New Hampshire, which recently revived an inactive website for state residents, was a bright spot in the report. In contrast, its neighbor, Massachusetts, dropped in the rankings after it shut down its website.

The silver lining, according to HCI3 and CPR, is that state lawmakers are increasingly aware of their advocacy efforts, and many are citing the report card in attempts to advance transparency legislation.

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“Legislative sessions are still underway and some proposed bills may still pass,” said Francois de Brantes and Suzanne Delbanco, executive directors of HCI3 and CPR, respectively. “There are hopeful signs of progress in New York, Connecticut, Maryland and Washington state, where officials are in the process of building websites and APCDs.

“We expect progress, even at a slow pace,” said de Brantes and Delbanco.

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The group leaders nevertheless struck a somber tone in discussing the roadblocks to greater transparency, including political pressure from interests who they say benefit from “price opacity.” They identified those interests as “providers, suppliers and other payers to the industry.”

Legislators and the media, they claimed, are often misled by claims that laws forcing greater price disclosure compromise “price as a trade secret” or risk illegally violating contracts between payers, providers, and suppliers.

They note, however, that the states that have successfully implemented their recommendations have not encountered any of the legal snafus that opponents predicted.

“Many of the arguments against price transparency—including that it leads to higher prices and breaks laws—are toothless,” they said. “We hope the legal analysis helps legislators and the media focus on the right considerations.”