Sponsors (20)
Introduced July 17, 2025 by Roger Wayne Marshall · Last progress July 17, 2025
The bill greatly expands price transparency, consumer protections, and data access to empower patients and plan oversight, but it shifts substantial compliance costs, penalty exposure, and new privacy/market risks onto providers, plans, vendors, and potentially consumers — especially smaller or rural entities.
Millions of patients (insured, Medicare/Medicaid beneficiaries, uninsured, and those with chronic conditions) get clearer, itemized EOBs and pre‑care cost estimates (including individualized in‑network rates and cost‑sharing) that let them compare prices and avoid many surprise bills.
Patients cannot face collections until they receive the required itemized bill and receive hold‑harmless protections when real‑time tools underestimate liability, reducing surprise collections and billing harassment.
Uninsured and self‑pay patients can access and pay disclosed discounted or minimum cash prices (for hospitals, labs, imaging, and ASCs), making many services more affordable for people without coverage.
Hospitals, providers, health plans, labs, ASCs, and vendors face substantial administrative, IT, and compliance costs to collect, standardize, and publish detailed price and claims data — costs that are likely to be passed on to consumers through higher premiums and service prices.
Large civil monetary penalties (ranging from daily fines up to $300/day, $10,000/violation, and up to $100,000/day for data sharing failures) create significant financial exposure for smaller providers, vendors, and plans, risking service reductions or vendors exiting the market.
Expanded permitted disclosures and more frequent, broader data sharing (even if de‑identified) raise privacy and reidentification risks, increasing potential misuse or unauthorized disclosure of sensitive health information.
Based on analysis of 11 sections of legislative text.
Mandates itemized patient cost estimates/EOBs, public machine‑readable price files for hospitals/labs/imaging/ASCs, required cash‑price acceptance, expanded data disclosures, and civil penalties.
Requires broad, detailed price transparency across health care: group health plans must give itemized, plain‑language good‑faith estimates and expanded explanation‑of‑benefits notices; providers (hospitals, labs, imaging, ambulatory surgical centers) must publish machine‑readable price files including payer‑negotiated rates and accept published discounted cash prices as payment in full; third‑party plan service providers must regularly disclose claims, pricing methodologies, rebates, and related data to plans. The bill creates civil penalties, phased implementation dates (beginning in 2026–2027 for many requirements), new data‑sharing rules under ERISA to permit certain disclosures for plan administration and quality activities, and federal rulemaking deadlines to establish standard formats and consumer tools.