Sponsors
Last progress April 24, 2025 (10 months ago)
Introduced on April 24, 2025 by Victoria Spartz
Referred to the Committee on Energy and Commerce, and in addition to the Committee on the Judiciary, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Requires the Government Accountability Office (GAO), working with the Federal Trade Commission (FTC) and the Department of Justice Antitrust Division (DOJ), to study how certain contract clauses between health insurers and health care providers affect market consolidation, consumer prices, and access to care. The GAO must also list FTC/DOJ actions on these clauses, assess whether those agencies have adequate resources and enforcement ability, and offer recommendations if more resources are needed; the report is due within 18 months of enactment and must be delivered to relevant congressional committees. Also defines key terms used in the study: “all-or-nothing clause,” “anti-steering clause,” “anti-tiering clause,” “gag clause,” and “tiered network plan,” clarifying which contract practices and network arrangements are within scope for the review.
The Comptroller General of the United States, in coordination with the Federal Trade Commission and the Assistant Attorney General of the Antitrust Division of the Department of Justice, must carry out a study. (This is a directive to GAO to lead the study with the named agencies.)
The study must evaluate the effect of specific anticompetitive contract clauses — anti‑steering clauses, anti‑tiering clauses, all‑or‑nothing clauses, and gag clauses — in contracts between health insurers and health care providers, including effects on consolidation in the health care industry, prices paid by consumers for medical services, and consumer access to health care.
The study must include a list of all actions the Federal Trade Commission and the Department of Justice have taken, directly or indirectly, related to the use of those contract clauses in contracts between health insurers and health care providers.
The study must contain an assessment of whether the Federal Trade Commission and the Department of Justice have the resources and the capability to effectively enforce the Federal antitrust laws as applied to the use of those clauses in such contracts.
The study must include recommendations for legislative or administrative actions, if necessary, to increase the resources of the Federal Trade Commission and the Department of Justice to enforce antitrust laws related to these clauses.
Who is affected and how:
Health insurers: Contracts and negotiation practices will be examined; the study may lead to increased regulatory scrutiny of clauses insurers use in provider agreements. Insurers could face calls for changes in contracting practices or increased enforcement.
Health care providers (hospitals, physician groups, clinics): Providers whose contracts include the named clauses may see those practices scrutinized; potential outcomes include pressure to renegotiate terms, more public attention to contract restrictions, or changes in network participation dynamics.
Patients and health care consumers: The study focuses on effects on consumer prices and access, so findings could lead to remedies that improve transparency, lower patient costs, or increase provider choice over time.
FTC and DOJ Antitrust Division: Agencies are a central part of the study and will be assessed for enforcement capacity; the report could justify increased staffing or funding requests, or changes in enforcement approaches.
Congress and policymakers: The report provides evidence and recommendations that may inform future legislation, oversight, or appropriation decisions related to competition in health care markets.
Short-term effects: The law itself requires only a study and definitions, so immediate effects are limited to data collection, agency cooperation, and increased visibility of the practices.
Medium- to long-term effects: Depending on findings, the study could lead to increased enforcement actions, requests for agency resources, rulemaking, voluntary industry changes, or follow-on legislation to restrict anticompetitive contract clauses and improve price transparency and patient steering protections.