HR-9393-119
Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 45 - 0.
Sponsored by Brett Guthrie (R-KY)
What it does
This bill would require all U.S. hospitals, clinical diagnostic laboratories, and imaging providers that receive Medicare payments to publicly post their prices — including gross charges, cash prices, and insurer-negotiated rates — in a standardized, machine-readable format beginning January 1, 2028. Hospitals would be required to list prices for at least 300 "shoppable" services in a consumer-friendly format. The bill establishes a tiered civil penalty structure for noncompliance, scaled by hospital size, with penalties up to $35 per bed per day for large hospitals and enhanced penalties (up to $10 million) for persistent, willful noncompliance.
Who benefits
Patients and healthcare consumers who would gain access to price information before receiving care, particularly those who are uninsured or have high-deductible health plans. Employers and self-insured businesses that negotiate coverage and could use price data to reduce costs. Health insurers and pharmacy benefit managers that could use public data in negotiations. Price-comparison tool developers and health technology companies. Researchers and journalists studying healthcare pricing. Rural and limited-English-proficiency patients, who receive specific accessibility protections under the bill. Small hospitals in rural or underserved areas, which receive penalty waivers if compliance would threaten patient access to care.
Who is hurt
Hospitals and health systems that would bear compliance costs — including IT infrastructure, data compilation, and ongoing attestation requirements. Large hospital systems with complex pricing structures may face the greatest administrative burden. Insurers and health plans whose previously confidential negotiated rates would become public, potentially weakening their bargaining position. Hospitals in competitive markets where disclosed rates could be used by rivals. Clinical diagnostic laboratories and imaging providers subject to new disclosure mandates. Hospital billing and contracting staff whose workloads would increase. Patients in areas served by financially marginal hospitals, if penalties accelerate closures — though the bill includes hardship and rural waivers to mitigate this risk.
Supporters argue
Supporters argue that healthcare is one of the only major industries where consumers routinely receive services without knowing the price in advance, and that this information asymmetry drives the U.S.'s persistently high healthcare costs. They contend that a 2021 CMS hospital price transparency rule — a regulatory predecessor — showed that when prices are disclosed, meaningful price variation is revealed, with the same MRI costing anywhere from $400 to $4,000 at facilities in the same city. They further argue the bill strengthens that rule by codifying it in statute, standardizing formats for machine readability, and adding enforceable penalties with teeth — addressing documented widespread noncompliance with the existing regulatory requirement.
Opponents argue
Opponents argue that posting list prices does not translate into meaningful consumer choice, because most patients cannot shop for care during emergencies, lack the expertise to compare complex medical billing codes, and are constrained by insurer networks regardless of posted prices. They contend that mandatory disclosure of negotiated rates could actually harm consumers by enabling hospitals to benchmark prices upward toward the highest disclosed rate — a concern raised in peer-reviewed research — rather than driving competition downward. They further argue that the compliance burden falls disproportionately on small, rural, and safety-net hospitals that already operate on thin margins, and that the Secretary's broad rulemaking authority to expand required disclosures creates regulatory uncertainty for providers.
Constitutional context
Congress grounds this bill in its authority under the Commerce Clause (Art. I, §8, cl. 3) and the Taxing and Spending Clause (Art. I, §8, cl. 1), conditioning Medicare participation on compliance with price transparency requirements — a well-established spending power mechanism affirmed broadly in NFIB v. Sebelius (2012). Post-Loper Bright (2024), the bill's broad delegations to the Secretary of HHS to define formats, expand required disclosures, and increase penalties through rulemaking may face heightened judicial scrutiny, as courts will now independently assess whether such delegations are sufficiently clear rather than deferring to agency interpretation.
Checks and balances
Congress sets the transparency mandates and penalty structure; HHS/CMS gains significant rulemaking and enforcement authority to define formats, expand disclosures, and impose civil monetary penalties; hospitals retain the right to administrative law judge hearings before penalties are finalized, though they may waive that right for a penalty reduction.
Historical precedent
CMS issued a hospital price transparency rule in 2019 (effective 2021) under existing regulatory authority, but compliance was widely reported as low and enforcement was limited; this bill attempts to codify and strengthen that framework in statute with significantly higher penalties.