Sponsors (6)
The bill increases pricing and quality transparency and limits some anticompetitive contracting to help patients and purchasers get lower-cost, higher-quality care, but it creates compliance burdens, potential privacy risks, and uneven exemptions that may favor large integrated systems.
Patients (including those with chronic conditions and Medicare/Medicaid beneficiaries) will get clearer provider-specific cost and quality information, enabling them to choose higher-quality, lower-cost care.
Group health plans and issuers can steer enrollees or offer incentives toward lower-cost providers, which can reduce enrollees' out-of-pocket spending.
Researchers, plan sponsors, and health system managers gain access to de-identified claims/encounter data, improving transparency, analysis, and plan management decisions.
Hospitals, provider networks, and their staff may face administrative and contractual disruption as they revise exclusive or affiliate agreements to comply with the law.
Insurers and plan sponsors will incur compliance costs (revising contracts, implementing data-sharing, submitting attestations) that may be passed on to enrollees or taxpayers.
Expanded sharing of de-identified claims data raises privacy and re-identification risks for patients, potentially compromising sensitive information despite HIPAA alignment.
Based on analysis of 2 sections of legislative text.
Bars contract terms that prevent plans/issuers from steering or incentivizing enrollee use of higher-quality, lower-cost providers, requires annual plan attestations, and narrows gag clauses.
Introduced November 21, 2025 by Jodey Cook Arrington · Last progress November 21, 2025
Prohibits contract terms in facility and insurer agreements that prevent group health plans and issuers from steering enrollees to higher-quality, lower-cost providers or from sharing provider-specific cost and quality data. It expands an existing ban on so-called “gag clauses,” requires group health plans to attest annually that they comply, and clarifies that reasonable public-disclosure limits remain allowed. The change amends provisions in the Internal Revenue Code and in the Public Health Service Act to expressly cover facility and insurer contracts and to bar several types of anticompetitive contract terms, while carving out limited exceptions (for example, certain HMO exclusive-contract models).