenton, N.J., according to reporter’s analysis of 2016 data from researchers at the University of California, Berkeley. The analysis excluded areas with more than three million people, which economists believe are too large to be considered single markets.
“If you’re the single hospital system in an area, you essentially can set your price, because you’re a monopoly,” said Patrick Conway, the chief executive of Blue Cross and Blue Shield of North Carolina. “We literally have to have them in network.” Even in a region with more than one hospital system, “if they are the dominant player in part of the geography, they can charge higher rates,” Mr. Conway said.
Hospital care is the largest single component of health-care spending in the U.S. It accounts for more than $1 trillion a year—roughly three times what is spent annually on prescription drugs, the third-largest category. The second largest is physician and clinical services, many of which are now provided by hospital systems as well.
Hospital prices grew at about three times the rate of economywide inflation between 1960 and 2016, according to data from the Centers for Medicare and Medicaid Services and Altarum, a nonprofit health systems research and consulting group in Ann Arbor, Mich.
“The marketplace is just not working,” said Gerard Anderson, a health-care economist at Johns Hopkins University. Insurers that must negotiate reimbursement with health-care providers for plans offered by employers pay roughly 50% more than Medicare on average, he said, and those rising costs are “the main culprit for why the U.S. spends so much on health care.”
Hospital-industry officials said that hospital-system consolidation hasn’t driven higher costs, pointing to an industry-funded analysis that said revenue per admission dropped at hospitals that were acquired, compared to non-merging hospitals, a finding that contradicted other studies. “It’s the insurers that retain the greatest leverage,” said Melinda Hatton, general counsel of the American Hospital Association. The hospital association also said that hospitals must rely on private-insurer payments to sustain themselves, because they lose money on uninsured patients and those covered by government programs. Ms. Hatton said hospitals’ mergers aim to reduce expenses and improve quality and efficiency.
The effect of contracts between hospital systems and insurers can be difficult to see directly because negotiations are secret. The contract details, including pricing, typically aren’t disclosed even to insurers’ clients—the employers and consumers who ultimately bear the cost.
Among the secret restrictions are so-called anti-steering clauses that prevent insurers from steering patients to less-expensive or higher-quality health-care providers. In some cases, they block the insurer from creating plans that cut out the system, or ones that include only some of the system’s hospitals or doctors. They also hinder plans that offer incentives such as lower copays for patients to use less-expensive or higher-quality health-care providers. The restrictive contracts sometimes require that every facility and doctor in the contracting hospital system be placed in the most favorable category, with the lowest out-of-pocket charges for patients—regardless of whether they meet the qualifications.
The restrictions in some hospitals’ contracts mean “you must always include them,” said Chet Burrell, former chief executive of CareFirst BlueCross BlueShield, which offers coverage in Maryland and the D.C. area. “If their costs are 50% higher for the same service, you have to include them. That cost is directly built into premiums…in the end the buyer of the service pays that.”
Hospital systems with restrictive language in their contracts can also protect their position by limiting rivals’ ability to draw patients based on lower prices, insurance executives said.
In some cases, contract clauses prevent patients from seeing a hospital’s prices by allowing a hospital operator to block the information from online shopping tools that insurers offer. Because of such restrictions, some health-insurance enrollees can’t find prices for hospital systems, including BJC HealthCare in St. Louis and NewYork-Presbyterian.
The gaps frustrate consumers such as Bob McKitrick, a teacher who lives near St. Louis and has insurance with a $5,400 family deductible. Mr. McKitrick checks prices carefully before getting care, he said, and he finds them for most providers. The website for his insurer, UnitedHealthcare, a unit of UnitedHealth Group Inc., doesn’t include information about hospitals owned by BJC, the parent of the well-known Barnes-Jewish Hospital and 14 others.
“How can we keep costs down if we can’t even get an estimate for care?” he said. “If you’re buying a car, they don’t say, ‘with this one, you won’t know how much it costs until you check out.’ ”
J.C. McWilliams, a vice president at BJC, said insurers’ tools sometimes offer inaccurate information and generally give a narrow picture that doesn’t reflect the total cost of care. Patients can get cost estimates from BJC directly, he said.
Hospital systems have also been snapping up other types of providers, including doctor practices, clinics and outpatient surgery centers, and raising these providers’ prices. A study published in April in the Journal of Health Economics found that doctors’ prices increased on average by 14.1% after they became part of hospital systems.
