Lower Costs, More Transparency Act of 2026
- Bill Number
- H.R. 9393
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-06-25: Forwarded by Subcommittee to Full Committee by Voice Vote.
- Last Updated
- 2026-07-02T21:02:08Z
AI-Generated Summary
Purpose The legislation, titled the Lower Costs, More Transparency Act of 2026, aims to increase price transparency across hospitals, clinical laboratories, imaging providers, ambulatory surgical centers, and health plans. It requires public disclosure of charges, negotiated rates, and cost-sharing information to enable consumers to compare prices and understand their financial responsibilities.
Key Provisions
- Hospital Price Transparency (Section 2): Beginning January 1, 2028, hospitals must publicly post standard charges (gross, discounted cash, payer-specific negotiated, and de-identified max/min) and prices for at least 300 shoppable services in a consumer-friendly format. They must also include plain-language descriptions, charity care policies, and attestations of accuracy. The Secretary of HHS must establish uniform machine-readable formats and monitor compliance through audits and complaints.
- Clinical Diagnostic Laboratory Test Price Transparency (Section 3): Applicable laboratories must post discounted cash prices (or gross charges) for specified shoppable tests on their websites, updated annually, with attestations.
- Imaging and Ambulatory Surgical Center Price Transparency (Sections 4–5): Similar requirements apply to imaging service providers and ambulatory surgical centers for shoppable services, using uniform formats and including ancillary services.
- Health Coverage Price Transparency (Section 6): For plan years beginning January 1, 2028, group health plans and issuers must:
- Provide cost-sharing estimates (including deductibles, copays, and out-of-pocket accumulations) via self-service tools or alternative formats upon request.
- Publicly release rate and payment information (in-network rates, out-of-network allowed amounts, average payments for drugs) in quarterly or monthly machine-readable files.
- Include summaries of trends, bundled payments, and network details.
- Attest annually to compliance.
- Disclose spread pricing for certain drugs via pharmacy benefit managers.
- Additional requirements include accessibility for limited English proficiency individuals, technical assistance from HHS, and reports on application programming interfaces (APIs), provider tools, compliance, price differences, and quality metrics.
Significant Changes to Existing Law The bill amends the Social Security Act (Medicare provisions), Public Health Service Act, Internal Revenue Code, and Employee Retirement Income Security Act. It expands and standardizes existing hospital transparency rules (e.g., building on section 2718(f) of the PHSA) while introducing new mandates for laboratories, imaging providers, and ambulatory surgical centers. It sunsets prior price comparison tool requirements for plan years on or after January 1, 2028, and replaces them with broader rate disclosure and self-service tools. Enforcement shifts toward civil monetary penalties scaled by facility size, with provisions for corrective action plans, waivers in rural/underserved areas, and non-duplication of penalties across statutes.
Potential Impacts
- Government Agencies: Increases oversight and enforcement responsibilities for HHS, CMS, DOL, and Treasury, including real-time compliance tracking, audits, and annual reports. May require additional rulemaking and technical assistance programs.
- Citizens: Provides consumers with detailed pricing and cost-sharing data to facilitate informed decisions, potentially affecting out-of-pocket spending and care choices.
- No direct international relations implications are addressed in the legislation.
Main Stakeholders Affected
- Hospitals (including critical access and rural emergency hospitals), clinical laboratories, imaging providers, and ambulatory surgical centers.
- Group health plans, health insurance issuers, and pharmacy benefit managers.
- Patients, beneficiaries, and enrollees seeking care.
- Federal agencies (HHS, CMS, DOL, Treasury) responsible for implementation and enforcement.
- State regulators involved in oversight of plans and providers.
Notable Legal, Constitutional, or Political Implications The bill relies on civil monetary penalties (up to scaled daily amounts, with increases for persistent noncompliance) and incorporates provisions from section 1128A of the Social Security Act for penalty procedures. It includes hardship exemptions, rural/underserved area waivers, and hearing waivers, while ensuring consistency with federal health information privacy standards. The legislation emphasizes machine-readable formats and API compatibility to support interoperability. No constitutional challenges are explicitly raised in the text, though the detailed enforcement and public disclosure mechanisms may intersect with administrative law and data privacy considerations.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (1)
Recent Actions
- 2026-06-25: Forwarded by Subcommittee to Full Committee by Voice Vote.
- 2026-06-25: Subcommittee Consideration and Mark-up Session Held
- 2026-06-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-06-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-06-23: Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Education and Workforce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-06-23: Referred to the Subcommittee on Health.
- 2026-06-23: Introduced in House
- 2026-06-23: Introduced in House
Bill Versions
- Lower Costs, More Transparency Act of 2026 — issued 2026-06-23 — PDF (128 pages)