Summary#
This bill, the Lower Costs, More Transparency Act of 2026, requires many health care providers and health plans to publish clear price information and to give patients tools to see what they would pay. The main change is a new set of federal rules, starting January 1, 2028, that expand price-disclosure duties for hospitals, laboratories, imaging providers, ambulatory surgical centers, and group health plans/insurers. The broad goal is to make prices easier to find so consumers, providers, and plans can compare costs and plan care.
- New hospital rules: Nearly all hospitals must publish standard charges, discounted cash prices or median cash prices, payer-specific negotiated prices, identifiers, and an attestation that the data are accurate. The Secretary of HHS must set standard formats and monitor compliance.
- Enforcement for hospitals: The bill sets daily civil penalties that scale by hospital size and allows much larger penalties for repeated, knowing noncompliance. Small and rural hospitals may get waivers or reductions in special cases.
- Labs, imaging, and ambulatory surgical centers: These providers must publish discounted cash prices (or gross charge if none) for specified tests and imaging services and keep the information updated annually. HHS may impose daily penalties (generally up to $300 per day) for noncompliance.
- Health plans and insurers: Group health plans and insurers must provide real-time cost-sharing estimates to members on request (through an online self-service tool or by phone/paper). They must also publish rate and payment data in machine-readable files on a regular schedule (quarterly or monthly, depending on the data). Plans must submit an annual attestation of compliance.
- APIs and reports: The bill directs HHS and other agencies to report on using standards-based APIs to make price data available and to study provider-facing tools and quality data options.
- PBM disclosure: Pharmacy benefit managers must disclose “spread pricing” information to the plan so cost estimates and published data can be accurate.
What it means for you#
- Patients / Consumers
- You can request an estimate of your out-of-pocket cost for a specific item or service. Estimates must include deductibles, copayments, coinsurance, prior-authorization or step-therapy rules, and how much toward your deductible or out-of-pocket max you have already paid.
- More price files and summaries will be published publicly so third-party tools can compare costs across plans and providers (if those tools are developed).
- Hospital patients
- Hospitals must publish many price points (gross charge, cash price, negotiated prices by payer). You may be able to see both the cash price and what each insurer pays for an item or service.
- People using labs or imaging
- Many labs and imaging suppliers must post discounted cash prices (or gross charges), including any routine specimen-collection fees.
- Patients with private insurance
- Your plan must provide a self-service tool (or phone/paper option) that can give a real-time cost estimate for a service by a specific provider or providers in a geographic area.
- Employers and plan sponsors
- Plans will need to publish machine-readable rate and payment files and make an annual attestation that they complied with the law.
- Health care providers and suppliers
- Hospitals, labs, imaging providers, ambulatory surgical centers, and many suppliers must collect, standardize, and publish price lists in formats the Secretary requires.
- Pharmacy benefit managers (PBMs)
- PBMs must disclose to plans which drugs are subject to spread pricing and differences between payment and reimbursement amounts.
- If you live in a rural area
- The Secretary can waive or reduce penalties for rural or underserved hospitals and centers if enforcement would threaten local access to care.
Expenses#
No publicly available information.
- The bill will likely require hospitals, labs, imaging providers, surgical centers, and plans to spend money on IT systems, staff time, and data-standardization to compile and publish the required files and to run real-time cost-estimate tools.
- HHS will need resources to write rules, set standard data formats, monitor compliance, perform audits, provide technical help, and publish enforcement actions and compliance data.
- Providers and plans that fail to comply may face daily civil penalties; persistent hospital noncompliance can trigger much larger, multi‑hundred-thousand to multi‑million dollar penalties.
- The bill orders several federal reports and studies (APIs, provider tools, quality data), which will have administrative costs to produce.
Proponents' View#
- The bill appears intended to make health care prices easier to find and compare by requiring standardized public data and consumer-facing cost tools.
- Supporters may argue that giving patients real-time cost estimates and publishing negotiated and in-network rates will let people shop for lower-cost care when services can be scheduled in advance.
- The law could make it easier for developers and third-party tools to build price-comparison apps because it directs use of machine-readable files and studies use of APIs.
- The bill includes steps to make data accessible (plain-language descriptions, translation and interpretation requirements) and requires attestation to improve data accuracy.
- It provides targeted relief (waivers, reductions) for rural and underserved providers to reduce risk of harming local access to care.
Opponents' View#
- One concern is the administrative and technical burden on hospitals, labs, ambulatory surgical centers, and plans to compile, standardize, and publish large volumes of data in the formats the Secretary will require. This could be costly, especially for small providers.
- The bill does not fully specify every technical detail (for example, the exact “consumer-friendly” formats, how plans should calculate complex cost-sharing in every situation, or precise API standards). This may leave important choices to future rulemaking and create temporary uncertainty.
- There is a risk that published machine-readable files and summary statistics will be large and complex. Without good user interfaces or third-party tools, raw files may be hard for ordinary consumers to use.
- Another concern is data accuracy and commercial sensitivity. The bill requires attestation and allows HHS to require additional information, but it also recognizes limits on publicly explaining waivers to avoid revealing commercially sensitive material. How to balance transparency and proprietary concerns is not fully detailed.
- Enforcement complexity: The bill creates many different penalty rules and monitoring processes. Determining overlapping jurisdiction or reconciling other existing transparency rules could be administratively complex; the bill includes language saying it should not prevent enforcement of earlier transparency rules, which suggests possible duplication or overlap.