A complete substitute amendment. v2 fundamentally restructures the original bill by consolidating provider price transparency requirements under a new Public Health Service Act section, introducing extensive ownership disclosure mandates for providers and health plans, and significantly revising enforcement mechanisms, including a new "hold harmless" provision for patients. v2 is effectively a different bill from v1.
Patients Deserve Price Tags Act
- Sponsor
- Sen. Marshall, Roger [R-KS]
- Committees
- Health, Education, Labor, and Pensions Committee (primary)
- Last action
- Jul 27, 2026
Bottom line
The bill aims to empower consumers and employers with unprecedented access to healthcare price and cost-sharing information, backed by stricter enforcement and new protections against unexpected medical bills.
What it actually does
This bill significantly expands and strengthens price transparency requirements across the healthcare sector, mandating public disclosure of standard charges and negotiated rates by hospitals, clinical laboratories, imaging centers, and ambulatory surgical centers. It also requires health plans and insurers to provide real-time cost-sharing information to members and publicly disclose detailed rate and payment data, while granting large employer health plans extensive access to their claims and financial data from service providers. The bill introduces substantial civil monetary penalties for non-compliance and includes patient protections against surprise billing.
Proponents argue
Supporters argue that this legislation is crucial for empowering patients to make informed healthcare decisions, fostering competition among providers and insurers, and ultimately driving down the escalating costs of healthcare. They contend that robust enforcement and comprehensive data access are necessary to overcome the widespread non-compliance seen with previous transparency mandates and to hold all healthcare entities accountable.
Opponents contend
Critics, primarily from the healthcare industry, contend that the bill imposes excessive administrative burdens and compliance costs, particularly on smaller providers and plans. They also raise concerns that public disclosure of proprietary negotiated rates could disrupt competitive markets, potentially leading to unintended consequences such as price collusion or reduced access to care, rather than the intended cost reductions.
The bill is substantial and highly technical, requiring significant time to understand its full implications, especially for those unfamiliar with healthcare regulations and the intricacies of health plan administration.
Section 2, new PHSA Sec. 2718A(b)
Enhanced Hospital Price Transparency and Enforcement
This provision requires hospitals to publicly disclose all their standard charges, including gross charges, discounted cash prices, payer-specific negotiated charges with each insurer and plan, and de-identified maximum and minimum negotiated charges. This information must be available in both machine-readable and consumer-friendly formats, updated quarterly, and include ownership details. Non-compliant hospitals face escalating daily civil monetary penalties, which can reach millions for persistent violations, and are prohibited from taking extraordinary collection actions against patients.
Supporters argue
Supporters argue this will empower patients to shop for care, drive competition among hospitals, and ultimately lower healthcare costs. The strong penalties are necessary to ensure compliance, as previous rules have been widely ignored.
Critics contend
Hospitals may argue that the administrative burden and cost of compliance are excessive, especially for smaller facilities. They might also contend that making negotiated rates public could disrupt competitive dynamics and lead to unintended consequences, such as price collusion or reduced access to care.
Tradeoffs
This provision balances the public's right to comprehensive price information against hospitals' concerns about administrative burden, the proprietary nature of negotiated rates, and potential impacts on competitive strategy.
Section 3, new PHSA Sec. 2718A(c)
Clinical Diagnostic Laboratory Price Transparency
This section extends price transparency requirements to clinical diagnostic laboratories. They must publicly disclose their standard charges (gross, discounted cash, payer-specific negotiated, de-identified max/min negotiated) for all specified clinical diagnostic laboratory tests, including ancillary services, in a machine-readable format. Labs must also disclose their ownership information and update data quarterly. Non-compliance can result in civil monetary penalties of up to $300 per day.
Section 4, new PHSA Sec. 2718A(d)
Imaging Services Price Transparency
This provision mandates that applicable imaging service providers publicly disclose their standard charges (gross, discounted cash, payer-specific negotiated, de-identified max/min negotiated) for all specified imaging services in a machine-readable format. They must also disclose their ownership information and update data quarterly. Non-compliance can result in civil monetary penalties of up to $300 per day.
