Healthcare Price Transparency Policy in the United States: A Comparative Policy Analysis of Federal and State Approaches

Healthcare price transparency policies aim to empower patients through information access, yet the 2021 CMS Hospital Price Transparency Rule demonstrates a critical implementation gap: achieving 70% hospital compliance while maintaining fewer than 5% consumer awareness. Despite nurses' essential role mediating between pricing data and patient decisions, transparency policies systematically exclude nursing perspectives from design and implementation. This comparative policy analysis examines the federal CMS rule, state innovation models in Washington, Colorado, Massachusetts, and New Hampshire, and the proposed LCMT Act using an integrated framework combining Bardach's Eightfold Path with the Conceptual Model for Nursing and Health Policy. Analysis of legislative documents, compliance data, and systematic review of articles reveals a persistent "nursing gap" between data availability and patient utilization across all policy approaches. Federal policies lack consumer education mechanisms, health literacy accommodation, equity provisions, and nursing workforce support. State models incorporating user-centered design achieve superior outcomes: New Hampshire attains 15% consumer awareness versus the federal baseline below 5%, while Washington demonstrates equity-focused design feasibility. The LCMT Act expands transparency scope without addressing fundamental CMS design flaws. Findings indicate that transparency effectiveness depends on implementation infrastructure rather than data mandates alone, requiring nurse navigators with protected time, EHR integration enabling point-of-care access, equity scaffolding for vulnerable populations, and deliberate health literacy accommodation.