Lower Costs, More Transparency Act of 2026
Jun 23, 2026
Introduced: Jun 23, 2026
Jun 23, 2026
Introduced: Jun 23, 2026
Summary
Makes healthcare prices clearer by requiring hospitals, labs, imaging centers, and health insurance plans to show the costs of their services to the public.
What problem does this solve?
People often don't know how much a medical service will cost until after they receive the bill, making it hard to shop for care. This law forces healthcare providers and insurers to post their prices online so patients can compare costs before getting treatment.
What does this bill do?
Hospital price transparency
Requires hospitals to post all their standard charges, discounted cash prices, and secret negotiated rates with insurers. This must include at least 300 common, 'shoppable' services in a consumer-friendly format.
Health plan cost-sharing tool
Requires health plans and insurers to provide members with an online self-service tool. This tool must show a member's specific out-of-pocket costs for any service from any provider in real-time.
Public rate disclosure by insurers
Requires health plans to publicly release machine-readable files with all their in-network negotiated rates and out-of-network allowed payment amounts for all services and drugs.
Enforcement and penalties for non-compliance
Establishes a system of warnings and fines for hospitals that do not comply. Fines are based on hospital size and increase for repeat offenses, with some penalties reaching millions of dollars.
Reference
Text:
Section:
Sec. 3, 4, 5
Header:
Clinical diagnostic laboratory test price transparency
Transparency for labs, imaging, and surgical centers
Extends price transparency rules to clinical labs, imaging providers, and ambulatory surgical centers. They must publicly post their discounted cash prices or standard charges for common services.
Spread pricing disclosure
Requires Pharmacy Benefit Managers (PBMs) to tell health plans when they engage in 'spread pricing,' which is when the PBM charges the plan more for a drug than it pays the pharmacy.
Accessibility for all
Requires that all published price information be made accessible to people with limited English skills or disabilities, such as by providing translation or interpretation services.
Who does this affect?
- Patients and Healthcare Consumers
- Hospitals and Healthcare Providers
- Health Insurance Companies and Group Health Plans
What is the real world impact?
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Empowers patients to make informed decisions
By making prices public, patients can compare costs for services and choose more affordable options, potentially lowering their out-of-pocket expenses.
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Increases competition among providers
When prices are transparent, hospitals and other providers may be forced to compete on price, which could drive down the overall cost of healthcare.
When does this start?
Most transparency requirements and enforcement actions are set to begin on January 1, 2028.
Provider and hospital transparency requirements
Beginning January 1, 2028, hospitals, labs, imaging centers, and ambulatory surgical centers must comply with the new price transparency rules.
Health plan transparency requirements
For plan years starting on or after January 1, 2028, health plans must provide cost-sharing tools and publish their rate information.
Government reports on implementation
Various government agencies must submit reports to Congress on the use of technology for data access, compliance levels, and price trends, with the first reports due in 2028 and 2029.