Stacey Pogue, Abigail Knapp
In July 2025, Senators Roger Marshall (R-KS) and John Hickenlooper (D-CO) introduced the Patients Deserve Price Tags Act, a bipartisan bill designed to make health care prices more transparent. The bill aims to expand and improve transparency efforts through three approaches: improving billing-related information for patients, strengthening employers’ access to information about the health plans they sponsor, and building on existing federal price transparency requirements for hospitals and health plans.
The legislation’s billing-related consumer protections require that, after a patient receives care, insurers must provide an explanation of benefits, and health care providers must provide an itemized bill, enabling patients to compare advanced cost estimates with their actual charges. A companion Forefront article explores the bill’s employer-focused provisions that strengthen employers’ access to benefits claims data and information on how third-party administrators of employer health plans price claims and determine their own compensation. This article explores the bill’s price transparency provisions, which codify federal rules and strengthen them to improve and expand price information that health care providers and health plans must publicly disclose.
Ensuring that patients know what their health care will cost is a basic and long-overdue step, especially as consumers shoulder higher out-of-pocket costs in a system that grows increasingly more expensive. However, price transparency efforts to date demonstrate that the availability of price data does not necessarily translate into actionable information for consumers, nor reduce overall health care spending. As policy makers pursue price transparency, they should consider what additional measures could serve as a complement to better contain high health care prices.
What Problems Does The Bill Address?
High prices make health care increasingly unaffordable for consumers. More than 40 percent of people with employer-sponsored health insurance find it difficult to afford health care, and more than one in four skipped or delayed needed care in the past year due to cost. Rising health care costs also suppress workers’ wages and squeeze employers. Efforts to increase the transparency of health care prices often aim to spur competition and drive down health care costs by arming consumers with long-hidden health care prices.
The first Trump administration established federal price transparency rules authorized by the Affordable Care Act (ACA) that require hospitals and health plans to post their prices in two different formats: a consumer-friendly format meant to help patients see costs upfront and shop for care, and machine-readable files (MRFs). While not intended for direct consumer access, MRFs are nonetheless meant to benefit the public. Federal rules envision that app developers, researchers, regulators, and others with the requisite knowledge would translate the raw data in MRFs into actionable insights for consumers, employers, and policy makers. Although hospitals and health plans have posted a massive amount of health care price data, actionable information on prices is still not readily and widely available due to ongoing problems with the usability and quality of the data. Health plan MRFs are unwieldy and inaccessible to all but a few users, and hospital files are often incomplete. In response, the Biden administration took steps to improve hospital data and compliance with the rules. The second Trump administration has prioritized improving price transparency and begun work on several fronts, including initial steps to jump-start delayed prescription drug price transparency and make health plan MRFs more usable.
Some improvements to price transparency at the federal level may require statutory changes, not just administrative changes to rules or guidance. For example, hospitals are the only type of health care provider required by the ACA to post their charges, even though many other types of providers deliver “shoppable services”—those that are non-urgent and can be scheduled in advance—such as lab work, imaging, and preventive care services. As such, efforts in Congress to improve price transparency are a welcome addition to existing regulatory requirements.
How Does The Bill Address These Problems?
The Patients Deserve Price Tags Act codifies the requirements in federal rule that hospitals and health plans post price information in both machine-readable files and a consumer-friendly format, making the provisions more durable. The bill also builds on existing rules to make already-required data more accessible and usable and to expand the types of providers that must post their prices.
Building On Hospital Price Transparency Rules
Beyond codifying the Hospital Price Transparency rules, the bill requires further standardization of price data. It directs the secretary of Health and Human Services (HHS) to establish a standard method and format for both consumer-facing information and MRFs to improve the accessibility and usability of the data. To help users better understand rates that are not negotiated as a simple dollar amount, the bill requires hospitals to disclose in their MRFs any algorithm or percentage that a rate is based on, as well as underlying terms or schedules that would be needed to derive the negotiated rate using the formula. The bill explicitly prohibits a current rule provision that allows hospitals to provide a web-based “price estimator tool” in place of posting prices of shoppable services. It also extends certain price transparency requirements to ambulatory surgical centers, labs, and imaging centers.
The bill steps up oversight by requiring federal regulators to review hospital compliance at least annually (rather than leaving the frequency to regulators’ discretion) and authorizing more aggressive financial penalties for noncompliance. Currently, a hospital with 550 beds that is out of compliance for a full year could face a $2 million penalty. Under the requirements of this bill, the same hospital could face a $5 million penalty and could be subject to an additional $5–$10 million in penalties if HHS determines that the hospital was knowingly and willfully noncompliant multiple times during the year.
