Fewer than one in four U.S. hospitals fully complies with federal price transparency rules, and the gap between what patients are billed and what care actually costs has persisted for years despite a legal mandate that took effect in 2021. Now, the Trump administration is escalating its response — issuing warning letters and corrective action requests to more than 500 hospitals since April, with annual penalties of up to $2 million for those that refuse to act.
ⓒ Trump
The enforcement push is grounded in years of accumulated frustration. The Centers for Medicare & Medicaid Services issued more than 730 warning notices and 269 corrective action plan requests as far back as April 2023. Fines issued in 2025 ranged from $32,301 for a small Louisiana facility to $309,738 for Arkansas Methodist Medical Center, with the all-time largest penalty — $871,122 — levied against Jackson Memorial Hospital in Miami in 2024. The pace of civil monetary penalties more than doubled in 2025 compared with prior years. Still, compliance rates have barely budged.
The stakes were raised further when updated 2026 requirements took effect in April, introducing perhaps the most significant shift since the original rule: hospital chief executives or designated senior officials must now personally attest in writing that posted prices are "true, accurate, and complete." The new rules also eliminate the use of estimated figures, requiring instead that hospitals publish actual dollar amounts drawn from 12 to 15 months of claims data — closing a loophole that had allowed providers to post placeholder numbers that were all but meaningless to patients trying to plan ahead.
Gary Claxton, senior vice president and director of the program on the healthcare marketplace at KFF, acknowledged the data's limits for ordinary patients. Pricing figures are far more useful to benefits consultants and sector specialists than to individual consumers, he said, and current reporting standards still make it difficult to make accurate comparisons on cost and quality. Even so, he framed the broader trajectory in cautiously positive terms: "There's a pretty widespread belief that prices are more divergent than they should be in a competitive market — and this is one way of trying to understand that more. It's moving in the right direction, but that doesn't mean it has gotten to where it needs to be."
The geographic distribution of the warning letters cuts across political lines in ways the administration has been eager to highlight. Texas led all states with 42 hospitals receiving notices, followed by Indiana with 34 — a striking figure given that Indiana has roughly one-fifth the population of California, which had 38 hospitals cited. Other heavily affected states include Florida, Alabama, and Louisiana, all Republican-governed. Among the named recipients: Baptist Medical Center in San Antonio, one of Texas's largest hospitals with 1,585 beds, and the University of Texas MD Anderson Cancer Center in Houston. Missouri-based Ascension, one of the country's largest nonprofit hospital networks, had 13 facilities across multiple states receive letters.
Several cited institutions pushed back on the characterization of their violations. MD Anderson said it discovered a minor formatting issue in a date field after receiving notice from CMS, corrected it quickly, and said the government confirmed no concerns about the integrity or completeness of its data. Ascension similarly described the cited problem as a minor technical error and said it remains committed to giving patients the information they need.
The American Hospital Association said its members have long supported price transparency and that the majority of hospitals are already meeting federal requirements. Ashley Thompson, senior vice president for policy at the association, nonetheless acknowledged in a statement that the current system is not working as well as it should for patients, and said hospitals would continue working with the administration on improvements.
The enforcement drive sits at the center of a deeper philosophical divide over how to tackle healthcare affordability. The previous administration under Joe Biden emphasized expanding coverage through subsidies under the Affordable Care Act and authorized the government to negotiate prices directly with pharmaceutical companies on certain Medicare drugs — a program that has carried over into Trump's second term. The current administration's approach leans more heavily on market mechanisms: the theory that publishing pricing data will spur competition among providers and lead to more efficient spending. The administration has also promoted TrumpRx, a site intended to help consumers compare prescription drug costs.
Critics have questioned whether price transparency alone moves the needle for most insured Americans, who rarely shop for medical care the way they might compare prices on a consumer purchase. But the administration, pointing to a White House estimate of more than $500 billion in projected savings from drug pricing deals over the next decade, argues that the combined pressure of transparency and negotiation represents a meaningful intervention in an otherwise opaque market.
Public opinion on the administration's healthcare record remains skeptical. According to the most recent survey by the Associated Press-NORC Center for Public Affairs Research, only 29 percent of U.S. adults approve of Trump's healthcare policies — a lower mark than his ratings on the economy, immigration, or overall management of the federal government.
The House Committee on Energy and Commerce has scheduled a hearing on price transparency for this week. Shawn Gremminger, chief executive of the National Alliance of Healthcare Purchaser Coalitions, is set to tell the committee that transparency is the foundation of any healthcare system that rewards competition on cost and quality — a sentiment likely to find bipartisan agreement even as the path to getting there remains contested.