By Caitlin Owens

September 18, 2020

Employers and private insurers paid hospitals, on average, 247% of what Medicare paid for the same services in 2018, per a new RAND study.

Why it matters: We all pay for this giant gap in prices through our premiums and lost wages.

The big picture: The price gap has been growing, with private insurers paying hospitals 224% of Medicare rates in 2016 and 230% in 2017. In 2018, prices were 267% of Medicare for outpatient services and 231% for inpatient services.

Between the lines: Prices varied drastically by location and by health system. Some states, including New York and Florida, paid more than 300% of Medicare rates, on average.

  • The most expensive system, John Muir Health, had prices that were 401.5% of Medicare. Sutter Health, which has settled a lawsuit brought by the state of California accusing the hospital system of price-gouging, was paid 326.6% of Medicare.
  • HCA Healthcare, one of the largest hospital systems, had prices that were 275.8% of Medicare. Community Health Network, another large health system that has continued to sue patients in coronavirus hotspots, was paid 260% of Medicare rates.

The other side: Hospitals have long argued that private insurance subsidizes inadequate government payment rates and that they must charge privately insured patients more to make ends meet.

The bottom line: Hospitals make up the largest portion of overall health care spending. The pandemic may have momentarily distracted us from health care costs, but they’re still high, and the pandemic’s economic fallout has only made them more unaffordable for many Americans.

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