Section 5, new PHSA Sec. 2718A(e)
Ambulatory Surgical Center Price Transparency
This provision extends price transparency requirements to specified ambulatory surgical centers (ASCs). They must publicly disclose their standard charges (gross, discounted cash, payer-specific negotiated, de-identified max/min negotiated) for all specified services in a machine-readable format. ASCs must also disclose their ownership information and update data quarterly. Non-compliance can result in civil monetary penalties of up to $300 per day.
Section 6, PHSA Sec. 2715A
Strengthening Health Coverage Transparency Requirements
This section mandates that group health plans and health insurance issuers provide a self-service tool at enrollment that offers real-time, personalized cost-sharing information, including in-network rates, out-of-network allowed amounts, deductibles met, and utilization management requirements. Plans and issuers must also publicly disclose quarterly machine-readable files of all in-network rates (for services and drugs), out-of-network billed/allowed amounts, and their ownership information. Non-compliance can lead to civil monetary penalties of up to $300 per member per day or $10,000,000.
Section 7, PHSA Sec. 2799A-9(l) and ERISA amendments
Mandated Data Access for Large Group Health Plans
This section prohibits contractual clauses (often called 'gag clauses') that prevent specified large group health plans from accessing their claims, encounter, payment, and ownership information from Covered Service Providers (including health care providers, networks, third-party administrators, and pharmacy benefit managers). It specifies HIPAA transaction standards for data exchange and allows the Secretary to assess civil penalties of up to $10,000 per day against Covered Service Providers who violate these data access provisions. Plans must also annually attest to compliance or identify non-compliant providers.
Section 8, new PHSA Sec. 2799A-12 and ERISA Sec. 502(c)(14)
Oversight and Penalties for Administrative Service Providers
This section expands on data access by requiring health plan service providers (including TPAs, PBMs, and providers) to provide quarterly to large group health plans and electing health insurance issuers highly detailed financial and contractual information. This includes claims data, calculation methodologies, all rebates and fees received, amounts paid to subcontractors, and payment data for alternative compensation arrangements. It also mandates ownership disclosure for these service providers. Any contractual provision limiting this access is void, and failure to comply results in a $100,000 daily civil penalty.
Section 10, PHSA Sec. 2799A-1(f), (g), and Sec. 2799B-6
Enhanced Explanation of Benefits and Patient Hold Harmless Protections
This section strengthens patient protections against surprise bills. It amends the Advanced Explanation of Benefits (AEOB) requirements to include a 'hold harmless' provision: if a patient's actual bill is substantially higher than the AEOB estimate, they are not responsible for the excess, unless due to unforeseen medical complications. Providers are also prohibited from billing patients for amounts substantially exceeding the AEOB if the discrepancy stems from their own good faith estimate. Additionally, health plans must provide a detailed, itemized Explanation of Benefits (EOB) within 45 days of a claim determination, including plain language descriptions, billing codes, plan payment, patient cost-sharing, and any discrepancies with the AEOB.
Section 11, new PHSA Sec. 2799B-10 and HITECH Act Sec. 13405(e)
Patient Access to Itemized Bills and Billing Protections
This section requires healthcare providers and facilities to inform patients of their right to request a detailed, itemized bill with any payment request. It prohibits debt collection actions if the provider fails to provide this notice or if the billed amount substantially exceeds federal transparency regulations or a good faith estimate (unless due to unforeseen complications or patient-initiated changes). Providers face a $10,000 penalty for non-compliance, and the HITECH Act is amended to mandate that itemized bills be provided free of charge within 30 days of request, including plain language descriptions, billing codes, and prices.
The definition of 'hospital' for the purposes of price transparency includes institutions licensed in any State, and explicitly lists Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
Section 2, new PHSA Sec. 2718A(a)(6)
Why it matters:This is standard legislative practice to ensure comprehensive applicability across U.S. territories, rather than an attempt to obscure.
Case for: Ensures that price transparency requirements apply uniformly across all U.S. jurisdictions, providing consistent consumer protections regardless of location.
