EXCLUSIVE — Hospitals in Florida are charging privately insured patients nearly four times what Medicare pays for the same care, the highest markup in the country, according to a new national analysis.
A report provided to the Washington Examiner by Hospital Watch, an independent hospital pricing watchdog, found that hospitals nationwide charge patients with employer-provided insurance an average of 269% more than Medicare rates.
But the gap is even larger in several states, with Florida leading the list at 380% above Medicare reimbursement levels.
Other states charging more than 300% include West Virginia, South Carolina, Georgia, Indiana, New York, California, Colorado, Idaho, and Arizona.
The findings come as lawmakers in Washington increasingly scrutinize healthcare affordability and hospital pricing.
On Wednesday, the American Hospital Association, the American Medical Association, the American Academy of Family Physicians, and the Purchaser Business Group on Health will testify before the House Energy and Commerce Committee about their investigations into rising healthcare costs.
Four Florida lawmakers serve on the committee, which has jurisdiction over healthcare policy and hospital regulation.
Hospital Watch senior adviser Adam Buckalew said pricing disparities contribute to rising insurance premiums and higher out-of-pocket costs for people covered through employer-sponsored plans.
“Hospitals account for roughly 40 cents of every healthcare dollar spent,” Buckalew said. “Not only that, their prices are rising faster than inflation, wages, and nearly every other part of the healthcare system. When hospital prices go up, premiums go up. When premiums go up, employers shift more costs to workers. Deductibles rise. Out-of-pocket costs rise. There’s no mystery here.”
The analysis used pricing data from SAGE Transparency, the RAND Corporation, the National Academy for State Health Policy, and the federal Centers for Medicare and Medicaid Services. It found hospitals charge privately insured patients 145% more than their estimated commercial breakeven costs on average.
Many of the states ranking highest in hospital markups, including Florida, West Virginia, South Carolina, Idaho, and Indiana, are politically conservative states that backed President Donald Trump in the 2024 presidential election. Arizona and Georgia also flipped red in the last presidential election.
The House Energy and Commerce Committee hearing comes as House Republicans return to Washington after a policy retreat in Florida. Affordability and healthcare were among the issues discussed at the conference, as polls show voters are increasingly concerned about both.
The new Medicaid work requirements carried out in the One Big Beautiful Bill Act have placed Republicans on the defensive. Democrats have portrayed the reforms as a risk to 12 million people’s Medicaid coverage, a statistic placed at the center of their midterm election messaging.
Buckalew said pricing issues affect patients nationwide regardless of politics.
“The bottom line is that there is hospital price gouging in all 50 states,” Buckalew said. “No matter where you live, hospital systems are using their market power to charge patients far more than the cost of care.”
Hospital groups have historically argued that higher commercial insurance prices help offset lower reimbursement from government programs. Hospitals also cite rising labor costs, inflation, and growing demand for complex care.
Still, healthcare affordability has become a central policy debate in Congress. Lawmakers have held hearings examining whether hospital consolidation and limited competition are contributing to rising costs.
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Buckalew said policymakers should strengthen price transparency requirements and more aggressively enforce antitrust laws to curb hospital consolidation.
“It’s time to confront the role hospitals play in our nation’s healthcare affordability crisis,” Buckalew said. “Patients across the country should be able to rely on hospitals to care for them when they are most in need. Real price transparency, stronger antitrust enforcement, and policies that restore competition are critical if we want to bring healthcare costs back down.”
