Sponsors (12)
Introduced September 26, 2025 by John James · Last progress September 26, 2025
The bill substantially increases price and billing transparency and strengthens patient billing protections — likely improving consumer decisionmaking and reducing surprise bills — but it also creates significant compliance costs, enforcement risks, privacy challenges, and potential short‑term market disruptions that could be passed on to patients or strain smaller providers.
Most patients (insured and uninsured) gain far greater price transparency across hospitals, labs, imaging centers, ASCs, and providers — letting them compare negotiated rates, gross charges, and expected costs before care.
Patients (including uninsured and low-income individuals) receive stronger billing protections — itemized EOBs/bills, binding good‑faith estimates when providers fail to justify excess charges, presumptions favoring patients in disputes, and limits on collections unless requirements are met.
Uninsured and self‑pay patients who pay cash can see and pay published discounted cash prices that providers must accept as payment in full, reducing out‑of‑pocket burden for cash-paying individuals.
Hospitals, providers, insurers, labs, imaging centers, ASCs, and vendors will face substantial administrative, IT, and compliance costs to compile, update, and publish the required data — costs that are likely to be passed on to consumers through higher premiums or prices.
Large daily civil penalties and enforcement exposure (including very high per‑day fines and per‑incident penalties) create acute financial risk for smaller providers, labs, imaging centers, ASCs, and vendors and could force some out of market or to raise prices.
Publishing payer‑specific negotiated rates and contract exhibits risks commercial disputes, renegotiation of contracts, and short‑term disruptions to negotiated reimbursement or network participation that could reduce patient access or alter costs.
Based on analysis of 11 sections of legislative text.
Requires standardized public and patient‑specific price disclosures across plans and providers, expands plan access to claims/payment data, and imposes penalties for noncompliance.
Requires wide-ranging price transparency and consumer notices across health plans, insurers, hospitals, laboratories, imaging providers, and ambulatory surgical centers, and gives plans expanded access to claims and payment data from vendors and providers. Sets standardized formats (including machine-readable files), frequent updates, consumer-friendly displays and itemized patient notices, binds good-faith estimates, and creates large civil penalties for noncompliance; several provisions take effect in 2026–2027 or within 1–2 years of enactment.