Case against: No specific opposition is typically raised against this definitional clarity, as it ensures broad and equitable application of the law.
Estimated impact: Broadens the geographic scope of hospital price transparency requirements to include U.S. territories, affecting healthcare providers and patients in those regions.
The 'hold harmless' provision for patients whose actual bill substantially exceeds the advanced estimate relies on the Secretary defining what constitutes 'substantially in excess' through future rulemaking.
Section 10, PHSA Sec. 2799A-1(f)(3)(A)
Why it matters:This is common legislative practice for complex policy details, allowing agencies to develop nuanced rules with stakeholder input. However, it can also defer contentious decisions.
Case for: Allows for flexibility in implementation, enabling experts to craft a definition that accounts for diverse medical scenarios and industry practices, avoiding overly rigid statutory language.
Case against: Critics might argue that deferring such a critical definition to rulemaking creates uncertainty for both patients and providers, potentially weakening the intended consumer protection if the definition is set too high.
Estimated impact: The ultimate financial protection for patients against surprise bills, and the associated financial risk for providers, will be determined by this future regulatory definition.
The bill repeatedly directs the Secretary to define ownership disclosure requirements in a manner that 'harmonizes disclosure requirements with requirements established under section 1124 of the Social Security Act and prioritizes the disclosure of individuals and organizations who's ownership or management relationship with a hospital impacts operational, financial, or clinical decision making for such hospital.'
Sections 2, 3, 4, 5 (e.g., PHSA Sec. 2718A(b)(8)(B))
Why it matters:This is a technical instruction for regulatory agencies, aiming to integrate new requirements with existing law and focus on relevant ownership structures, which is standard legislative drafting.
Case for: Ensures that ownership transparency is meaningful by focusing on entities that genuinely influence operations, finance, or clinical decisions, avoiding disclosure of irrelevant minor interests.
Case against: Some might argue that relying on harmonization and prioritization could lead to loopholes or a narrower scope of disclosure than intended, depending on how the Secretary interprets 'impacts operational, financial, or clinical decision making'.
Estimated impact: The effectiveness of ownership transparency in identifying potential conflicts of interest or undue influence will depend on the specificity and rigor of the Secretary's definitions.
The data access requirements for group health plans only apply to 'specified large employers' (those with an average of at least 50 employees) and 'specified large plans' (those with an average of at least 50 participants).
Section 7, PHSA Sec. 2799A-9(l)(1)(F)
Why it matters:This is a common legislative technique to limit the scope of new regulations, often to reduce the burden on smaller entities, and is not necessarily evasive.
Case for: Focuses the administrative burden of data sharing on larger entities that typically have more resources and greater negotiating power, while shielding smaller employers and plans from potentially disproportionate compliance costs.
Case against: Critics might argue that excluding smaller employers and plans from these data access benefits leaves many without the tools to effectively manage their healthcare costs, perpetuating opacity for a significant portion of the insured population.
Estimated impact: Limits the direct benefits of enhanced data access to larger employers and plans, potentially leaving small and medium-sized businesses at a disadvantage in managing healthcare costs.
Health insurance issuers offering coverage in the individual or group market *may*, on an annual basis, elect to require a health plan service provider to submit the detailed financial and contractual reports.
Section 8, PHSA Sec. 2799A-12(b)(5)
Why it matters:This phrasing provides flexibility for insurers, potentially reflecting industry lobbying or a desire to avoid imposing universal mandates on all issuers, which is a common legislative compromise.
Case for: Allows insurers to decide if the benefits of receiving detailed data outweigh the administrative effort of requesting and processing it, providing flexibility in a diverse market.
Case against: Critics might argue that making this optional for insurers undermines the goal of comprehensive transparency, as many issuers may choose not to opt-in, leaving a gap in oversight and potentially perpetuating opaque practices.
Estimated impact: The actual extent of detailed financial data disclosure from service providers to health insurance issuers will depend on individual issuers' decisions to opt-in, rather than being a universal mandate.