In many cases, insurer-hospital contracts allow hospitals to move these new acquisitions immediately to the hospitals’ reimbursement rates—which are typically far more generous for the same services. That leads to a fast markup in prices.
In addition, hospitals often receive extra charges, known as “facility fees,” that are supposed to cover the extra costs associated with care given in a hospital setting, including regulatory and safety standards that apply to hospitals. Hospitals can often impose these fees after they acquire an off-site clinic or office.
“It’s just paying more for the same services,” said Mark Weinstein, chief executive of the Independent Colleges and Universities Benefits Association, which provides health coverage for employees at 27 schools in Florida. Last year, the group heard complaints from employees about unexpected extra fees for visits to doctors owned by hospitals, he said. Ultimately, the group began paying the extra cost itself, to spare workers. “Our leverage is little,” he said.
American Hospital Association executive vice president Thomas Nickels said facility fees, which are also paid by Medicare, are needed to cover the extra costs that hospitals must shoulder, including treating any patient who needs care. “We have far more regulatory requirements, legal requirements, facility and structural requirements” than other providers, he said.
The Justice Department is suing Atrium Health, a system with huge market share in the Charlotte, N.C., area, arguing that the hospital operator “uses its market power to impede insurers from negotiating lower prices with its competitors and offering lower-premium plans.” The California attorney general is suing Sutter Health, a 24-hospital operator in Northern California, citing anticompetitive practices.
Atrium Health said it “has neither violated any law nor deviated from accepted health-care industry practices for contracting and negotiation.” Sutter said “the California Attorney General’s lawsuit gets the facts wrong and mischaracterizes how Sutter Health serves patients and communities.”
Insurer Anthem Inc.’s agreement with NewYork-Presbyterian restricts its ability to exclude the hospital system, which includes the prestigious Columbia University Irving Medical Center and Weill Cornell Medical Center, from its health plans. To help win the New York area business of the Health Transformation Alliance, an employer group, Anthem partnered with a small company called Brighton Health Plan Solutions, which had its own plans that don’t include NewYork-Presbyterian. Simeon Schindelman, chief executive of Brighton, said the company is “very open to strategic alliances that help us bring lower cost, better quality health care to even more families.” Anthem declined to comment on its contracts.
Companies have been thwarted from developing new plans for workers. A few years ago, officials at Home Depot asked Anthem, which administered its coverage, to create a plan for employees around the country with a more-limited network of health-care providers. The retailer wanted to include only hospitals and doctors with the lowest costs and highest-quality care.
The insurer turned down its client’s request, and a major reason was restrictive contracts with hospital systems. A spokeswoman for Home Depot confirmed the account of the situation and declined to comment further.
Officials at Walmart a few years ago asked the insurers that administered its coverage— Aetna Inc., UnitedHealthcare and Arkansas Blue Cross and Blue Shield—if the nation’s largest private employer could remove from its health-care networks the 5% of providers with the worst quality performance. The insurers told the giant retailer their contracts with certain health-care providers didn’t allow them to filter out specific doctors or hospitals, even based solely on quality measures.
A spokesman for Walmart confirmed the company had explored such an approach. Aetna, UnitedHealthcare and Arkansas Blue Cross and Blue Shield declined to comment.
Stuart Piltch, chief executive of Cambridge Advisory Group, a health-care consulting and data firm, approached Anthem and UnitedHealthcare a few years ago on behalf of an employer in the Milwaukee region. The employer was considering a network that would let employees pay less out of their pockets if they chose doctors and hospitals selected based on quality and cost for particular types of care.
The insurers said they couldn’t deploy such a plan “due to their contracts with the dominant player, which is Aurora,” Mr. Piltch said, so the employer wasn’t able to move forward. “The free market has been distorted in an unhealthy way,” he said.
Advocate Aurora Health’s Dr. Nelson said in the statement, “We are relentless in our pursuit of high quality and low cost in tandem, not [as] an either/or proposition.”
Trump Administration Releases Transparency Rule in Hospital Pricing
Plans to propose similar requirement for insurers; legal challenges are likely.
The Trump administration Friday released a far-reaching plan that would for the first time force hospitals and insurers to disclose their secret negotiated rates.
Administration officials said the final rule will compel hospitals in 2021 to publicize the rates they negotiate with individual insurers for all services, including drugs, supplies, facility fees and care by doctors who work for the facility.
