Sponsors (24)
Official title: Amend the Public Health Service Act to provide for hospital and insurer price transparency.
Introduced July 17, 2025 by Roger Wayne Marshall · Last progress July 17, 2025
The bill substantially expands price transparency, consumer protections against surprise bills, and data access for oversight and research — improving consumers' ability to shop and plans' ability to audit — but does so at the cost of significant compliance burdens, penalty exposure, market and privacy risks, and implementation complexity that may raise costs or strain smaller providers and plans.
Patients (including those with chronic conditions, low‑income people, Medicare/Medicaid enrollees, and the uninsured) receive clearer, standardized itemized EOBs and bills plus binding good‑faith cost estimates and hold‑harmless protections, reducing surprise bills, collections, and unexpected out‑of‑pocket shocks.
Uninsured and self‑pay patients can find and pay published discounted or minimum cash prices for hospital, lab, imaging, and ambulatory surgical services, allowing cash‑pay users to pay that amount as payment in full and lowering out‑of‑pocket costs.
Consumers gain broad price‑shopping capability through standardized, machine‑readable price files and consumer displays (with plain‑language guides), enabling third‑party tools and more informed provider choices before care.
Health plans, hospitals, labs, ASCs, vendors, and providers face substantial administrative, IT, and compliance costs to create itemized EOBs, machine‑readable files, real‑time tools, and attestations — costs that are likely to be passed on to consumers via higher premiums or prices.
Small, rural, and safety‑net providers, small laboratories, smaller insurers and ASCs face disproportionate operational burden and penalty exposure (daily fines and per‑violation penalties), risking service reductions, clinic closures, or reduced availability in underserved areas.
Large civil monetary penalties (ranging from daily fines to per‑violation caps) create acute financial liability for plans, providers, and vendors, potentially driving vendors out of markets or raising vendor fees and plan costs.
Based on analysis of 11 sections of legislative text.
Mandates detailed, code‑level price transparency, itemized bills, patient cost notices, broad data disclosures by plans and vendors, and civil penalties for noncompliance.
Requires broad health care price transparency and stronger patient billing protections across insurers, group health plans, hospitals, clinical labs, imaging providers, and ambulatory surgical centers. The bill mandates plain‑language good‑faith estimates and itemized bills, public posting of standardized machine‑readable price lists (including payer‑specific negotiated rates and billing codes), new data‑sharing and disclosure rules for plan service providers, and civil penalties for noncompliance. Implementation timelines vary by provision: some insurer notice and Exchange requirements begin for plan years starting January 1, 2026; hospital, lab, imaging, and ASC public posting standards phase in mostly by July 1, 2027; and required data disclosures by plan service providers take effect on specified plan‑year schedules (1–2 years after enactment). The bill preserves most state price‑transparency laws unless they conflict with the federal requirements.