Building On Transparency In Coverage Rules
Beyond codifying the Transparency in Coverage rules that apply to insurers and group health plans, the bill ensures that health plan members are held harmless for any cost-sharing amounts they ultimately owe in excess of the amount generated by the plan’s online consumer cost tool.
The bill calls for a limit on MRF file sizes and the exclusion of irrelevant data that significantly inflate file sizes, which are among the changes recommended by experts to make data in health plan MRFs easier to access and use. In addition to publicly posting their MRFs online, the bill requires health plans to also submit their MRFs to the Marketplace and state and federal regulators.
The bill also increases enforcement. It requires federal regulators to audit MRFs from at least 20 issuers and 200 group health plans and report findings to Congress annually. In addition, the bill outlines a corrective action process and authorizes HHS to assess civil monetary penalties of up to $300 per day for each affected plan member or $10 million, whichever is lower.
Does The Bill Go Far Enough?
The price transparency provisions of the Patients Deserve Price Tags Act enshrine existing rules into law. While the rules do not appear at particular risk today—they have withstood legal challenges and been embraced by both the Trump and Biden administrations—codifying them increases certainty and consistency for stakeholders. The bill also builds on existing rules with a focus on improving compliance and making price data more usable. While aligned administrative efforts are underway, creating additional statutory direction and authority in these areas could improve access to price transparency data and insights that can be drawn from it. Finally, by extending provider price transparency requirements beyond hospitals to surgical centers, labs, and imaging centers, the bill gives consumers and others prices from types of providers that commonly deliver shoppable health care services and may cost less than hospitals for the same service.
There are, however, notable limits to consumer-focused price transparency as a lever to bring down health care costs. First, most health care spending occurs on services that are not shoppable. For shoppable services, many patients do not realize that price information is available, and even when they do, the complexity of medical payment and billing makes it difficult for them to price shop. Many patients, reasonably, follow their doctors’ recommendations. Furthermore, for consumers to shop based on price, they need a choice between providers, a prerequisite that can be limited in today’s increasingly consolidated health care market. For all of these reasons, price transparency is considered a relatively weak cost-containment strategy. Some observers are concerned that price disclosure may even raise prices in some circumstances by granting providers even greater negotiating power by revealing the rates their competitors secure from insurers. Nonetheless, ensuring that consumers can readily access what their health care will cost in advance is necessary to inform their decision making and long overdue.
What Other Strategies Would Maximize The Bill’s Impact?
If the Patients Deserve Price Tags Act is enacted, health plans would begin submitting MRFs to state and federal regulators each month, in addition to posting them online, as they do now. Federal or state regulators could create a central repository from which to share the data, making them easier to find and use. Today, they are spread across thousands of different sites. Colorado provides a model: It was the first state to require health plans to submit price transparency data to the insurance department, which plans to make the data available to consumers, employers, and researchers in early 2026. Colorado also created the first state-sponsored web-based tool to make consolidated hospital price transparency data available free of charge. Given federal administrative efforts already underway to make the data in health plan MRFs easier to use, states newly receiving the files could leverage these data, where feasible, to support their ongoing cost-containment efforts, such as cost-growth benchmark enforcement, enhanced rate review, and post-transaction monitoring.
Policy makers in and outside of Congress could also consider complementary policies aimed at lowering health care prices. Staying within the transparency framework, policy makers could require unique billing identifiers for hospital-owned off-campus clinics, as some states have done and a bipartisan Senate bill seeks to do. This step would provide a foundation for efforts to curb controversial hospital billing practices, such as charging facility fees in outpatient settings. In addition, policy makers could improve the transparency of who owns or controls health care entities, which is an area where state policy makers have shown growing interest and innovation.
Giving consumers and employers information on prices so they can be better shoppers and purchasers is a necessary step, yet it is expected to reduce prices only minimally. As such, policy makers frustrated by high health care prices will need to advance transparency in concert with other policies. Complementary approaches, such as site-neutral payments, stronger antitrust enforcement, and price regulation, have more potential to lower health care prices and rely on a foundation of improved transparency to be most effective.
Authors’ Note
Stacey Pogue and Abigail Knapp are employees of the Center on Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy. Their research related to this article is funded by Arnold Ventures.
Stacey Pogue and Abigail Knapp “Unpacking The Price Transparency Provisions Of The Patients Deserve Price Tags Act” November 25, 2025, https://www.healthaffairs.org/content/forefront/unpacking-price-transparency-provisions-patients-deserve-price-tags-act. Copyright © 2025 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.