The administration proposed extending the disclosure requirement to the $670 billion health-insurance industry. Insurance companies and group health plans that cover employees would have to disclose negotiated rates, as well as previously paid rates for out-of-network treatment, in file formats that are computer-searchable, officials said.
The insurers, including Anthem Inc. and Cigna Corp. , would have to provide a transparency tool to give cost information to consumers in advance, senior administration officials said.
The requirements are more far-reaching than many industry leaders had expected and could upend commercial health-care markets, which are rife with complex systems of hidden charges and secret discounts. The price-disclosure initiative has become a cornerstone of the president’s 2020 re-election health strategy, despite threats of legal action from industry.
“Right now there is too much arbitrage in the system,” a senior administration official said in an interview Thursday with The Wall Street Journal. “There are a ton of vested interests who will oppose this. We expect to get sued. We’re really goring people’s oxes.”
Hospitals and insurers typically treat specific prices for medical services as closely held secrets, with contracts between the insurers and hospital systems generally bound by confidentiality agreements. Policy makers, employers and patients are often unable to see clearly which hospital systems and doctor practices are driving high costs.
The proposal covering insurers is the newest part of the price-disclosure initiative, and it would include the private-employer market, where about 158 million people get their health insurance. Insurers and group health plans would have to put the negotiated rates into a file that third-party developers could incorporate into shopping tools.
Insurers would also have to create a web-based tool for beneficiaries that discloses the list price, the negotiated rate, cost sharing, and the amount left on a plan deductible, as well as allowable out-of-network rates, officials said. There will be a 60-day public comment period on the proposal.
The requirements could cost insurers an estimated $200 million annually based on estimates in the proposal. The estimate includes planning and developing the online tool
The proposal also states that “price transparency may have the opposite effect because in some markets where pricing is very transparent, pricing can narrow and average costs can increase.”
Studies show consumers are often required to pay more out of pocket when they don’t have the price information they need to comparison shop. Employer health-plan deductibles are outpacing wage growth and have risen to an average $1,655 for a single plan, according to a September survey by the Kaiser Family Foundation. Workers on average pay $6,015 toward the cost of their coverage.
On the final rule covering hospitals, facilities will have two obligations. First, they will have to provide insurer-specific negotiated rates in a computer-readable file.
Second, hospitals will have to post negotiated charges online for 300 specific services that patients typically shop around for. Seventy of those services, including vaginal birth, colonoscopy, and joint-replacement surgery, are stipulated in the rule, according to senior administration officials. Hospitals can select the other 230 services they post online.
Hospitals face fines of up to $300 a day if they don’t comply with sharing negotiated rates.
The requirements would cost hospitals more than $23 million annually, according to an estimate in the rule.
Taken together, the price-disclosure initiatives could reshape the $3.5 trillion health-care industry.
Prices charged for health care vary widely depending on whether a provider is in or out of the patient’s insurance network and on the insurer’s undisclosed price agreements with hospitals. A magnetic resonance image of the lower back costs $141 at an imaging center in Jefferson, La., but $7,646 at a hospital in Torrance, Calif, according to data from Clear Health Costs, which publishes information on health costs.
Hospitals, insurers and others in the industry have spent the past nine months since the idea was floated by the White House denouncing the proposal and gearing up for a pitched legal battle.
The industry is also likely to argue in any legal challenge that negotiated rates are proprietary and include confidential contractual agreements. Industry groups have also said it runs counter to the First Amendment.
Pharmaceutical companies prevailed with a similar argument when the Trump administration said they had to disclose list prices for drugs in television ads. A federal judge in July ruled that the requirement overstepped regulatory authority.
“It will have a negative impact on competition,” said Tom Nickels, executive vice president of the American Hospital Association, though he hadn’t yet seen the final rule.
If rates are public, health-care companies say, some hospital systems might push for payment rates that match their crosstown rivals’.
Proponents argue it would bring costs down. Out-of-network doctors could try to compete with in-network negotiated rates. Health systems that charge higher negotiated rates could lose business if they don’t match competitors’ rates or justify the reasons for their steeper costs. And employers could press their insurers to include hospitals with lower negotiated rates in their networks.
Employers and patients are often unable to see which hospital systems and doctor’s offices are driving prices upward. Some health-care economists argue that the secrecy is a factor in why the U.S. spends more per resident on health care than any other developed nation.
The administration’s vision is to arm patients with information needed to make health-care decisions much like shopping for other consumer services. Rates potentially could be posted on public websites, where consumers would check the negotiated price of a service before they pick a provider.
