Sponsors
The bill aims to increase competition, transparency, and antitrust enforcement in health-plan contracting to lower prices and expand choice, but it risks raising administrative and compliance costs, creating legal uncertainty, and potentially reducing providers' ability to design networks that coordinate care.
Patients (including Medicare, Medicaid, people with chronic conditions, and uninsured individuals) could face lower prices and better access if anti-competitive contract clauses are curtailed or enforced against.
Health plan enrollees would get clearer price and quality information because gag clauses and certain restraints would be defined or limited, improving transparency for patients.
Smaller providers and competing health systems would face fewer coercive contracting practices, giving hospitals and health systems greater bargaining freedom and supporting market competition and patient choice.
Health insurers and plan administrators could face higher negotiation, compliance, and administrative costs as contract provisions are restricted or litigated, which may be passed to consumers as higher premiums.
Providers, carriers, and administrators will face regulatory and legal uncertainty during the 18-month study and afterwards if definitions or recommendations are broad or ambiguous, increasing litigation and operational risk.
Health systems may lose leverage to design networks and tiers (including narrow networks used to coordinate care), which could reduce their ability to manage care quality or coordination for some patients.
Based on analysis of 3 sections of legislative text.
Requires GAO (with FTC and DOJ coordination) to study how anti‑competitive insurer–provider contract clauses affect consolidation, prices, access, and enforcement capacity, and to recommend actions.
Introduced April 24, 2025 by Victoria Spartz · Last progress April 24, 2025
Requires the Government Accountability Office (GAO), working with the Federal Trade Commission (FTC) and the Department of Justice Antitrust Division, to complete a study within 18 months that evaluates how certain insurer–provider contract clauses (anti‑steering, anti‑tiering, all‑or‑nothing, and gag clauses) affect health care consolidation, consumer prices, and access to care. The GAO must list related FTC/DOJ actions, assess agency enforcement resources and capabilities, and recommend legislative or administrative steps if more resources or authority are needed; the report is to be delivered to specific House and Senate committees. Also establishes clear, Act‑specific definitions for the covered restrictive contract provisions and for tiered network plans to ensure consistent interpretation for the study and report.