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Trump Directs Alex Azar To Help Make Health Care Costs More Transparent


Health care costs are notorious for being opaque, confusing, sometimes confounding. So yesterday, President Trump signed an executive order that aims to reduce health care costs by letting patients know what their treatment will cost. The idea is that patients can then shop around.


PRESIDENT DONALD TRUMP: This lack of price transparency has enriched industry giants greatly, costing Americans hundreds of billions of dollars a year.

KING: This new order directs the Department of Health and Human Services to develop policies that would make providers show the price of health care before a patient undergoes treatment. With me now is Secretary of Health and Human Services Alex Azar.

Good morning, sir.

ALEX AZAR: Hey, Noel. Thank you for having me.

KING: We're glad to have you. So based on this new executive order, if I'm a patient, at what point in my treatment or pre-treatment will I get to see the prices?

AZAR: Yeah. That's a great question. What we will be doing is requiring hospitals to provide information based on their negotiated rates with insurers. And we'll be doing rulemaking to determine what level of detail that'll have.

But think of it - from an insurer perspective, another element of what we're doing - when you go to the doctor or the hospital, you get in the mail an explanation of benefits a couple of weeks later, if you remember that. And that tells you the list price of the service you had, the negotiated discount your insurance company got and how much you're going to pay out of pocket. Why can't you get that before you go in?

KING: Yeah.

AZAR: Why can't you get that and comparison shop? And, you know, the vested interests, they say, oh, nobody shops for health care. Well, they don't because they don't have price and quality information until now when we drive that change. And in fact, when you look at it, 70 - seven, zero - percent of inpatient hospital services are what one would call shoppable. Ninety-three percent of outpatient hospital services are shoppable. So there's a chance for a market.

KING: So this is hitting at a real condition - a chance for a market, I like that. Secretary Azar, while you're with us, I want to ask you about this very critical issue of conditions at border detention centers where migrant children are being held. A senior Border Patrol official told NPR that kids are getting stuck in these holding cells because HHS doesn't have enough space in its facilities, essentially saying your department cannot keep up with the numbers of people coming across the border. Is that the case?

AZAR: It's an absolute crisis, Noel. We're seeing kids flood across the border unaccompanied - these are unaccompanied children - in rates that are double what we saw last year. So we've already had as many unaccompanied children come into the country as we did in the entirety of last year. We are full. And we are out of money. We're going to run out of money in July. And we've begged Congress to pass a supplemental appropriation to give us more money so we can add beds, so we can fund our ongoing work with these kids.

You know, there's a false narrative out there that, somehow, we want to have these kids stay with us in these shelters for a long period of time. We get these kids because there's no alternative. Twelve-year-old girl comes across the border...

KING: Yeah.

AZAR: She's got to stay somewhere. And then we place them with a family member here in the United States as quickly as possible.

KING: But there were media reports of these appalling conditions that kids were being held in. And then the administration acted. It moved the kids out of this facility. Why did it take that for the administration to act? It does suggest that there's some wiggle room here, someplace for these kids to go.

AZAR: Well, I'd have to refer you to the Department of Homeland Security on that, for details about that situation. But this is part of what the acting secretary and I have been talking about is - these Customs and Border Patrol facilities, they were not built to house migrant families. They weren't built to house tens of thousands of influx of unaccompanied children in. And so that's part of what the supplemental is asking for is resources so they can get those types of proper facilities to care for these people.

And then we need the money so that we can expand our capacity and be able to take in these kids so that we can then process them through, find safe and secure environments to place them with sponsors here in the United States. And I'd love to have a census - a daily census in my facilities of zero. That's not practical, but we're all working to try to improve conditions.

And we got to get this money, though. We got to get this money, and we got to get it immediately. This is not a time for gamesmanship. And it's got to - we got to get it funded. And it's got to come in a way that doesn't harm the ability to just run the program for the sake of getting these kids placed out there as quickly as possible.

KING: Secretary Azar, you mentioned the high number of unaccompanied minors coming across the border. But some of the kids coming across the border are coming across the border with adults who are family members, they're just not their parent or legal guardians - say an auntie or an uncle. So they're being separated and they're being treated as unaccompanied. Do you think that regulation needs to change so these kids can just stay with a responsible family member?

AZAR: Well, that's an issue for Congress to consider. There's the Trafficking and Victims Protection Act, which Congress has put in place, that has very stringent requirements to protect children. That would be for Congress to address.

We do end up placing these kids with some of those very same aunts and uncles after we vet them. We go through the full background checking on them to ensure they're appropriate from a child welfare perspective. So it may be that once those parents are released into the country, the kid ends up being with those same people they crossed the border with.

KING: Secretary of Health and Human Services Alex Azar, thank you so much for joining us.

AZAR: Thank you.

KING: All right. I want to bring in NPR's White House correspondent Tamara Keith. She's been listening in.

Hi, Tam.


KING: All right. So you heard Secretary Azar say, we need the money. We need the money. We need the money. And it's up to Congress to get us the money. Can you talk a little bit about the role that Congress is playing or not playing here? Where do we stand on this funding?

KEITH: Right, so both the House and Senate are working on bills that would deliver humanitarian aid to the border. Already, though, the White House has issued a veto threat for the House bill - that's the one from the Democrats - saying that it's partisan, underfunds necessary accounts and would make the country less safe. And it also - the statement from the White House also complains that the Senate bill, as well as the House bill, don't fund ICE detention beds.

Now, the veto threat may be a moot point because the Senate is having some trouble with some Republicans not willing to support it. And the House is having trouble with Democrats - more progressive Democrats and members of the Hispanic Caucus feeling like it doesn't go far enough to sort of dictate to the administration how children should be treated. So there's a lot to be negotiated. And there's not a lot of time, actually, because the 4th of July recess is coming up.

KING: But based on what you're saying, it sounds as though the administration's hands aren't entirely tied in this situation.

KEITH: Well, what I'm saying is that both the House and the Senate do think that more money is needed but that the White House wants it in a certain form and a form that they may not be willing to - Congress may not be willing to give it to them in.


KING: So until we come to an agreement, this situation could just continue.


KING: NPR's White House correspondent Tamara Keith.

Tam, thanks so much for your time.

KEITH: You're welcome.

(SOUNDBITE OF LONE'S "APPLE HI") Transcript provided by NPR, Copyright NPR.