The White House push on price disclosure comes as President Trump seeks to close the gap with Democrats, who hold an advantage on health care in public polling.
President Trump has stated that under his health-care plan, Americans will get better care at a lower cost than they currently pay. About three in 10 adults are very or somewhat confident the president will deliver on his promise, while 62% say they aren’t too confident or not at all confident, according to an October poll by the Kaiser Family Foundation.
The White House is prepared to defend the rule and the proposal covering insurers from lawsuits, a senior administration official said. Officials said authority for the requirements stem from the Public Health Service Act.
“You’ll be able to negotiate all over the place,” Mr. Trump said in an October speech in Florida. “And you’ll be able to pick everything you want, from the hospital to the doctor. And it’s going to save you a tremendous amount of money.”
Hospitals Push Back on Price-Disclosure Rule
Industry groups vow to challenge Trump administration proposal requiring disclosure of secret payment rates.
Hospitals are pushing back against the Trump administration’s new health-pricing disclosure rule, with the industry planning a legal challenge to block it.
The final rule, released Friday along with a proposed rule aimed at insurers, would require hospitals to disclose the secret rates they negotiate with insurers for all services, including supplies and care provided by doctors who work for the facility. If they take effect, the requirements would be a major change for the health industry, where the negotiated prices are generally kept confidential and can vary widely, even within the same market.
A coalition of hospital-industry groups, along with some individual hospital operators, will go to court in the near future to head off the hospital-focused regulation, said Tom Nickels, executive vice president of the American Hospital Association.
“What they’re doing is illegal,” he said. It goes well beyond language in the Affordable Care Act that was cited as backing the rule, he said. The rule also forces hospitals to reveal trade secrets, and violates their First Amendment rights by hurting their ability to negotiate freely with insurers, he said.
Insurers, too, criticized the move, while an employer group offered a more mixed view. Brian Marcotte, CEO of the National Business Group on Health, said companies want their employees to know the real cost of the care they receive. But, he said, he worries that revealing all the rates might be counterproductive and potentially push them higher.
A spokeswoman for the Department of Health and Human Services referred to earlier comments by Secretary Alex Azar, who said the department was on “very sound legal footing for what we’re asking. And we certainly hope that America’s hospitals will want to respect their patients’ right to know what the price of the service is before they’re asked to purchase it.”
The Trump administration has argued that its transparency push will bring down costs, as consumers become better able to shop around for care. But the full effect is unclear. Some industry experts have said costs could go up, if hospitals demand that insurers grant them higher rates won by their competitors.
Zack Cooper, a health economist who is an associate professor at Yale University, suggested that the likely outcome of transparency around negotiated rates was for the wide range of health-care prices to tighten, as both insurers and hospital systems see the results of their rivals’ negotiations and push to match them. “The range of prices will go down,” he said. The mean price may go up, he said, but the effect is likely to vary in different markets.
Revealing health-care rates may also help employers to decide which hospitals and doctors to include in their health plans and which insurers to select, said John Barkett, senior director of policy affairs at benefits consulting firm Willis Towers Watson. “It will be easier to see who the good and bad actors are, and who the effective and ineffective negotiators are,” he said.
Hospitals worry that making the rates public could push them down, Mr. Nickels said. “It would be a race to the bottom,” he said, posing a particular risk to rural hospitals and others that are already financially strapped. He said in other instances, the regulation could lead to increased rates.
Hospitals also worry about the potential cost of the regulation, they said. In a survey of hospital executives this summer by health-care consulting firm Advis, the biggest concern about the then-proposed rule was uncertainty about its implementation, followed by the cost of compliance and concern about revealing secret rates.
“It’s an increased burden on hospitals and other providers,” said Ali Santore, vice president for government affairs at Providence, a 51-hospital system based in Renton, Wash. Like other hospital-industry officials, she suggested that consumers most need to know their out-of-pocket costs for health-care services, and the new rule would create more confusion.
Hospital Groups Sue To Block Price-Transparency Rule
Health-care providers say disclosure requirement pushed by Trump violates First Amendment.
Hospital groups sued to block a Trump administration rule forcing them to disclose secret rates, for the first time laying out the industry’s legal strategy for defeating the president’s central health-policy initiative.
The lawsuit filed Wednesday says the rule compelling the hospitals to publish their negotiated rates with insurers violates the First Amendment and goes beyond the statutory intent of the Affordable Care Act.
