Lowering Health Care Costs for Americans Act
Sponsored By: Senator Marshall, Roger [R-KS]
Introduced
Summary
Premium tax credit reform. This bill would cap advance premium tax credit payments by income, create Treasury-linked Healthcare Affordability Accounts for advance payments, and require wide price and billing transparency across hospitals, labs, imaging, and health plans.
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- Families and consumers: Would set monthly premium tax credit caps by income from $10 to $40 and route advance payments into Healthcare Affordability Accounts treated like special health savings accounts. HAA balances could not be used to pay for abortion care or enumerated gender transition procedures.
- Hospitals, labs, and imaging providers: Would have to publish standard charges and machine‑readable negotiated prices, display consumer‑friendly shoppable services, and update disclosures regularly. Noncompliance could trigger daily civil penalties and larger multi‑million dollar fines for persistent violations.
- Employers and self‑funded plans: Would gain full, timely access to claims, encounter, and pricing data in standard electronic formats and new auditing rights. Health plan service providers could face civil penalties up to $100,000 per day for certain disclosure failures.
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Bill Overview
Analyzed Economic Effects
5 provisions identified: 4 benefits, 0 costs, 1 mixed.
State reinsurance grants and faster waivers
The bill would authorize multi‑year HHS grants for states to run invisible high‑risk pools and reinsurance. It would appropriate $500 million for FY2027 and $5 billion for each year FY2028–FY2030. States with approved waivers could use those funds to set ceded premiums, attachment points, and design how to identify high‑cost enrollees. If a State lacks a qualifying waiver for plan year 2026, the Secretary would use federal allocations to provide payments to stabilize that State's individual‑market premiums. The bill would also speed and simplify Section 1332 waiver reviews and allow expedited 45‑day and provisional approvals with model guidance due within 60 days of enactment.
Stronger plan data access rules
The bill would require group health plans to have timely access to all claims, encounter, and payment data and supporting documents. Data must be provided in standard electronic formats (ASC X12N and NCPDP) and access generally may not be delayed more than 15 days. Health‑plan service providers must give detailed quarterly disclosures at no cost and plans must annually attest that data are available. The Secretary and DOL could assess large civil penalties for violations (for example $10,000 per day and other high daily fines and caps), and contract clauses that unreasonably limit access would be void.
Marketplace subsidies, HAAs, and abortion rules
This bill would extend the enhanced premium tax credits through 2031 and substitute a 700% of poverty AGI limit for some years. It would phase down the extra credit in steps (20% in later years, then 40%, 60%, and 80%) and add monthly floors that subtract $10, $20, $30, or $40 depending on household income. For plan years starting after Dec 31, 2026, advance premium tax credits would be sent into a new Healthcare Affordability Account (HAA) and the Treasury would make periodic payments to HAAs for certain years. The bill would bar HAA money from paying for abortion or enumerated gender‑transition procedures, and it would bar CSR payments or advance CSR support for QHP coverage of abortion except for life‑saving or rape/incest exceptions. Insurers would have to report and disclose the premium amount attributable to abortion coverage and notify enrollees at enrollment.
Bills, EOBs, and price tools protect patients
For plan years starting Jan 1, 2026, group plans would have to send an EOB‑style, itemized notice within 45 days after any payment request. Providers would have to give patients an itemized bill within 30 days after final third‑party payment that lists codes, prices, payments made, and charity care info. Exchanges would have to offer a real‑time price and coverage tool that shows in‑network or allowed amounts and holds members harmless if the estimate is wrong. Collections would be barred until providers meet these itemized bill rules, and HHS could fine providers up to $10,000 per violation.
Clear prices for labs, imaging, and ASCs
Beginning July 1, 2027, clinical labs, imaging providers, and many ambulatory surgical centers would have to post machine‑readable, consumer‑friendly prices online. Posts must show plain descriptions, billing codes, gross charges, a cash price the provider must accept as payment in full, and payer‑specific negotiated dollar rates (with any formula disclosed). The Secretary must set a uniform file format by Jan 1, 2027. HHS may fine noncompliant providers (typically up to $300 per day), and federal transparency rules would not override stronger State price‑transparency laws.
Sponsors & CoSponsors
Sponsor
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.
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