A perspective on affordability, transparency, and whole-person health

The cost of health care is not only a financial issue. It is an access issue, a prevention issue, and, ultimately, a community health issue. When prices rise beyond what families and employers can reasonably absorb, people may delay care, avoid follow-up appointments, or make difficult choices between medical needs and other basic expenses.

Indiana is testing a new response. Through House Enrolled Act 1004, the state has established pricing and transparency requirements intended to place greater pressure on high hospital prices. The law requires certain nonprofit hospital systems to offer direct-to-employer health care arrangements with average prices at or below 260% of Medicare rates. It also creates a broader benchmark under which covered nonprofit hospital systems must bring aggregate average inpatient and outpatient prices at or below statewide averages by June 30, 2029, or risk losing state nonprofit status (House Enrolled Act 1004, 2025).

Why Prices Matter Beyond the Hospital

Hospital care represents a substantial share of health spending, and prices paid by private health plans are often far higher than Medicare rates. A national RAND Corporation analysis found that employers and private insurers paid an average of 254% of Medicare prices for hospital inpatient and outpatient services in 2022. The same analysis found that outpatient hospital facility prices averaged 279% of Medicare rates (Whaley et al., 2024).

These differences do not remain confined to a hospital bill. They can influence insurance premiums, employee benefit costs, deductibles, and out-of-pocket expenses. For households already managing transportation barriers, food costs, housing instability, medication expenses, or caregiving responsibilities, an unaffordable medical expense can become one more obstacle to stability.

That matters in behavioral health as well. Physical health, mental health, substance use treatment, housing, transportation, and financial security do not exist in separate compartments. When one part of a person’s life becomes unstable, the effects often reach the others. A person who delays medical treatment because of cost may experience worsening symptoms, increased stress, or a crisis that eventually requires more intensive and expensive care.

What Makes Indiana’s Approach Different

Indiana’s law connects pricing expectations to direct employer arrangements, reporting requirements, financial oversight, and the nonprofit status of certain hospital systems. This represents a shift from transparency alone toward accountability tied to measurable benchmarks (House Enrolled Act 1004, 2025).

The direct-to-employer provision may give employers another avenue for negotiating health care costs. Rather than relying exclusively on traditional insurer networks, qualifying arrangements can connect employers more directly with hospitals under a defined Medicare-based ceiling. The broader 2029 requirement takes a different approach: It compares covered nonprofit systems with statewide inpatient and outpatient pricing averages.

It is important to recognize that price limits are not a simple solution. Hospitals must maintain staffing, emergency services, specialized care, technology, and facilities. Rural and safety-net providers may face different financial pressures than large systems with greater negotiating power. Any pricing policy must, therefore, be monitored for its effects on quality, workforce stability, and access—especially in communities where health care options are already limited.

Affordability Is Part of Whole-Person Care

For community-based organizations, the larger lesson is that affordability belongs in conversations about health outcomes. A referral is only meaningful when a person can reach the provider, understand the process, afford the service, and remain connected to care. Transparent prices and stronger purchasing leverage may help, but communities also need coordinated services, prevention, early intervention, and support for the social conditions that shape health.

At Community Service Board of Middle Georgia, we understand that effective care requires more than responding to a crisis. It requires meeting people where they are, reducing barriers, connecting services, and supporting recovery over time. Although Indiana’s policy applies outside Georgia, it raises questions that matter everywhere: What should accountability look like? How can purchasers identify fair prices? How do we protect rural access while addressing high costs? And how can savings be translated into better access for the people who need care?

A Policy Worth Watching

Indiana’s experiment will not answer every question immediately. Its success should be evaluated not only by whether prices fall, but also by whether people experience lower financial burdens, employers obtain better value, providers remain sustainable, and communities gain more reliable access to care.

Still, the law signals an important change in the national conversation. Health care affordability is increasingly being treated as a matter of accountability—not simply an unavoidable feature of the system. For behavioral health and human service organizations, that conversation is essential. When care becomes more affordable and accessible, individuals are better positioned to seek help earlier, remain engaged in treatment, and build healthier, more stable lives.

References

House Enrolled Act 1004, 124th Gen. Assemb., 1st Reg. Sess. (Ind. 2025). https://iga.in.gov/legislative/2025/bills/house/1004/details

Whaley, C. M., Kerber, R., Wang, D., Kofner, A., & Briscombe, B. (2024). Prices paid to hospitals by private health plans: Findings from Round 5.1 of an employer-led transparency initiative (RR-A1144-2-v2). RAND Corporation. https://doi.org/10.7249/RRA1144-2-v2