HR9393119th CongressWALLET

Lower Costs, More Transparency Act of 2026

Sponsored By: Representative Guthrie, Brett [R-KY-2]

In Committee

Summary

health care price transparency: This bill would require hospitals, labs, imaging centers, ambulatory surgical centers, and health plans to publish machine-readable prices and give patients real-time, individualized cost estimates.

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 4 benefits, 0 costs, 1 mixed.

Hospital price lists and penalties

If enacted, many hospitals would have to publish machine-readable and consumer-friendly price lists starting January 1, 2028. Hospital postings would include gross charges, discounted cash prices (or median self-pay prices), payer-specific negotiated dollar rates for many services, provider identifiers, charity care links, and an accuracy attestation. The Health Department would notify noncompliance, require fixes, and could fine hospitals by bed count (for example, hundreds of dollars per day up to higher per-bed rates after one year). Repeated or knowing violations could trigger lump-sum penalties in the hundreds of thousands or millions, with limited waivers for rural or emergency hardships.

Online cost estimates for employer plans

If enacted, employer group plans for plan years starting January 1, 2028 would have to give members a free, real-time online tool with individualized cost estimates. The tool would show in-network rates or maximum allowed out-of-network amounts, your deductible and out-of-pocket balances, copays and coinsurance, prior-authorization rules, and any financial incentives. Plans would also publish machine-readable rate and payment files (quarterly for non-drug items, monthly for drugs) and require PBMs to report spread-price drugs and per-drug pharmacy payment differences. Plans must submit an annual attestation and make data accessible to people with limited English or disabilities.

Ambulatory surgical center price lists

If enacted, ambulatory surgical centers paid by Medicare would have to post annual price lists online starting January 1, 2028. ASCs must show plain-language descriptions, coding identifiers, gross charges, and discounted cash prices or a median self-pay cash price for each of at least 300 shoppable services. The agency could notify centers, require corrective plans, and impose civil monetary penalties up to $300 per day for ongoing failures, with limited waiver authority and later authority to raise penalties for violations in 2029 or later.

Clinical lab cash prices online

If enacted, clinical diagnostic laboratories paid by Medicare would have to post discounted cash prices or, if none, gross charges for each specified shoppable test on a public website starting January 1, 2028. Prices must include usual ancillary fees and be updated at least yearly. The agency would notify noncompliance and could impose civil monetary penalties up to $300 per day after a cure period, with technical assistance and some exclusions for labs whose prices are already posted by hospitals or ASCs.

Imaging provider price postings

If enacted, imaging providers paid by Medicare would have to post discounted cash prices or, if none, gross charges for each specified imaging service on a public website starting January 1, 2028. Prices must be updated at least annually and include an accuracy attestation. The agency could notify noncompliance, require corrective action, and impose civil monetary penalties up to $300 per day after a cure period, with limited waiver rules for access and exclusions where hospitals or ASCs already post prices.

Sponsors & CoSponsors

Sponsor

Guthrie, Brett [R-KY-2]

KY • R

Cosponsors

  • Rep. Pallone, Frank [D-NJ-6]

    NJ • D

    Sponsored 6/23/2026

Roll Call Votes

No roll call votes available for this bill.

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