What Maryland can teach Washington about hospital accountability

OPINION:

As a Democrat who represented Maryland in Congress, I believe government has a responsibility to make healthcare accessible and affordable.

That responsibility includes asking difficult questions of institutions that have public support, substantial tax advantages and enormous influence over the cost of care.

Hospital prices help determine what families pay for insurance, what employers can afford to provide and how far public healthcare dollars stretch. Any serious effort to lower healthcare costs must examine hospital pricing and demand a better accounting of what patients receive in return.

Maryland should lead that effort. The state has spent decades building an oversight infrastructure that few other states have. Now we must use it more effectively and set an example for lawmakers in Washington to follow.

Maryland’s approach dates to the 1970s, when the Health Services Cost Review Commission began setting hospital rates. Maryland remains unique in maintaining this system. Public oversight of hospital charges is part of our state’s governing tradition, rooted in the belief that access to care is too important to ignore meaningful accountability.

That history makes failures to meet federal price transparency requirements particularly troubling. Four Maryland hospitals recently appeared on a federal list of facilities receiving notices over transparency deficiencies. Maryland hospitals, accustomed to supplying detailed financial and rate information to state regulators, should be well prepared to meet federal disclosure requirements.

The test should be whether the information works. Can a patient obtain a meaningful estimate before a scheduled procedure? Can an employer or researcher analyze the published data? Are the files accurate and updated? Hospitals should be expected to answer those questions and correct deficiencies promptly.

State rate regulation does not answer every question a patient brings to the billing desk. Families still need to understand their deductibles, coinsurance and potential charges from separate providers. A regulated hospital price can still leave a family facing a bill they cannot afford.

That is why transparency must be paired with stronger accountability for nonprofit hospitals’ charitable obligations. Tax exemptions represent a public investment. When a hospital receives that support, taxpayers deserve to know how much assistance reaches patients who cannot afford care, how eligibility is determined and whether families can actually obtain the help available to them.

Community benefit reporting should distinguish direct financial assistance from other activities hospitals count toward their public mission. Research and professional education can have real value, but lawmakers should be able to see those expenditures separately from assistance that reduces an unaffordable patient bill.

Maryland lawmakers had an opportunity to strengthen that accounting during the 2026 legislative session. Senate Bill 832 and House Bill 1136 would have required certain nonprofit hospitals to meet minimum community benefit requirements, disclose more information about those benefits and face potential consequences for their tax exemptions if they failed to comply. Neither measure advanced beyond committee.

The General Assembly should return to that work in the coming legislative year. Clear, measurable standards would give hospitals a predictable obligation and the public a way to judge performance. Charitable status comes with certain responsibilities that must be verified, but enforcement must recognize differences among institutions.

For instance, rural hospitals that need their tax breaks just to break even are not in the same financial situation as urban nonprofit hospitals with multimillion-dollar profit margins.

This should be an area of cooperation between Democrats and Republicans. We can value our hospitals, respect the professionals who work in them and still insist that their financial practices serve patients.

Maryland’s payment reforms make the timing especially important. The state entered the federal Achieving Healthcare Efficiency through Accountable Design model in January. Further changes scheduled for 2028 include federal responsibility for Medicare fee-for-service hospital global budgets, while the state retains responsibility for other payers.

Usable pricing information and clear reporting on patient assistance should be priorities throughout that transition.

Washington also needs to confront the market power of large hospital systems. The Congressional Budget Office has found that consolidation can give providers greater bargaining power to negotiate higher prices with private insurers. Those costs reach families through their insurance premiums and reach taxpayers through federal insurance subsidies.

Congress should strengthen scrutiny of hospital mergers, support enforcement against anticompetitive conduct and require meaningful evidence that tax-exempt systems are meeting their public obligations. Transparency will be more effective when purchasers have choices and regulators can act on the information disclosed.

Maryland has the experience to show how hospital accountability can work. Our leaders should turn that experience into clear prices, enforceable charitable obligations and greater patient protection. Washington should be prepared to follow.

• Albert Wynn is a former member of Congress from Maryland’s 4th Congressional District and a former state senator from the 25th Legislative District.