Sponsors (2)
Official title: To promote price transparency in the health care sector.
Introduced June 23, 2026 by Brett Guthrie · Last progress June 23, 2026
The bill substantially expands price transparency and provides real-time, member-specific cost estimates and public machine-readable data to help consumers shop and regulators oversee markets, but it also imposes significant data, IT, and compliance costs — including daily penalties and disclosure risks — that could be passed on to consumers and strain smaller or rural providers.
Insured patients (Medicare, Medicaid, employer plans) can get member-specific, itemized, real-time out-of-pocket cost estimates before scheduling care, reducing surprise bills and helping plan medical decisions.
People seeking common, shoppable services (labs and imaging) — including Medicare beneficiaries and uninsured/cash-pay patients — can see published discounted cash prices or gross charges for tests and imaging, enabling price comparison and potentially lower out-of-pocket spending.
Public, machine-readable rate and payment files (for hospitals, plans, and providers) increase market transparency and oversight, enabling policymakers, researchers, employers, and developers to compare prices, detect pricing trends, and build consumer tools.
Hospitals, labs, plans, PBMs, pharmacies, and other providers face substantial administrative, IT, and ongoing data-integration costs to collect, standardize, and publish the required real-time tools and machine-readable files — costs that are likely to be passed to consumers through higher premiums or reduced benefits.
Smaller and rural hospitals, labs, imaging suppliers, and pharmacies may struggle to meet technical and resource requirements (or pay daily penalties), risking financial stress and potential reductions in local services or access.
Civil monetary penalties (often daily) and enforcement risk create ongoing financial exposure and legal risk for noncompliant entities, which could divert funds from patient care or provoke costly disputes.
Based on analysis of 7 sections of legislative text.
Requires standardized public price postings and member‑specific cost estimate tools for hospitals, ASCs, labs, imaging providers, and group health plans, with enforcement and penalties.
Requires hospitals, ambulatory surgical centers, clinical labs, imaging providers, group health plans, and issuers to publish standardized, consumer‑friendly price information and to provide member‑specific cost estimates. Sets uniform formats, accessibility standards, enforcement mechanisms including civil monetary penalties, and reporting requirements, with most provider and plan requirements taking effect January 1, 2028. Aims to expand and standardize machine‑readable price files, shoppable service lists (minimum 300 services), payer‑specific negotiated rates or discounted cash prices, and real‑time estimate tools for plan participants; gives the HHS Secretary and Treasury rulemaking and enforcement authority and requires periodic reports to Congress.