Sponsors (12)
The bill substantially increases price transparency and consumer billing protections—potentially lowering surprise bills and enabling audits and market analysis—while imposing large compliance, enforcement, privacy, and competitive risks that could raise costs or disrupt providers and contracting dynamics.
Patients (including people with chronic conditions, uninsured, and Medicare beneficiaries) will get clearer, timely, itemized EOBs/bills and real‑time cost estimates with hold‑harmless protections so they can see insurer payments, itemized charges, and be protected if an in‑tool estimate understates their responsibility.
Uninsured and self‑pay patients can view and pay published discounted or minimum cash prices (accepted as payment in full) at hospitals, labs, imaging centers, and ASCs, lowering out‑of‑pocket costs for cash‑pay consumers.
Consumers, researchers, and regulators gain standardized, machine‑readable price files and searchable consumer displays (including at least 300 shoppable services) across hospitals, labs, imaging centers, ASCs, and plans, enabling shopping tools, price comparison, and market analysis.
Hospitals, labs, imaging centers, ASCs, plans, PBMs, TPAs, and vendors will face substantial IT, data‑aggregation, legal, and administrative compliance costs (monthly/annual reporting, machine‑readable formats, real‑time tools) that are likely to be passed on to consumers, employers, or taxpayers.
Requiring publication of payer‑specific negotiated rates, pricing formulas, and contract algorithms risks exposing proprietary commercial information, undermining negotiating leverage and prompting legal challenges or contract renegotiations that could disrupt networks or raise costs.
Large, recurring civil monetary penalties (some daily or per‑violation and very large in aggregate) create acute financial risk for smaller providers and vendors and could force service reductions or closures in resource‑constrained settings.
Based on analysis of 11 sections of legislative text.
Mandates detailed price and billing disclosures, itemized post‑payment bills and enhanced EOBs, expanded plan/vendor data reporting, and civil penalties for noncompliance.
Introduced September 26, 2025 by John James · Last progress September 26, 2025
Requires much more detailed price and billing transparency across health care: plans must provide enhanced good-faith estimates and EOB-style notices; providers must give timely, itemized post-payment bills; hospitals, labs, imaging providers, and ambulatory surgical centers must publish machine-readable price lists and consumer displays; and plans and third-party service vendors must disclose detailed payment, contract, and rebate data. Implements binding limits on patient bills tied to prior disclosures, sets civil penalties for noncompliance, and phases in standards and machine-readable formats from 2026–2027 (and later dates for some disclosures).