Lower Costs, More Transparency Act of 2026

Increased visibility of hospital costs: Specified hospitals must publish standard charges and prices for at least 300 shoppable services in a consumer-friendly format (Section 2(a)(2)(A)(ii)(I)).

Improved access to pricing for laboratory tests: Applicable laboratories must make the discounted cash price or gross charge for specified clinical diagnostic laboratory tests available on their websites (Section 3(a)(1)(A)).

Clearer pricing for imaging services: Providers of specified imaging services must make the discounted cash price or gross charge public on an internet website (Section 4(a)(1)(A)).

Transparent pricing for surgical centers: Ambulatory surgical centers are required to compile and make public their standard charges and prices for shoppable services (Section 5(a)(2)(A)).

Better cost-sharing information for health plan members: Group health plans must provide participants information on cost-sharing amounts, such as deductibles and copayments, upon request through a self-service tool (Section 6(b)(1)).

Enhanced transparency for health insurance rates: Group health plans and insurance issuers must make rate and payment information available to the public (Section 6(c)(1)).

Support for non-English speakers: The Secretary will ensure through rulemaking that hospitals take reasonable steps to make charge and price information accessible to individuals with limited English proficiency through translations or interpretation services (Section 2(b)).

Increased Price Transparency through Technology: The bill calls for an evaluation of using APIs to allow consumers to access rate and payment information, as well as their specific cost-sharing amounts, through third-party internet tools (Subsection (b)(4)).

Improved Patient Decision-Making: A proposed "provider tool" is intended to aid in patient decision-making by providing healthcare providers with information regarding plan costs (Subsection (c)(1)(B)).

Enhanced Shopping for Services: The use of APIs may increase the ability for individuals to "shop" for services by providing real-time access to pricing and cost-sharing information (Subsection (b)(4), (b)(5)).

Identification of Pricing Disparities: Regular reports will assess differences in negotiated prices between rural and urban areas, as well as between various market types, which could highlight inequities (Subsection (d)(2)).

Potential for Quality Comparisons: The government will study how to include healthcare quality data alongside price information, which could help people choose better care (Subsection (e)).

Financial penalties for hospitals: Hospitals that fail to comply with transparency requirements are subject to civil monetary penalties that can increase based on the number of beds or the duration of noncompliance (Section 2(a)(4)(B)).

Financial penalties for laboratories: Applicable laboratories that fail to comply with price transparency requirements can face civil more than $300 per day (Section 3(a)(5)(A)(ii)).

Financial penalties for imaging providers: Providers of specified imaging services can be subject to civil monetary penalties of up to $300 per day for noncompliance (Section 4(a)(5)(A)(iii)).

Financial penalties for surgical centers: Ambulatory surgical centers may face civil monetary penalties of up to $300 per day for failing to meet transparency requirements (Section 5(a)(4)(B)(i)).

Increased Costs for Private Entities: The bill notes that the implementation of API standards could create costs for issuers, employers, and other private-sector entities (Subsection (b)(7)).

Potential Burden of New Tools: The creation and maintenance of a "provider tool" may result in a burden and cost for plans, coverage, providers, issuers, and employers (Subsection (c)(1)(J)).

Regulatory and Enforcement Costs: The reports required by this bill will analyze the costs to the Federal Government and States to regulate and enforce API and provider tool standards (Subsection (b)(8), (c)(1)(K)).

Privacy Risks: The implementation of new data-sharing technologies like APIs requires an analysis of how they interact with federal health information privacy standards, suggesting potential risks to data security (Subsection (b)(1), (b)(9)).