Health Care Price Certainty for All Americans Act

Increased price clarity for consumers: Specified hospitals, ambulatory surgical centers, and laboratories must make their standard charges and prices public, including "shoppable services" (Section 2, a(2)(A)(i)(II)).

Improved access to cost estimates: The bill allows for "price estimator tool[s]" that let individuals immediately obtain price estimates for services via a hospital or surgical center's website (Section 2, a(2)(D)(ii) and d(2)(D)(ii)).

Better understanding of insurance costs: Group health plans must provide information on cost-sharing, such as deductibles, copayments, and coinsurance, in a timely manner upon request (Section 3, b(1)).

Transparency in negotiated rates: Group health plans and insurance issuers are required to make available rate and payment information, including in-network rates for items and services (Section 3, c(2)(A)(i)).

Support for those with language barriers: The Secretary is tasked with ensuring that price information is accessible to individuals with limited English proficiency through steps like interpretation or translations (Section 2, e; Section 3, e).

Increased Price Transparency for medications: Health plans and insurance issuers are prohibited from restricting or penalizing pharmacies that inform participants of the difference between their out-of-pocket costs and the cost of a drug without insurance coverage (SEC. 727 (a); SEC. 9827 (a)).

Enhanced Oversight of Vertical Integration: The bill requires Medicare Advantage organizations and prescription drug plans to submit detailed information regarding their ownership and financial relationships with healthcare providers and pharmacies (SEC. 5 (a)(1); SEC. 5 (a)(2)). This data is intended to help evaluate the impact of integration on healthcare access, price, quality, and outcomes (SEC. 5 (b)(1)).

Detailed Accountability Reports: The Medicare Payment Advisory Commission is tasked with submitting reports to Congress that evaluate specific metrics, such as the relationship between risk scores and incentive-based payments (SEC. 5 (b)(1); SEC. 5 (b)(2)).

Risk of reduced access to care: The Secretary has the authority to waive or reduce civil penalties if they determine that imposing them would result in an "immediate threat to access to care" for individuals in a specific service area (Section 2, a(2)(B)(iv) and b(6)(E); Section 2, c(5)).

Financial penalties for non-compliant facilities: Hospitals, laboratories, and imaging providers may face significant civil monetary penalties for failing to comply with transparency and attestation requirements (Section 2, a(2)(B)(i); Section 2, b(6)(B); Section 2, c(5)).