Sponsors (4)
The bill increases patient choice and limits certain restrictive contracting practices—benefiting smaller payers and employers—while creating legal and market adjustments that could disrupt some integrated care arrangements and raise costs for providers and enrollees.
Group health plan participants (especially patients with chronic conditions) may gain broader provider choice because plans and issuers cannot contractually bar steering or incentives to use other providers.
Employers and enrollees (including middle-class families) face fewer unexpected financial obligations because plans cannot force side‑agreements or payment terms for affiliates not party to the contract.
Smaller insurers and third‑party payers (and ultimately taxpayers) can negotiate lower rates or pay different rates because agreements may not prevent others from making lower payments than a contracted plan/issuer.
Unclear enforcement and rulemaking about who qualifies as a "covered entity" or a "value‑based network arrangement" could create litigation and compliance uncertainty for plans, providers, and healthcare workers.
Patients (particularly those in integrated or HMO arrangements) could see disruptions to coordinated care if narrow exceptions do not cover their existing value‑based or integrated care contracts when those contracts are renegotiated.
Some providers may raise list prices to offset lost contracting leverage, which could push up premiums or out‑of‑pocket costs for enrollees over time, affecting middle‑class families.
Based on analysis of 2 sections of legislative text.
Introduced November 21, 2025 by Jodey Cook Arrington · Last progress November 21, 2025
Prohibits group health plans and health insurers from entering into contracts with providers, networks, TPAs, or other service providers that restrict a plan or issuer from steering patients, offering incentives to use other providers, or allowing other plans to pay lower rates. The law creates narrow exceptions for certain HMOs and value‑based network arrangements and requires HHS, Labor, and Treasury to issue implementing regulations within one year. The prohibitions apply to contracts entered into, amended, or renewed 18 months after the law takes effect.