HR-9645-119
Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 25 - 15.
Sponsored by Jason Smith (R-MO)
What it does
This bill would require Medicare-participating hospitals, clinical laboratories, imaging providers, and ambulatory surgical centers to publicly post standard charges, negotiated rates, and discounted cash prices for hundreds of common services in machine-readable and consumer-friendly formats. It directs the Secretary of Health and Human Services to set uniform reporting formats, monitor compliance, and impose civil monetary penalties (scaled by facility size, up to millions of dollars for persistent noncompliance) on facilities that fail to comply, with waivers available for rural or underserved providers facing hardship.
Who benefits
Patients and consumers seeking to compare prices before receiving care, particularly uninsured and self-pay patients; employers and insurers negotiating rates who gain access to competitor pricing data; price-comparison and health-tech companies that build tools using the disclosed data; policymakers and researchers studying health costs.
Who is hurt
Hospitals, laboratories, imaging centers, and ambulatory surgical centers that bear compliance and reporting costs, especially smaller and rural facilities with limited administrative staff; facilities facing civil monetary penalties for noncompliance, which could reach millions of dollars for large hospitals; insurers whose negotiated rates become visible to competitors and other payers, potentially affecting their negotiating leverage.
Supporters argue
Supporters argue that opaque hospital pricing has long prevented patients from comparison shopping or anticipating costs, and that codifying and strengthening existing CMS price transparency rules into statute would make compliance more consistent and enforceable. They contend that publicly available negotiated rates could increase competitive pressure on prices, citing early studies showing modest price convergence in markets with existing transparency rules.
Opponents argue
Opponents argue that the extensive reporting, formatting, and attestation requirements would impose significant administrative burdens and compliance costs on hospitals and labs, particularly smaller rural facilities, potentially straining already thin margins. They contend that publishing negotiated rates could enable insurers to identify and demand the lowest rates competitors receive, potentially reducing rather than increasing price competition in some markets, an effect noted by some economists studying existing transparency rules.
Constitutional context
Congress is exercising its Spending Clause authority (Art. I, §8, cl. 1) by conditioning Medicare payments on compliance with these disclosure requirements, a well-established mechanism for regulating providers who voluntarily participate in federal healthcare programs; this differs from the individual mandate at issue in NFIB v. Sebelius (2012) because it regulates program participants rather than compelling private conduct. The broad delegation of rulemaking authority to the Secretary to define formats, penalties, and compliance standards may also draw administrative-law scrutiny under Loper Bright v. Raimondo (2024), as courts now review such agency interpretations independently.
Checks and balances
Congress delegates substantial rulemaking, monitoring, and enforcement authority to the HHS Secretary, including setting penalty amounts and compliance standards, with courts retaining independent judicial review of the resulting regulations post-Loper Bright.
Historical precedent
This bill would largely codify and expand CMS's existing hospital and ambulatory surgical center price transparency rules, first implemented via regulation in 2021 under the Affordable Care Act and Trump-era executive action.