Michigan has some of the most aggressive private hospital price negotiation in the country. This report measures whether that pressure reached the prices hospitals actually publish.
The share of more than 268,000 benchmarkable list prices published by major hospital systems operating in Michigan that currently sit above 260% of the corresponding Medicare rate, the line Indiana wrote into law.
Indiana's House Enrolled Act 1004 requires the state's largest nonprofit hospital systems to offer employers health care arrangements priced at or below 260% of what Medicare pays. It is the most direct hospital pricing benchmark enacted in the country. Michigan has no equivalent because no Michigan statute draws a line against Medicare, and no Michigan hospital is required to price against one.
What sets Michigan apart is its market. For decades, Michigan's large employers and organized labor, anchored by the automotive industry, have negotiated hospital prices as hard as any purchasers in the country. If private pressure alone could pull published prices toward a defensible benchmark, Michigan is where the series would expect to see it.
The Solomon Report measured it, using the identical instrument as Reports No. 1 through No. 3. Across 57 hospital facilities in five major systems operating in Michigan, the answer is closer to the line than any state measured before, and still well above it.
Report No. 1 measured Indiana's published hospital prices against the 260% of Medicare benchmark in Indiana's own law and found 86.8% above the line. Report No. 2 applied the same line to Ohio and found 93.2%. Report No. 3 applied it to Texas and found 94.1%. This report applies it to Michigan, not because Michigan is bound by it, but because it is the only price benchmark an American legislature has enacted with this level of directness, and because a common yardstick is what makes states comparable at all.
Price benchmarks tied to Medicare are spreading. Indiana's employer contracting requirement reaches independent hospitals on September 1, 2026. Oregon has operated a cap on what its state employee plans pay hospitals, with documented savings exceeding $100 million in its first two years. Vermont has adopted employer-plan price limits of its own. Whether Michigan ever draws such a line is a question for Michiganders. What this report establishes is where the published prices of the hardest negotiating hospital market in the series stand today relative to the strictest line that exists.
Across 57 facilities in five major hospital systems operating in Michigan, 62.6% of the 268,263 published list prices that can be directly benchmarked against a Medicare rate currently exceed 260% of that rate. The figure is computed conservatively. Each price is compared against the higher of Medicare's applicable payment rates for the same billing code, so a price is counted above the line only when it exceeds 260% of the most generous Medicare figure available. By the identical computation, Indiana's share was 86.8%, Ohio's was 93.2%, and Texas's was 94.1%.
Michigan is the first state in the series to fall meaningfully below the pack, and the direction is consistent with its market. A state whose employers and unions have pressed hospital prices for decades clears the line far less often than states without that history. It is the strongest evidence the series has produced that private negotiation can move published prices at all.
Even in the hardest negotiating market measured, nearly two-thirds of published list prices exceed the point another state's legislature identified as the limit of defensibility. The finding is not sensitive to where the line is drawn: 76.3% of Michigan prices exceed 200% of Medicare, and 57.5% exceed 300%. Nor does it ride on statistical outliers. Restricting the population to prices between one-tenth and one-hundred times the corresponding Medicare rate reproduces the finding exactly, at 62.6% on 266,932 prices.
The variation within the state is the widest the series has recorded. Across Michigan's facilities, the share of benchmarkable prices above the line runs from 18.6% at the lowest to 95.7% at the highest. Two hospitals in the same state, holding their prices against the same benchmark, can stand nearly eighty points apart. What a patient pays depends heavily on which facility they enter.
A comprehensive metabolic panel is among the most common blood tests in medicine, a standardized set of measurements ordered millions of times a year. It is the same test wherever it is drawn. Across the Michigan systems in this report, its published price is not:
| Comprehensive metabolic panel (CPT 80053) | Lowest | Highest |
|---|---|---|
| Published list price, Michigan facilities | $13 | $427 |
One billing code, one routine test, priced by hospitals in a single state from their own published files, across a 33-fold range. The test does not change from one hospital to the next, but the number attached to it does.
A published list price above 260% of Medicare violates no Michigan law, because Michigan has drawn no such line. This report makes no compliance determination about any hospital anywhere. It measures distance, not violation.
What the finding does establish is that private negotiation, even at its most aggressive, has not brought published prices to the line. Michigan is the closest a market in this series has come, and it remains far short. The distance between what this market produces and what a benchmark defines is not small, it is the biggest thing the data reveals.
This measurement required no subpoena, no special access, and no cooperation from any hospital. Federal law compels the disclosure and Medicare's rates are public record. Anyone can measure how far a price sits from the benchmark, and a state that wants to know where its prices stand can know.
Four states, one instrument. Indiana, with the strictest benchmark law in the country, publishes list prices that exceed its own line in 86.8% of benchmarkable cases. Ohio exceeds it in 93.2%, Texas in 94.1%. Michigan, the hardest negotiating market yet measured, exceeds it in 62.6%. Michigan comes closer to the line than any state before it, but it still doesn't reach it. Even here, most published prices sit above the point Indiana set as the limit.
The Solomon Report intends to keep measuring.
Solomon Report findings are computed from hospitals' federally required price transparency files and public Medicare fee schedules. Findings compare published hospital charges for a given billing code against Medicare's payment rates for the same code, using the higher applicable Medicare rate so that all figures are conservative. Prices published without a matchable billing code are excluded rather than estimated. List prices are distinct from negotiated rates. This report uses the identical computation as Reports No. 1 through No. 3, all of which were re-run and reproduced exactly at the time of this analysis. The finding is robust to conservative restriction: limiting the population to prices between one-tenth and one-hundred times the corresponding Medicare rate (266,932 of the 268,263) yields 62.6%. The quoted per-code example was selected as a standardized, high-volume laboratory service to avoid codes whose published figures reflect per-unit quantities or device-bundling differences rather than facility pricing. To keep the focus on market-wide patterns, findings are reported in aggregate rather than by institution.
The Solomon Report is an ongoing public reporting series from Solomon Copilot that measures what public healthcare pricing data actually shows. Hospital prices and Medicare rates are public records. The Report puts them side by side.