Congress mulls more transparency as healthcare costs loom large
With the midterm congressional elections approaching and healthcare affordability top of mind for voters, lawmakers are actively considering new healthcare transparency reforms, including requirements for providers to show plainly what patients will have to pay and new billing standards for hospitals.
Senate Health, Education, Labor and Pensions Committee Chairman Bill Cassidy, R-LA, highlighted such price transparency legislation — Patients Deserve Price Tags Act (S 2355/HR 5582) — during a field hearing in Louisiana during last week’s congressional recess. Cassidy's interest could signal that the legislation, which has may cosponsors from both parties, could soon see action at the Committee.
The bill would codify and expand current hospital price transparency rules that were established in the first Trump administration by extending requirements to clinical diagnostic laboratories, imaging centers, and ambulatory surgical centers. It would also make the prices that hospitals post clearer by requiring actual dollar-and-cents amounts, not estimates, as well as sharply increase financial penalties for hospitals and insurers that fail to disclose their negotiated rates. In addition, group health plans and insurers would have to give patients upfront, personalized cost estimates through an online self-service tool, as well as paper or phone options, before care is provided. The bill also ensures group health plans have access to claims data and prohibits third-party administrators from restricting that access.
While several plan sponsor trade groups publicly support the legislation, they are working with lawmakers to make certain provisions more workable and better aligned with the PBM-focused transparency rules enacted in the Consolidated Appropriations Act, 2026 and proposed by the Department of Labor.
The HELP Committee may also soon take up the Healthy Competition for Better Care Act (HR 6248/S 4027), a bipartisan bill backed by plan sponsors that would promote affordability and health care transparency and increase competition in the healthcare provider markets by restricting anti-competitive contract terms between payers, providers, and hospitals like “anti-steering” or “anti-tiering” provisions and “all-or-nothing” clauses.
Another plan sponsor policy priority would be addressed by new bipartisan House legislation, the Transparency in Billing Act of 2026 (HR 8684), which would require group health plans and insurers to only pay claims for items and services furnished at a hospital’s off-campus outpatient departments submitted by hospitals that have separate unique health identifiers for such outpatient departments. This “site-neutral” reform is intended to highlight situations where hospital’s off-campus outpatient departments seek higher payments for the same services provided in independent physician offices.
These bills add to a growing slate of proposals that could ultimately be folded into a possible Republican party-line budget bill or a year-end health package during the lame duck session. Given the election-shortened legislative calendar this year and a raft of other pressing business, however, the outlook is uncertain.
