The Ayotte administration and New Hampshire’s hospitals are touting a compromise deal on their Medicaid Enhancement Tax (MET) lawsuit, an agreement Gov. Kelly Ayotte (R) calls “a win for our state, for rural healthcare access, and, most importantly, for patients.”
But according to a recent study, Granite Staters are still losing when it comes to price transparency from the hospitals that serve them. In fact, not a single major hospital in the state meets the full transparency standard, according to the group Patients Rights Advocate (PRA).
President Donald Trump has made price transparency — letting patients know how much the services they receive actually cost — a priority since his first term. On Feb. 25, he signed an executive order entitled, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information.”
According to the order, “opaque pricing arrangements allowed powerful entities, such as hospitals and insurance companies, to operate with insufficient accountability regarding their pricing practices, resulting in patients, employers, and taxpayers shouldering the burden of inflated healthcare costs.”
“It is the policy of the United States to put patients first and ensure they have the information they need to make well-informed healthcare decisions,” the order adds. “The federal government will continue to promote universal access to clear and accurate healthcare prices and will take all necessary steps to improve existing price transparency requirements.”
The Trump administration may want to start in the Granite State.
According to PRA, New Hampshire’s hospitals are among the nation’s worst for transparency compliance. Not a single hospital in the state that is fully compliant. And only one of the state’s seven major hospitals (Concord Hospital) achieved a “sufficient pricing data” rating.
“While none of the Granite State hospitals reviewed last fall were in compliance, we are optimistic that with President Trump’s recent hospital price transparency executive order, hospitals will begin to post clear, upfront prices,” said Cynthia Fisher, founder and chairman of PRA. “Real prices will allow patients to compare prices before care to save money and provide remedy and recourse for overcharges and billing errors. Transparency in healthcare will shift the power to patients, the true purchasers of care.”
(PRA’s New Hampshire hospital ratings and analysis can be found here.)
To be considered “sufficient” by PRA, a hospital must use the CMS Validator Tool, a web-based tool provided by the Centers for Medicare & Medicaid Services (CMS) to help hospitals ensure compliance with Hospital Price Transparency regulations. The hospital must also post the payer-specific negotiated charge that applies to each item or service, for at least 50 percent of the items and services identified.
Not acceptable, says Connie Partoyan, executive director of Better Solutions For Healthcare.
“There’s a basic expectation of transparency not being met by the hospitals in New Hampshire, despite the federal requirements established in 2021. Patients and employers confronting higher healthcare costs caused by hospitals’ bad actions deserve better.”
While the Trump administration has made price transparency a priority, it’s not a partisan issue. New Hampshire Democrat Sen. Maggie Hassan has long called for robust enforcement of key health care price transparency requirements, and she’s backed bipartisan legislation to force hospitals to make more treatment information public.
And yet, little progress has been made, particularly in New Hampshire, critics say.
Steve Ahnen, president of the New Hampshire Hospital Association, rejects the report and its findings.
“New Hampshire hospitals and health systems continue to invest considerable time and resources to comply with the Hospital Price Transparency Rule and have adopted federal price transparency requirements,” Ahnen told NHJournal in a statement.
“We find the report not only extremely disappointing, but fundamentally unsound. We disagree with its findings. We find the report to be misleading and based on incomplete information. Its methodology was flawed, counter to the actual federal regulations, and the American Hospital Association has repeatedly debunked such misleading reports on price transparency,” Ahnen claims.
“The Centers for Medicare and Medicaid Services, the federal agency in charge of evaluating compliance with this regulation, follows its own criteria and finds a high rate of compliance through official audits.”
PRA responds that industry experts have acknowledged lax enforcement by CMS, and Axios reports the Biden administration only took enforcement action against 18 of America’s more than 6,100 hospitals between 2022 and 2025.
One of those 18 was Frisbie Memorial Hospital in Rochester, N.H., which was slapped with a fine of more than $100,000 for being “noncompliant with the price transparency requirements” in 2023.
When Trump signed the first executive order in 2017, the PRA’s Cynthia Fisher greeted it with enthusiasm.
“Today, patients don’t have access to prices or choices or even ability to see quality,” Fisher said at the time. “I think the exciting part of this executive order is the president and administration are really moving to put the patient in the driver’s seat and be empowered for the first time with knowledge and information.”
That excitement has given way to frustration. According to PRA’s data, only 21 percent of the 2,000 U.S. hospitals it reviewed were compliant with the 2021 Hospital Price Transparency Rule, down from 36 percent in July 2023.
Earlier this month, Oklahoma’s legislature passed a bill requiring the state’s hospitals to post the exact prices of available services online for upfront public viewing, with mechanisms included for state enforcement and patient protection.
“Across the country, elected leaders are taking bold action to put power in the hands of their constituents with upfront prices. We don’t expect the momentum to slow down, and we surely won’t let it,” Fisher said.
