A new report card tracking health care price transparency finds that 45 states failed to offer essential information to consumers shopping in the U.S. health system, a significant step back since easier-to-understand public health solutions were to have become the norm in this post-Affordable Care Act world.

In 2014, not one state received an “A” grade and only Maine and Massachusetts claimed a “B” grade, according to the second annual Report Card on State Price Transparency Laws. The data – compiled by nonprofit organizations Catalyst for Payment Reform and the Health Care Incentives Improvement Institute – signifies a stark contrast to last year’s results, where 14 states were awarded a “C” or better. Also, 72% of the nation fell within the “D” and “F” range last year.

Massachusetts and New Hampshire heralded an “A” grade in 2013. But, it was a different story this year, as the Granite State was given an “F” this year because of the inoperability of its health care website, which was created to disseminate pricing and other information.

The report card assists policy makers, consumer advocates and other health care stakeholders to assess health care price information on state-by-state basis. The collaborative research project looks at state all-payer claims databases, which are compiled by each state to analyze price and quality information. Payers include health insurers, Medicaid, children’s health insurance and state employee health benefit programs, prescription drug plans, dental insurers, self-insured employer plans and Medicare.

“Access to meaningful price information is more important than ever as consumers continue to take on a rising share of expenses,” says Suzanne Delbanco, executive director of CPR. She highlights, however, that there is still work to be done to get a truer picture of the price of health care.

Even as President Barack Obama has noted that the administration will extend enrollment limits for the ACA, employers have previously addressed concerns over high health care costs by implementing strategies to push costs to employees. These strategies include offering high-deductible plans, looking to private and public exchanges for help in covering employees or even drawing up strategies to answer the growing trouble of retiree medical costs.

This year, the report card’s grading system delved further into the price transparency debate, and broadened its focus from solely states that have adopted laws on price transparency to states that have put the wheels in motion towards disseminating this information into websites, all-payer databases and additional regulations.

While noting that New York, Pennsylvania and Texas didn’t take steps to earn a passing grade after flunking previously, Francois de Brantes, HCI3 executive director, highlights that the report card seeks to “inform advocates, lawmakers, and policy experts about today’s best practices or what constitutes a top grade and, over time, generate improvements in public policies and consumer websites across the nation.”

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