Sponsors (4)
The bill makes it easier for plans to steer enrollees toward higher‑value, lower‑cost providers and protects value‑based arrangements—potentially lowering costs and improving quality—while risking reduced provider bargaining power, higher administrative costs, and legal or competitive unevenness that could raise prices or spark disputes.
Patients — including Medicare and Medicaid beneficiaries and people with chronic conditions — gain increased ability to be steered to higher‑quality or lower‑cost providers, expanding choice and potentially lowering out‑of‑pocket spending.
Hospitals, health systems, and patients benefit from stronger competition among providers and insurers, which can incentivize higher quality care and put downward pressure on prices.
Hospitals, health systems and other providers, and healthcare workers gain clearer legal protection for value‑based arrangements (ACOs, centers of excellence), reducing regulatory uncertainty and helping sustain innovative care models.
Integrated health systems and some providers may lose negotiating leverage or revenues from exclusive contracting, which could prompt consolidation or local price increases that harm patients and provider employees.
Insurers and plans could face higher administrative and negotiation costs as they rework contracts to comply, potentially leading to higher premiums or costs passed to taxpayers and middle‑class families.
Group health plans and covered entities may face legal uncertainty and litigation risk because definitions, enforcement standards, and the Secretary's exemption discretion are ambiguous.
Based on analysis of 2 sections of legislative text.
Prohibits health plans, issuers, and covered entities from using contract terms that block steering, incentives, or lower‑rate arrangements that improve access to higher‑quality or lower‑cost care, with limited exceptions.
Prohibits health plans, issuers, and certain facility contracts from including terms that block patients from getting higher‑quality or lower‑cost care. The law bans contract clauses that prevent plans or issuers from steering enrollees to certain providers, offering incentives to use other providers, or paying lower rates to other plans, while carving out limited exceptions for some integrated HMO and value‑based network arrangements.
Introduced November 21, 2025 by Jodey Cook Arrington · Last progress November 21, 2025