Health Care Price Certainty for All Americans Act
Sponsored By: Representative Smith, Jason [R-MO-8]
In Committee
Summary
price transparency is the core aim of this bill. It would require hospitals, labs, imaging centers, ambulatory surgical centers, and health plans to publish standardized, consumer-friendly prices and cost estimates so patients can compare expected costs before care.
Show full summary
- Hospitals, labs, imaging providers, and ASCs must post standard charges and consumer prices, including payer-specific negotiated rates and cash prices for a CMS-specified set of shoppable services (at least 300 where applicable). Hospitals face per-day civil monetary penalties that scale by size, starting at $342 per day for the smallest hospitals and up to $6,277 per day for the largest.
- Group health plans and issuers must give enrollees a real-time, web-based cost-sharing tool and publish machine-readable in-network rates and allowed amounts, including drug payment details and PBM "spread" reporting, for plan years beginning on or after 2029.
- Medicare Advantage organizations and Part D sponsors must report identifiers and payment flows to reveal vertical integration for plan year 2028 and every third plan year after. The bill also funds implementation with $65 million to HHS and Treasury and $35 million to Labor in FY2027 to support rules, data systems, audits, and enforcement.
*Provides $65 million to HHS and Treasury and $35 million to Labor in FY2027, a total of $100 million in implementation funding, increasing federal spending.*
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Bill Overview
Analyzed Economic Effects
4 provisions identified: 4 benefits, 0 costs, 0 mixed.
Health plan price and cost tools
If enacted, for plan years starting January 1, 2029, group health plans would have to give a free online self-service tool that returns real-time, personalized cost estimates for a specific service. Plans would also post quarterly machine-readable rate and payment files showing in-network dollar rates by provider and recent plan-paid averages for drugs. Plans must provide plain-language explanations, translation and assistive services, and a yearly CEO/CFO attestation that data is complete. The bill would also bar plans, issuers, or PBMs from stopping pharmacies from telling you when a cash price is cheaper than your insured out-of-pocket cost. Key terms like "in-network rate" and "applicable spread price drug" would be defined for these rules.
Hospital, ASC, lab, and imaging prices
If enacted, hospitals paid by Medicare would start posting comprehensive price information beginning January 1, 2027 and follow a uniform format by January 1, 2028. Hospitals would have to publish prices for at least 300 "shoppable" services, including gross charges, discounted cash prices (or a three-year median cash price), and payer-specific negotiated rates. Ambulatory surgical centers, clinical labs, and imaging providers would post similar discounted cash prices and attest annually starting January 1, 2028. The Secretary could audit noncompliance and impose civil money penalties (hospital penalties are tied to bed counts, for example $342/day for very small hospitals and higher per-day amounts for very large hospitals), with hardship waivers for rural or access-threatened providers.
Medicare Advantage and Part D reports
If enacted, applicable Medicare Advantage organizations (those with at least 25,000 enrollees) and Part D sponsors would submit ownership and payment identifiers and aggregated payment-flow data for plan year 2028 and every third plan year after. Reported data would include TINs/NPIs for specified providers and totals of incentive payments and recoupments involving affiliated providers, pharmacies, and PBMs. After the Secretary publishes the data, MedPAC must report to Congress analyzing vertical integration and payment patterns using the 2028 data and a follow-up report four years later.
Funding for agency implementation
If enacted, the bill would appropriate $65 million for fiscal year 2027 to HHS and Treasury and $35 million for fiscal year 2027 to the Department of Labor, with those funds available through fiscal year 2032. The money would pay for rulemaking, enforcement, data systems, guidance, and outreach to implement the transparency rules. Each agency would have to file an annual report by September 1 describing how the funds were spent.
Sponsors & CoSponsors
Sponsor
Smith, Jason [R-MO-8]
MO • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
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