Sponsors (12)
Introduced September 26, 2025 by John James · Last progress September 26, 2025
The bill greatly increases price transparency, consumer protections (cash‑price access, itemized estimates, hold‑harmless rules), and plan oversight—at the cost of substantial compliance, IT, and enforcement burdens, privacy/security risks, and potential strain on smaller providers that could lead to higher prices or reduced access.
Patients (insured and uninsured) gain far more price transparency across hospitals, labs, imaging centers, ASCs, and plans via standardized, machine-readable data and searchable consumer displays, enabling comparison shopping and better cost estimates.
Members and patients receive real-time, upfront itemized cost estimates (online, phone, or paper) with a hold‑harmless protection so plans must make members whole if the billed charge exceeds the estimate beyond the member's responsibility.
Uninsured and self-pay consumers can access and pay published discounted or minimum cash prices (for hospitals, labs, imaging, ASCs), and those published cash prices must be accepted as payment in full, lowering out‑of‑pocket costs for many who pay cash.
Hospitals, providers, labs, imaging centers, ASCs, health plans, and vendors face extensive new administrative, IT, data‑formatting, and reporting costs to compile and maintain monthly/annual machine‑readable disclosures and real‑time tools, costs that are likely to be passed to consumers, employers, or taxpayers.
Requiring disclosure of payer‑specific negotiated rates, contract formulas, and algorithmic pricing risks exposing proprietary commercial information, provoking legal challenges, disrupting negotiations, and altering contracting dynamics.
The bill imposes substantial civil monetary penalties (including large daily fines) for noncompliance, creating acute financial risk for smaller providers, vendors, and plans that could result in facility strain or closures and reduced service availability.
Based on analysis of 11 sections of legislative text.
Creates broad price-transparency rules: expanded good-faith estimates/EOBs, mandatory itemized bills, machine-readable price lists for hospitals/labs/imaging/ASCs, and new plan/vendor data disclosures.
Requires broad new price-transparency and billing rules across health care and health plans. It expands good-faith estimate content and mandates EOB-style notices from plans; forces providers to deliver timely, itemized bills and limits collections if those bills or prior estimates aren’t provided or are exceeded without documented reasons; and requires hospitals, laboratories, imaging providers, and ambulatory surgical centers to publish detailed, machine-readable price lists and consumer-facing price displays. The bill also creates new data‑sharing rules for plans, vendors, and employers, adds strong reporting and disclosure duties for third‑party plan service providers, and creates civil penalties and enforcement authorities for noncompliance.