“The burden of compliance with the rule is enormous, and way out of line with any projected benefits associated with the rule,” according to the suit, which was filed by the American Hospital Association and other industry groups in U.S. District Court in Washington.
The groups say the disclosure under the rule would be compelled speech in violation of the First Amendment. They are asking for an expedited decision, saying hospitals could otherwise spend needless time and resources preparing for a rule that may be invalidated by the court.
“Hospitals should be ashamed that they aren’t willing to provide American patients the cost of a service before they purchase it,” said Caitlin Oakley, a spokeswoman for Health and Human Services. “President Trump and Secretary [Alex] Azar are committed to providing patients the information they need to make their own informed health-care decisions and will continue to fight for transparency in America’s health-care system.”
The lawsuit, while expected, highlights the scope of industry concern over the regulatory burden associated with the rule, which was completed last month. The legal standoff could complicate other White House initiatives to expand price disclosure throughout the $3.5 trillion health-care industry.
Administration officials have said they are on solid legal ground and that the rule will drive down prices by making consumers wiser shoppers.
“The rule today will irritate many vested interests in Washington, D.C.,” Joe Grogan, head of the White House Domestic Policy Council, said last month when the rule was announced.
The lawsuit is a public-relations gamble for hospitals. They risk being criticized by the Trump administration as opponents of a transparency push that some health analysts say may benefit patients. White House officials have said lawsuits would be a sign that the industry was protecting its interests at the expense of consumers.
At the same time, hospitals face millions of dollars in estimated compliance costs under the rule, which many in the industry say is misguided.
The administration estimated the rule would cost hospitals more than $23 million annually in 2016 dollars. Annual costs range from $38.7 million to $39.4 million in 2019 dollars.
Hospital groups say the true cost is far higher. The rule requires hospitals to publicize the rates they negotiate with individual insurers for all services, including drugs, supplies, facility fees and care by doctors who work for the facility. It is scheduled to take effect in January 2021, with hospitals facing fines up to $300 a day if they don’t disclose negotiated rates.
Complying would require spreadsheets with hundreds of thousands of columns, the groups said in the lawsuit. They say such files could crash most standard computer systems.
“Some members worry about the ability of their websites to function at all with such a large file,” the lawsuit states.
According to the lawsuit, the required disclosure of “highly confidential” rates violates the First Amendment, which protects free speech.
Drugmakers used the same argument in a lawsuit that led a judge in July to block a rule that would have required them to include list prices for prescription medications in television ads.
The hospital groups’ lawsuit also said the rule exceeds the administration’s legal authority. Specifically, it cites a provision in the Affordable Care Act, which was further shaped by administration guidance, that required hospitals to make public their “standard charges.” The new rule, however, essentially expands the definition of standard charges, as well as the definition of hospital services, to include negotiated rates.
The hospitals said that expansion goes beyond what Congress intended when it passed the health-care law in 2010, and forces them to disclose confidential contractual information.
The Trump administration has said disclosure would introduce competition and inject more free-market dynamics into the industry. It has also proposed extending the requirement to insurers.
Hospital-price growth has helped fuel increases in U.S. health-care spending. Inpatient hospital prices grew 42% between 2007 and 2014, according to a study this year in Health Affairs, while prices charged by doctors increased 18%.
Hospital groups argue price disclosure could raise prices. If rates are public, they say, some hospital systems might push for payment rates that match their crosstown rivals’.
They say consumers really just want to know their out-of-pocket costs, which requires data from insurers, rather than negotiated amounts for care.
While White House officials have said they have statutory authority, the administration has lost a number of court challenges over its health-policy actions.
A federal appeals court this year halted an administration plan that would have let almost any company opt out of providing contraception coverage on moral or religious grounds. The administration in October asked the Supreme Court to review the case.
And a federal judge in October said the federal government owed health insurers $1.6 billion after President Trump halted payments to the industry under the ACA that reduce consumers’ out of pocket costs.
The new lawsuit is also brought by the Federation of American Hospitals, which represents investor-owned and managed community hospitals, the Association of American Medical Colleges, the Children’s Hospital Association, and three hospitals in Nebraska, California and Missouri. They also plan to file a motion for summary judgment this week, officials said, which asks the court for an immediate judgment in their favor.
“We are concerned our patient families may confuse these commercial rate disclosures and not seek essential care for their children,” said Mark Wietecha, president and chief executive of the Children’s Hospital Association.
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