Lowering Health Care Costs for Americans Act
Sponsored By: Senator Sen. Marshall, Roger [R-KS]
Introduced
Summary
Lower health costs and boost price transparency. This bill would cap monthly premium assistance by income bands, create Healthcare Affordability Accounts tied to advance premium tax credits, and require far-reaching hospital, lab, and group-plan price and data disclosures.
Show full summary
- Families and consumers: Would get new monthly premium caps tied to income bands and extended enhanced premium tax credits up to 700% of the federal poverty line for 2027–2031, with a phasedown through 2032. HAAs would let advance credit payments fund premium and cost-sharing accounts and include new ID and enrollment verification rules.
- Patients and providers: Would force hospitals to publish payer-specific negotiated charges and require clinical labs to post test prices starting July 1, 2027. Itemized billing rules would limit collections and add penalties up to $10,000 per instance and lab penalties up to $300 per day for ongoing noncompliance.
- Employers and group health plans: Would require quarterly access to full claims and payment data from service providers, ban contract terms that block plan access, harmonize good-faith estimates and explanations of benefits, and authorize civil penalties up to $100,000 per day for disclosure violations.
*Would authorize at least $5.5 billion in appropriations for FY2027–FY2030 and extend subsidy payments, increasing federal spending.*
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
5 provisions identified: 3 benefits, 0 costs, 2 mixed.
Faster plan data for sponsors
If enacted, plan sponsors and fiduciaries would get fast access to claims and payment data. Contracts must give fiduciaries full claims and encounter information within 15 days and service providers must give quarterly, free machine‑readable data and payment formulas. Health plans must also publish monthly machine‑readable files starting by January 1, 2027 showing in‑network item rates, recent drug net prices, and out‑of‑network billed/allowed amounts. The bill would void contract gag clauses that block data and creates large civil penalties for violations, including $10,000 per day and authority up to $100,000 per day for certain breaches.
Federal grants for state reinsurance
If enacted, the federal government would award grants to help States run reinsurance and invisible high‑risk pool programs. The bill would authorize $500 million for FY2027 (administration) and $5 billion for each FY2028–FY2030, available until spent. The Secretary must set an allocation method within 45 days and can use funds to stabilize premiums where States lack qualifying waivers, and the bill shortens and expedites 1332 waiver reviews with a 45‑day track for urgent cases.
Marketplace premium help and accounts
If enacted, enhanced Marketplace premium tax credits would be extended through January 1, 2032 and, for 2027–2031, the household income limit would use 700% of the poverty line instead of 400%. The enhanced extra help would be phased down across years (20%, 40%, 60%, 80% in the windows shown) and a small per‑month cap would apply by income band ($10 under 200% FPL; $20 for 200%–<300%; $30 for 300%–<400%; $40 for 400%+). For plan years after 2026 through 2031, advance premium payments would generally be deposited into new Healthcare Affordability Accounts (HAAs); HAAs and advanced CSR payments could not be used to cover abortion services and the part of a premium attributable to abortion coverage would generally be excluded from federal subsidies. The bill also expands tax reporting (Form 6055) for premiums and authorizes CSR funding beginning in 2026.
Clear hospital, lab, and surgery prices
If enacted, hospitals would post monthly machine‑readable price files and a consumer price display with at least 300 shoppable services through December 31, 2026 and all shoppable services after that. Clinical labs, many imaging providers, and hospital‑owned ambulatory surgery centers would post searchable prices (labs monthly if changed; imaging at least yearly; ASCs monthly), and each must accept a stated discounted cash price as full payment for cash payers. The agency would set formats by early 2026–2027, monitor accuracy, require corrective plans, and can fine providers (tiered hospital fines and up to $300 per day for labs/ASC/imaging) for ongoing noncompliance. Federal price rules would not override stronger State price‑transparency laws unless a State law prevents the federal rule from applying.
Better price tools and billing protections
If enacted, providers would have to give a written, itemized bill no later than 30 days after they get final third‑party payment, and collections could not start until you get that bill. Group plans must provide an itemized Explanation of Benefits or notice within 45 days for plan years starting on or after January 1, 2026. Exchanges and plan websites would offer a free, real‑time pricing tool that shows in‑network rates, your deductible and out‑of‑pocket progress, and a hold‑harmless promise if the tool shows a higher cost than you are billed. Also, adults over 18 enrolling through the Exchange would need a government‑issued photo ID, and plans that cover abortion would have to tell enrollees at enrollment the premium amount for that coverage and that it is not eligible for the premium tax credit (for plan years after December 31, 2026).
Free Policy Watch
You just read the policy. Now see what it costs you.
Pick a topic. PRIA runs your household against live legislation and sends you a free personalized readout.
Pick a topic to get started
Sponsors & CoSponsors
Sponsor
Sen. Marshall, Roger [R-KS]
KS • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
View on Congress.govTake It Personal
Get Your Personalized Policy View
Take the PRIA Score to see how policy affects your household, then upgrade to PRIA Full Coverage for year-round monitoring.
Already have an account? Sign in