Outcome Evidence

• The 2017 Employer’s Forum of Indiana study found that across 120 Indiana hospitals, prices negotiated for employers in Indiana averaged 272 percent of what Medicare would have paid for the exact same services at the same hospitals over the period 2013–16. source & source
• Since 2019, Anthem in Indiana negotiates hospital outpatient prices based on the Medicare price (inpatient prices have already been negotiated based on the Medicare price) for the Employers’ Forum of Indiana. source & source
• Two 2017 Congressional Budget Office (CBO) reports found that the private insurance companies Aetna, Humana, and UnitedHealthcare were paying an average of 200% of Medicare rates for the same common health care services and as much as 350% of Medicare for MRIs. source & source
• A 2019 Rand Corporation report examined reimbursement rates in 25 states. Their findings showed higher payments from private insurance compared to those of Medicare ranging from 156% (Michigan) to 400+% (Indiana). source
• The gap between what hospitals and physician offices were paid by fee-for-service Medicare for outpatient cardiovascular tests increased between 2005 and 2015, as did the proportion of these tests that took place in hospitals, according to a new study in JAMA Internal Medicine. source
• Congressional Budget Office estimates suggest that when implemented on the Federal level, New York’s arbitration approach to out of network balance bills could cost billions, while the “benchmark” or average payment rate strategy proposed in the Senate — and already in place in California — could save billions. source