Resources

This webinar highlighted the growing state momentum on hospital price caps. State presenters from Vermont, Washington, New Mexico, and Maine shared an inside look at pre-implementation planning, current implementation experience, and pending legislation to address rapidly rising hospital prices.

View the webinar slides

This interactive hospital price transparency dashboard by the Vermont Green Mountain Care Board and Onpoint Health Data shows the payments for commercial payers and across different inpatient and outpatient facilities in Vermont, comparing commercial plan allowed amounts to what Medicare would have paid for the same services, based on the unadjusted national Medicare base rate.

This blog post summarizes legislative actions taken by multiple states in 2025 to address rising health insurance premiums and affordability concerns through the enactment of hospital price caps in either the commercial market or state employee health plans. Highlighted states include Indiana, Vermont, New Mexico, and Washington.

In a study using 2022 Health Care Cost Institute data, the authors estimated that implementing site-neutral payments for commercial insurers by capping prices at 150% of Medicare non-hospital payments would have saved purchasers and patients in 48 states and Washington, D.C. a total of $10.8 billion, or an average of $72.10 per commercially insured person in 2022. The study further provides state-specific figures for estimated total and per capita savings. Using NASHP’s Hospital Cost Tool data, the authors further estimated the state-specific impacts of savings from site-neutral payment on state-level hospital operating margins.

The authors examine the effect of Oregon’s payment cap, implemented in 2019, on hospitals' finances, operations, and care delivery. They found small and nonsignificant changes in Oregon hospitals’ revenues, expenses, and margins after implementation of the cap. They also observed limited changes in hospital operations and the patient experience of care.

This guide helps policymakers understand the regulations, payment programs, and reporting requirements that apply to hospitals. Through a collection of fact-sheets on hospital payment streams, various designations, and key sources of information, this guide offers a starting point to understand the organizational and financial differences across hospitals in the United States.

This blog post provides an overview of how states have established hospital price controls in their state employee health plans, commercial markets, or across the entire market for both state employee health plans and commercial markets. Highlighted states include Oregon, Washington, Colorado, Nevada, New Jersey, Vermont, Indiana, Maryland, Massachusetts, Montana, and Oklahoma.

Noting limitations that inhibit policymakers from readily assessing the full scope of outpatient facility fees in the commercial market, this article examines states' efforts to analyze facility fees in their commercial markets and highlights key findings from each state, including Colorado, Maine, Connecticut, and Washington.

This two-pager describes how Washington plans to implement reference-based pricing within its state employee health plan to limit hospital prices, lower health care premiums and out-of-pocket costs for public employees and teachers, and increase investments in preventative health services.

This article summarizes Rhode Island’s Health Care affordability standards that were established in 2010, results of an evaluation of the affordability standards, and policy considerations for other states interested in reducing health care costs in the commercial market. The authors conclude that Rhode Island’s affordability standards have led to relative reductions in hospital prices across the state’s commercial market and yielded cost savings for consumers in the fully insured market. While the standards reduced hospital revenues and contributed to lower hospital operating margins, the authors cite to evidence from other research suggesting that the standards may also have led Rhode Island hospitals to operate more efficiently.

This resource includes a list of all legislation successfully passed by 20 states (as of September of 2025) that seek to address facility fees charged by health systems for services, with links to bill language and brief overviews of the legislation.

The paper discusses the problematic payment differential between hospital inpatient and outpatient care and offers payment reform considerations for policymakers. The author argues that reducing or eliminating the differential for services commonly provided in both settings would be complicated, but a fix could reduce costs, remove perverse incentives, and make patient cost sharing fairer and more predictable.

The authors quantify and illustrate the difference in price between hospital outpatient departments and physician offices among people with employer-sponsored insurance between 2018 and 2022. The data show that care delivered in hospital outpatient settings costed more than in physicians’ offices when assessing the same service.

This report provides an overview of existing state, federal, and private sector hospital efficiency measures; the advantages and limitations of those measures; potential modifications to existing measures; and options for how states can employ new or existing measures to better understand current hospital efficiency levels and incentivize improved efficiency. It focuses on measures that primarily use publicly available or state-accessible data and organizes them into three main domains: (1) Delivery of Wasteful Hospital Services; (2) Hospital Revenue per Unit; and (3) Hospital Expenses.

This working paper describes a study of the effects of mergers of hospitals and physician practices, which resulted in a 71.5% increase in the share of physicians employed by hospitals from 2008 to 2016, on competition and pricing. Through examination of a large, geographically diverse set of mergers, the authors report strong evidence that, on average, integration between doctors and hospitals leads to significant and sudden increases in hospital and physician prices, likely a function of less competition. The authors further conclude that many of the observed mergers are likely anticompetitive and harm both consumers and end payors of health care services by increasing the cost of care without generating commensurate increases in quality.

This report summarizes results from modeling the savings potential of three policy options to address hospital consolidation - site-neutral payments, bans on facility fees, and commercial hospital price caps - and the financial impact of these policies on consumers in three states: Indiana, Massachusetts, and North Carolina. Modeling found that all three policy strategies generated predicted savings to consumers in all three states and that each policy can be structured to minimize impact on hospital finances.

This document provides a brief overview of hospital price growth targets and describes a hospital-specific market basket methodology that states can use to calculate hospital performance against a hospital price growth target. This document also offers design and implementation considerations for states pursuing a hospital price growth target.

This paper summarizes results of a study that compared hospital prices and margins and insurer premiums and fees in Rhode Island and comparison states before and after the initiation of Rhode Island's affordability standards in 2010, which capped hospital price growth for the fully insured commercial segment of the state’s health insurance market. The authors found that the standards were associated with large relative reductions in hospital prices, averaging 9 percent over the course of the study period. In addition, hospital price reductions translated into substantial reductions in fully insured premiums relative to comparison states.

This article challenges the notion that low rates by public payers force hospitals to upcharge commercial rates in order to offset public payer losses, also known as "cost shifting". Based on a review of empirical evidence, the author suggests that hospitals are more likely to cut costs when they face reductions in public payments which can potentially lower the quality of or restrict access to care. The author further suggests that policymakers should not expect that changes in public payments will substantially affect private prices or premiums for private insurance or that changes to public payments will be benign for providers in that they will be directly offset by private insurer payments.

This blog post highlights states' actions to address health care affordability in the commercial market through the use of hospital price caps. It highlights results from Oregon's successful implementation of price caps for its state and public school employees and describes legislative actions that Washington, Colorado, Nevada, New Jersey, Vermont, Indiana, Massachusetts, and Oklahoma were taking.