A new report from a leading patient-rights group shows hospital compliance with Trump's price transparency rule has more than doubled since 2024, but roughly half of American hospitals still refuse to post their prices.

Patient Rights Advocate, a nonprofit that tracks whether hospitals follow federal disclosure requirements, sent a letter to President Trump this week sharing findings from its Eighth Annual Hospital Price Transparency Compliance Report. The group found that 49.4% of U.S. hospitals reviewed now meet federal transparency standards, up from just 21.1% in November 2024, the Daily Caller News Foundation first reported.

That jump, more than doubling in under two years, marks the highest compliance level PRA has ever recorded. And the group credits the Trump administration's renewed enforcement focus for driving the change.

But the same data carries a blunt warning: more than 80% of hospitals still do not post actual dollars-and-cents prices for most of their items and services. Patients walking into those facilities have no reliable way to know what they will owe before they receive care.

From 21% to 49%: what changed after four years of drift

Trump first enacted the Hospital Price Transparency Rule in 2019, when the Centers for Medicare & Medicaid Services finalized policies designed to force hospitals to publicly list their negotiated rates. The idea was straightforward: patients deserve to know what a procedure costs before they agree to it, the same way consumers compare prices for virtually everything else they buy.

PRA's letter to Trump drew a sharp line between the current administration's approach and what came before. The group described 2021 through 2024 as "years of inaction" on enforcement. During that stretch, compliance barely moved, and hospitals that ignored the rule faced little consequence.

The numbers back that characterization. Breitbart reported that the Biden administration fined only 18 hospitals for noncompliance over that entire period, even as the vast majority of facilities flouted the rule. A 2023 analysis cited in that reporting found that full implementation of price transparency could save consumers up to $80 billion in healthcare costs, with a separate 2024 report suggesting employers could cut their costs by 27%.

Those savings remain largely theoretical as long as half the industry refuses to comply.

Courts backed the rule, hospitals fought it anyway

The hospital industry has not gone quietly. The American Hospital Association challenged the transparency rule in federal court, arguing the disclosure requirements were too burdensome. A Trump-appointed federal judge, Carl Nichols, rejected that argument and granted the administration's motion for summary judgment, upholding the rule in its entirety. Trump called the decision a "big victory for patients" on social media, Fox News reported.

The American Hospital Association announced it would appeal. That legal fight continues even as compliance climbs, a reminder that institutional resistance to price disclosure runs deep.

Cynthia Fisher, the founder of Patient Rights Advocate, has been one of the most vocal champions of the transparency push. She praised Trump's executive order renewing and strengthening the first-term rules, saying it "cements Trump's legacy as the president who transformed American health care and lowered the costs of care and coverage for all consumers."

49% compliant still means 51% are hiding prices from patients

PRA's letter to Trump did not sugarcoat the gap that remains. The group noted that approximately half of the hospitals it reviewed are still noncompliant, still hiding prices from patients who have a legal right to see them.

PRA put it plainly in its letter to the president:

"More than 80% of hospitals do not even post actual dollars-and-cents prices for most of their items and services. In no other industry would it be acceptable for consumers to be deliberately kept in the dark about the price of the services and products they are purchasing. Healthcare should be no exception."

That framing resonates beyond advocacy circles. Republican campaign strategist David Kochel told the Daily Caller News Foundation that the issue has broad political appeal.

"The vast majority of Americans want hospitals to disclose their prices upfront and be held accountable. Yet, the majority of hospitals are still not complying with the federal hospital price transparency rule. This is an opportunity for this administration and candidates nationwide to support voters."

Kochel's point is hard to argue with on the merits. Price transparency polls well across party lines. Voters who struggle with medical bills, and that covers most of the country, do not need a policy briefing to understand why hospitals should tell them what things cost before sending a bill.

PRA credits Trump's 'Great Health Plan' for momentum

In its letter, PRA tied the compliance gains directly to Trump's broader healthcare agenda, referencing a "Great Health Plan" the president released earlier in 2026. The group wrote that the progress "reflects your focus on price transparency as a means of reducing healthcare costs for the American people."

Oklahoma state Rep. Mark Lepak offered a similar assessment of Trump's approach, saying the president is "actually doing it" on healthcare costs "by taking powerful action in both of his terms and refusing to be swayed by special interests in Washington."

PRA also highlighted the broader economic stakes on social media. In a September 11 post on X, the group argued that employers and unions still lack the basic pricing information they need to negotiate better insurance rates for workers, a problem that price transparency is designed to solve.

The White House did not respond to the Daily Caller News Foundation's request for comment on the letter or the compliance findings. Some lawmakers have recently called for greater healthcare price transparency amid rising costs, though no specific legislation was identified.

Enforcement is the only language hospitals understand

The trajectory is clear enough. When the federal government treated the transparency rule as optional, fining only 18 hospitals over four years, compliance stalled at 21%. When the Trump administration signaled it would enforce the law, compliance more than doubled.

That pattern should surprise no one. Hospitals are sophisticated institutions with armies of lawyers and lobbyists. They do not volunteer to disclose information that could undercut their pricing power. They comply when the cost of defiance exceeds the cost of disclosure, and not a moment before.

The 49.4% figure is real progress. It is also a reminder that more than half the industry is still betting it can wait out the rule, outlast the administration, or win on appeal. Every day a hospital refuses to post its prices, patients walk in without knowing what they will owe, and walk out with bills they never agreed to.

Americans can price-compare a set of tires, a plane ticket, or a gallon of milk. They deserve the same basic information before a hospital hands them a bill that could reshape their finances for years.