The Trump administration has been working behind the scenes for months on a strategy to force greater price disclosure across much of the $3.5 trillion health-care industry.

The push relies on existing administrative tools, according to people familiar with the discussions. Those include Labor Department powers under the law that sets minimum standards for private-industry health plans and current hospital-payment rules under Medicare.

The administration is strongly interested in forcing insurers to publicize the negotiated rates they pay for services, the people said. The requirement could affect insurers providing coverage in the private-employer market, where about 158 million people get their health insurance.

The White House also wants doctors and hospitals to give patients their total price of care before they get services or treatment whether or not the health-care provider is in the patient’s insurance network, said the people familiar with the discussions.

The White House didn’t make anyone available to comment on the discussions.

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The initiatives are expected to go beyond an earlier proposal to require hospitals, doctors and other medical providers to publicly disclose the secretly negotiated prices they charge insurance companies for services, according to people familiar with the discussions. That idea, raised by the White House in February, prompted a backlash from the industry, which said it would be cumbersome and fail to provide consumers with meaningful data on their out-of-pocket costs.


The discussions have provoked disagreements within the administration over how far to go in the price-disclosure effort, the people familiar said. President Trump supports the initiative, which could become a part of his health-care message in his 2020 re-election bid.

“We’re going to be announcing something, I think over the next two weeks, that’s going to bring transparency to all of it,” Mr. Trump said at a May 9 White House event on surprise billing. “And I think, in a way, it’s going to be as important as a health care bill.”

The administration’s efforts comes as interest grows nationwide in peeling back the mystery around health prices. More than 20 states have passed price transparency laws related to prescription drugs.

Supporters say that requiring price and rate disclosure could fundamentally alter economic forces in the industry, potentially driving down costs if hospitals and doctors lower prices to match competitors.


Consumers are often required to pay more out of pocket without the price information they need to comparison shop. Employer health-plan deductibles are outpacing wage growth and have risen 212% since 2008 to an average $1,573 for a single plan, according to the Kaiser Family Foundation.

But critics say it wasn’t clear whether enough consumers would use price information to seek out lower-cost treatment and bend the cost curve. And the proposals would likely be met with stiff industry opposition, including lawsuits challenging the White House’s authority to mandate cost disclosures.

Tom Nickels, executive vice president of the American Hospital Association, has said a broad proposal requiring price disclosure wouldn’t give consumers an accurate picture of out-of-pocket costs under their insurance plans.

The White House believes it can use a number of executive tools to push its agenda on transparency. One possibility: new requirements in a 2019 proposed rule on hospital outpatient payments.


The Labor Department also could compel disclosure of negotiated amounts insurers pay for services, according to the people familiar with the discussions. It may have authority through the Employee Retirement Income Security Act, a federal law that sets minimum standards on private-industry health plans, they said.

It isn’t known how far the White House will go on the effort, and many of the ideas, such as requiring disclosure from insurers, are still under consideration or in early discussion phases, the people familiar with the conversations said.

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David Silverstein, a Denver strategist who pushed for cost disclosure legislation in Colorado, said he had been in talks for a year with the administration on price-transparency ideas. He said he had sent briefs to key administrators and spoken to the President’s Council of Economic Advisers.

“I wrote something up on this for the president and I said let’s call it ‘Trump Tax Cuts 2.0’,” he said.


In one case, Mr. Silverstein said he was invited to a meeting on the topic late last year at the White House.

“It was very hush hush, I wasn’t told who was going to be there,” he said. “Nobody from the health-care industry was there. It was people like me and an employer group. There were no hospital or insurance groups.”

Marty Makary, a health policy professor at Johns Hopkins University, said he has also consulted with the administration.

“They’re figuring out the best way to do it and talking to a lot of people,” Dr. Makary said. “They see the attractiveness to the public and voters.”

The proposal floated this year that could require hospitals and doctors to disclose their negotiated rates with insurers has generated dozens of comments.

“I am a sophisticated consumer of health care resources and I am unable to advise my patients where they can get quality, low-cost care,” Paul Burgoyne, of St. Clair Shores, Mich., wrote in support of the proposal.

Industry, however, is fighting the idea. William Prentice, chief executive of the Ambulatory Surgery Center Association, said a disclosure requirement could violate contracts between providers and insurers.

The administration initiatives mandating disclosure could spark the development of mobile apps that would let consumers shop and compare prices, said former Oklahoma Republican Sen. Tom Coburn, who also has met with the White House on the effort.

Write to Stephanie Armour at stephanie.armour@wsj.com