Author: Carrie Sheffield

This op-ed is part of a series about Forgotten Women—financially insecure women between the ages of 50 and 65—and policy solutions that can offer them hope. Learn more about the Hope Agenda from Independent Women’s Voice here. Originally appeared in RealClearHealth.

Addressing healthcare costs and uncertainty is key for women and all Americans, especially those heading toward retirement, when healthcare costs increase substantially. New polling from Independent Women’s Voice identified that 89% of women are looking for leaders to offer financial solutions for people who can’t find new work but can’t afford to retire. More transparency and flexibility in our healthcare system could offer greater hope and security to this group. And indeed, no surprise, since nine in 10 Americans say they support requirements for transparency in healthcare prices.

Kaiser Family Foundation’s (KFF’s) December polling found nearly half of U.S. adults say it is difficult to afford healthcare costs, and one in four adults skipped or postponed obtaining needed health care in the past year because of costs. KFF found 61% of uninsured adults said they went without needed care because of cost.

About one in five adults (21%) told KFF they did not fill a prescription, and about one in 10 say they cut pills in half or skipped doses of medicine in the last year because of cost.

Transparency would introduce greater competition and lower costs greatly in the healthcare sector, something we need particularly as our country ages. Requiring hospitals and healthcare providers to share all pricing information publicly allows patients to shop around or at least plan for healthcare expenses. Women make most healthcare decisions and use more health care than men, so this affects us more.

Yet just 36% of hospitals fully comply with transparency rules, according to PatientRightsAdvocate.org’s latest Compliance Report. The Department of Health and Human Services only assessed fourteen penalties against noncompliant hospitals, and the charges are just slaps on the wrist that might as well say “just keep ignoring the rules.”

An astronomical 90% of the public supports healthcare price transparency. The Trump administration took action to require healthcare providers to disclose their prices, starting in 2021.

In the U.S. Senate, the Braun-Sanders Health Care PRICE Transparency Act 2.0 would increase penalties against non-compliant healthcare systems. This bill requires actual prices up front, and is a much-needed bill.

Making health insurance plans portable from job to job empowers and funds patients over systems. Ultimately, this means unchaining employees from employers for insurance.

Women increasingly value flexibility in their workplace environments, including working as independent contractors. But supporters of reclassification of workers from independent contractors to W-2 wage earners use the fact that independent contractors lack benefits as an excuse for taking away that freedom. But better than taking away choice and employment through forced reclassification efforts is a third way: portable benefits.

Portable benefits are benefits attached to the worker—not the employer—and move with the individual from job to job. This is critical for freelancers and gig economy workers who do not have employer-based health care.

Both red and blue states have introduced portability reforms. Utah became the first state to pass such a reform in April 2023. According to the final bill, contributions to portable benefits must be voluntary, and benefits can follow the worker without affecting their worker status. In Massachusetts, lawmakers introduced legislation to establish a portable benefits system for all flexible workers and also allow rideshare drivers to maintain their 1099 worker status should a portable benefits program be created in Boston.

Interest in establishing a portable benefits system isn’t isolated to the states. There’s a bipartisan and bicameral interest in Congress to establish a $20 million pilot program to direct the Department of Labor to “incentivize states, localities and nonprofit organizations to experiment with portable benefits models.”

Another way to expand the portability of health benefits is to expand eligibility of health savings accounts (HSAs). Today, only about 10% of Americans can use HSAs under an “HSA-eligible” insurance plan. HSAs are personal health savings accounts that some of your pre-taxed income can go into, along with possible contributions from your employer and family members, to cover certain medical bills. By expanding HSA use, the default model in Singapore, Americans will be empowered to cut out third-party insurance fights. Singapore has higher quality and lower cost health care thanks to widespread use of HSAs. Of course, HSAs don’t work unless you have real, upfront prices, too.

In America, health insurance adds an additional “cook in the kitchen” that hikes up prices. Sen. Rand Paul, R-Kentucky—a Duke-trained ophthalmologist—correctly noted that Lasik eye surgery, deemed elective and not covered by many insurers, illustrates consumer power increasing over time because of price transparency driving prices down.

A Mises Institute study reported, “In 1997, a precursor to LASIK surgery that involved the surgeon wielding a knife cost $8,000. In 2012, a safer laser-guided surgery cost only about $3,800. Prices halved in 15 years even as quality rose.” The same is true for other types of elective, cosmetic surgeries not covered by insurance, and where actual prices can be seen in advance, reports economist Mark J. Perry from the American Enterprise Institute.

The Trump administration prioritized lowering the cost of prescription drugs, including speeding generics to the marketplace, and an update to Medicare’s drug-pricing dashboard to increase transparency. President Trump’s Council of Economic Advisers reported, “The prices for prescription drugs fell 0.6% during the 12 months [of] 2018. This is the largest decline in prescription drug prices in almost half a century (46 years).”

Enforcing and expanding existing rules on healthcare price transparency and expanding the portability of health insurance coverage (including increasing eligibility of HSAs) will drive down healthcare prices and save money for patients and taxpayers alike.

As America’s median age increases and healthcare costs continue to rise, America’s forgotten women know failing to act is not an option and want to know which politicians will take this seriously.