House health panel examines transparency bills for U.S. care costs

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Healthcare cost transparency bills

Highlights

House Subcommittee on Health reviews expanding the Lower Costs, More Transparency Act to require standardized price transparency from hospitals, surgical centers, labs, and imaging providers.
Lawmakers consider legislative codification of transparency rules to create stability and reduce compliance volatility for hospitals, many of which have invested millions to meet shifting requirements.
Proposed measures would require CMS to publish prior authorization data for Medicare Advantage and commercial plans, allowing public access to approval and denial rates for health claims.

Legislative push to codify pricing rules

As reported by the House Committee on Energy and Commerce, Subcommittee on Health Chairman Morgan Griffith says the hearing examines policies intended to improve health care price transparency and support lower costs across the system.

In his prepared opening statement, Griffith says health care affordability remains a long-standing priority for the committee and Congressional Republicans. He says greater transparency can help patients compare treatment options, seek higher-value care and avoid unexpected bills, while also encouraging competition among insurers and providers in a market that continues to face consolidation.

Griffith says the current administration, as well as President Trump’s first term, prioritizes more transparency in health care, but some existing measures rely on regulation and can be changed by a future administration. He says codification would create a more standardized format and a more stable set of rules for hospitals and insurers, adding that hospitals have already invested millions of dollars to comply with shifting requirements.

Proposals target hospitals, insurers and prior authorization data

The hearing reviews an updated version of the Lower Costs, More Transparency Act, which Griffith says passed the House floor in 2023 under former Chairman Cathy McMorris Rodgers. He says the bill is designed to expand price transparency across hospitals, ambulatory surgical centers, clinical laboratories and imaging testing.

Lawmakers are also considering proposals that would give the Centers for Medicare and Medicaid Services, or CMS, additional tools to improve transparency data and enforcement. Griffith says one discussion draft would require Medicare Advantage and commercial health plans to publicly post prior authorization data so individuals can see approval and denial rates for health claims.

Another measure under review is H.R. 5582, the Patients Deserve Price Tags Act, backed by Representative John James of Michigan. Griffith says the bill takes a different approach from the broader transparency package but shares the same objective of making health care pricing more visible and the market more accountable.

Our earlier coverage of Ahold Delhaize U.S.’s $40 million settlement outlined allegations that the company reported inflated “usual and customary” prescription drug prices on claims to Medicare Part D, Medicaid and TRICARE. The piece also highlighted how whistleblower actions and federal enforcement focus on pricing accuracy in taxpayer-funded programs, an issue closely tied to broader efforts to make health care costs more transparent and accountable.

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