Sponsor
Victoria Spartz
Representative · R-IN
This bill seeks to increase price transparency and curb coercive or secretive contracting to boost competition and patient choice, but those gains may come with higher insurer and administrative costs, legal uncertainty for providers and carriers, and some tradeoffs in network management and federal spending.
Patients (including people with chronic conditions, Medicare/Medicaid beneficiaries, and uninsured individuals) are likely to get clearer price and quality information and face lower out-of-pocket costs and better access if gag clauses and anticompetitive contracting restraints are curtailed.
Smaller providers, competing health systems, and hospitals may face fewer coercive contracting practices (e.g., all‑or‑nothing clauses), improving competition, provider bargaining power, and patient choice in networks.
FTC/DOJ resourcing and GAO study recommendations could strengthen antitrust enforcement and deterrence of harmful contracting practices, benefiting consumers over time.
Insurers and plan administrators could face increased negotiation complexity, compliance and administrative costs as contract provisions are restricted or litigated, which may be passed on to consumers as higher premiums.
The study, its recommendations, or subsequent enforcement could create regulatory and legal uncertainty for providers, carriers, and administrators during the 18‑month study and afterward until guidance or case law clarifies definitions and scope.
Health systems may lose leverage to design networks or tiers (including narrow networks used to coordinate care or maintain quality), which could hinder care coordination or quality management in some plans.
Based on analysis of 3 sections of legislative text.
Mandates an 18‑month GAO study (with FTC/DOJ coordination) on effects of anti‑competitive insurer–provider contract clauses and on enforcement capacity, with recommendations.
Representative · R-IN
Requires the Government Accountability Office (GAO), working with the Federal Trade Commission (FTC) and the Department of Justice Antitrust Division (DOJ), to complete a study within 18 months on how specific contract clauses between health insurers and providers (anti-steering, anti-tiering, all‑or‑nothing, and gag clauses) affect market consolidation, consumer prices, and access to care. The GAO must list FTC/DOJ actions related to those clauses, evaluate whether those agencies have sufficient resources and ability to enforce antitrust law against such clauses, and recommend legislative or administrative steps to bolster enforcement if needed, then deliver the report to designated House and Senate committees.
Official title: To require the Government Accountability Office to evaluate the effects of anticompetitive contracting clauses in contracts between health insurers and health care providers and to determine actions taken by the Federal Trade Commission and the Department of Justice relating to the use of such clauses in such contracts and to assess their ability to effectively enforce the Federal antitrust laws with respect to such use.
Introduced April 24, 2025 by Victoria Spartz · Last progress April 24, 2025