Healthcare price transparency legislation gains momentum in Congress

Price transparency bills continue to be a focus in Congress as an area to pursue in possible year-end healthcare legislation.

Two House committees and a Senate committee approved bills within the past two weeks. Among various other healthcare bills that have made it out of the committees are:

• Health Care Price Certainty for All Americans Act (House Ways and Means Committee)
• Lower Costs, More Transparency Act (House Energy and Commerce Committee)
• Patients Deserve Price Tags Act (Senate Health, Education, Labor and Pensions Committee)

There was significant bipartisan support at the committee level for Lower Costs, More Transparency (45-0) and Patients Deserve Price Tags (21-1), the latter of which has a dozen Democratic sponsors or co-sponsors.

Although the Ways and Means Committee needed a party-line vote to pass Health Care Price Certainty for All Americans (25-15), the opposition by Democrats may have been partially due to framing. The bill was presented as implementing aspects of President Donald Trump’s Great Healthcare Plan, which was announced in January 2026.

In the Energy and Commerce Committee, a companion bill to Lower Costs, More Transparency likewise faced partisan division. The Prices on the Wall Act of 2026, which passed by a 24-21 vote, would require hospitals and ambulatory surgical centers (ASCs) to physically post their cash prices within the facility. Democrats voiced opposition based on the impracticality of static wall displays, among other concerns.

Bills would expand pricing and insurer disclosures

The three main transparency bills all maintain the core hospital and insurer transparency frameworks that have been implemented in regulations with respect to machine-readable files and the general categories that need to be included in those.

The two House bills share many common provisions, potentially facilitating negotiations over a consolidated measure. Both push an expansion of transparency requirements to labs, imaging centers and ASCs. The bills also direct HHS to establish uniform formats for the files, allowing for pricing comparisons across healthcare settings. They include escalating fines for repeat violators.

Insurers would have to disclose prior authorization metrics, spending on administrative overhead relative to medical claims, and detailed encounter data. Lower Costs, More Transparency has provisions requiring electronic prior authorization and establishing prior authorization deadlines in Medicare Advantage, giving statutory weight to recently implemented and looming regulations.

Pharmacy benefit managers (PBMs) would be obligated to provide information on rebates, administrative fees and contractual methodologies, according to the two House bills.

Senate bill emphasizes patient cost protections

The Senate’s Patients Deserve Price Tags Act has the sharpest focus on consumer protections. For example, the bill requires insurers to provide advance explanations of benefits (AEOBs) to patients, mirroring a provision in the No Surprises Act that has not been implemented due to technical infrastructure hurdles.

In opposing the Health Care Price Certainty Bill as authored by the Ways and Means Committee, Rep. Richard Neal (D-Mass.), the committee’s ranking member, issued a statement in which he said AEOBs would be a better option than offering “pages and pages of negotiated rates” to patients ahead of a healthcare service.

No Surprises “passed out of this committee unanimously [in December 2020], but the law isn’t being implemented,” Neal said.

Per the new legislation, AEOBs would be based on good-faith estimates transmitted from providers to insurers. Stakeholders have said transferring that information at scale and in real time would be challenging given the lack of standardized electronic data interchange in the healthcare industry.

If out-of-pocket costs “substantially” go beyond the estimate on the AEOB, patients would be held harmless for the excess unless the provider can document that the increase is due to unforeseen medical circumstances. In addition, providers could not engage in extraordinary collection actions if deemed to be noncompliant with transparency provisions.

Patients Deserve Price Tags also requires providers to offer patients a detailed, itemized bill upon request following a service. Bills would include plain-language descriptions and billing codes for each item or service, or a total price if items and services are bundled.

Other information on the itemized bill would alert the patient to the availability of charity care and language assistance.

Price estimator tools emerge as a key dividing point

One concern for hospitals is whether legislative expansion of price transparency would track with current regulations establishing that a price estimator tool satisfies the requirement to list prices for shoppable services.

The Ways and Means bill specifies that using estimator tools would allow hospitals to fulfill the requirement, whereas Patients Deserve Price Tags would phase out the tools and require actual price listings for shoppable services. Lower Costs, More Transparency is not explicit on the issue.

“Eliminating this option would reduce patients’ access to a familiar, consumer-friendly resource while disregarding the significant investments hospitals have made to develop and maintain these tools,” the American Hospital Association (AHA) wrote in comments on the Senate bill.

Patients Deserve Price Tags also requires price listings for all shoppable services, whereas current regulations require hospitals to list no more than 300 such services.

Ownership reporting could add compliance burden

Proposed language in all three bills would require ownership disclosure by healthcare entities. Although the specifics vary, organizations would have to divulge information on ownership interests and controlling interests.

In its comments on Patients Deserve Price Tags, the AHA said the requirement could be unnecessarily burdensome.

“The legislation would require hospitals to disclose ownership information without clearly defining the scope of the requirement or accounting for information hospitals already report to the federal government,” according to the comment letter.

“Because the Centers for Medicare & Medicaid Services already collects and publicly reports much of this information, relying on a centralized federal source may give patients and the public more consistent information while avoiding duplicative reporting requirements,” the AHA added.

The House bills include requirements for Medicare Advantage organizations to report on ownership stakes they have in providers.

Regulatory changes move alongside litigation

CMS signaled its own upcoming changes to price transparency. In the 2027 proposed rule for the hospital Outpatient Prospective Payment System, the agency issued a request for information (RFI) on matters such as whether hospitals should have to disclose additional information about payer contracts beyond negotiated amounts.

Such information could include quality incentive payments and value-based payment arrangements, among other categories, CMS said in the rule.

In step with the emphasis on MRF uniformity as seen in the new congressional bills, CMS also asked how the files could be more standardized in aspects such as data definitions and coding. One goal is to make MRFs more usable for employers and researchers.

The agency also posed the question of whether additional requirements can ensure that pricing data is not merely compliant with current regulations, but also accurate.