Who Controls Your Health Care? Congress Advances Legislation with New Ownership Disclosure Requirements

By Abigail Knapp, Erica Socker, and Stacey Pogue

In July 2026, committees in the House and Senate advanced legislation to improve transparency in health care markets. The legislation includes bills that would codify and expand the existing price transparency requirements, which have often been the focus of transparency discussions in Congress. However, the latest price transparency bills voted out of the House Energy and Commerce (E&C) and Senate Health, Education, Labor, and Pensions (HELP) Committees include a notable addition: new requirements for certain health care providers and health plans to disclose who owns and controls them. Table 1 at the end of this piece provides an overview comparing each bill’s ownership disclosure requirements.

Ownership transparency fills an important gap in efforts to make the health care system more affordable and competitive. The progress made on price transparency reveals the high and variable prices charged for care, driven by increasing consolidation and corporatization. Yet, policymakers’ ability to track consolidation and mitigate its harmful effects on prices, access, and quality is limited by a lack of information on health care entities’ ownership and control structures. As Congress looks for ways to improve affordability, ownership transparency is a foundational piece that policymakers and regulators could leverage to strengthen oversight over health care markets and rein in high health care costs.

The recent committee activity reflects growing bipartisan momentum to increase transparency and accountability for health care entities. The price transparency legislation and its new ownership transparency provisions received unanimous approval in the House E&C Committee and just a single no vote in the Senate HELP Committee. With ownership transparency now teed up for Congress to potentially act on later this year, this blog post highlights the role ownership transparency plays in understanding and curbing the effects of consolidation, and analyzes the recent legislation advanced in the House and Senate. 

Decades of horizontal and more recently vertical consolidation have resulted in highly consolidated, complex health care markets. Insurance companies and private equity firms are accelerating the trend toward consolidation and corporatization as they acquire physician practices, hospitals, and other health care entities. In many cases, these acquisitions fly under the radars of regulators because of their size, allowing corporate owners to amass substantial market power while avoiding regulatory scrutiny. The result is a less competitive market with opaque, convoluted ownership and control relationships that make it challenging to monitor consolidation or identify who owns a doctor’s practice. 

Health care consolidation and corporatization increase prices and health care spending. In addition to undermining affordability, they can also negatively impact other aspects of health care including quality of care, clinician autonomy, and providers’ financial health. 

Despite the consequences of consolidation, there are major gaps in federal policymakers’ ability to track changes in ownership, assess its implications, and intervene where appropriate to improve competition and affordability. Some ownership data is currently collected at the federal level, including through Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS). However, these data are often incomplete and fail to capture the broader set of control relationships (such as management services organizations or real estate investment trusts) that do not constitute formal ownership, but can still contribute to consolidation or influence a provider’s care delivery and financial outcomes. 

In the absence of national information on ownership and control structures, state policymakers are taking action to increase transparency as they grapple with rising health care costs and widespread consolidation. Massachusetts has long collected provider ownership data, and other states like Indiana and Maine have recently enacted ownership transparency laws. For example, Indiana passed a law in 2025 requiring hospitals, physician practices, health insurers, and other health care entities to disclose entities with an ownership or controlling interest, including private equity investors, on a regular basis. Maine’s new law requires the disclosure of detailed information on health care entities’ ownership and organization structures, and establishes a new review process for transactions involving management services organizations, private equity companies, and hedge funds. Data collected through Massachusetts’ Registration of Provider Organizations program is crucial for informing the state’s market oversight and monitoring activities.

The legislation pending before Congress could provide greater insight into ownership and consolidation trends for federal policymakers and regulators, and similarly support their efforts to oversee health care markets and lower health care costs. The bills advanced by the House E&C and Senate HELP Committees, respectively, include:

H.R. 9393: Lower Costs, More Transparency Act of 2026

S. 2355: Patients Deserve Price Tags Act

Table 1 provides an overview of each bill’s specific ownership disclosure requirements. Although each bill takes a somewhat different approach, the House and Senate ownership transparency provisions share several core features. Both proposals integrate the new ownership disclosures requirements into legislation to codify and strengthen price transparency, and thus apply the ownership disclosures to a similar set of health care entities. Hospitals, clinical diagnostic laboratories, imaging services providers and suppliers, ambulatory surgical centers (ASCs), and health insurers and group health plans (referred to subsequently as health plans) must all disclose ownership information to the Department of Health and Human Services (HHS) under the bills. 

Both bills also aim to identify individuals or entities who own or control providers and health plans. Capturing relationships that may not reflect formal ownership but that can still influence clinical care decisions or the market power providers have in price negotiations is important given the proliferation of layered, complex relationships among health care entities. Under the Patients Deserve Price Tags Act, providers and health plans must disclose any entity with an ownership, investment, or controlling interest, as well as management services organizations (MSOs) and significant equity investors. It directs HHS to align these disclosure requirements with existing federal law to the extent possible, with a focus on entities that influence provider operations, finances, or clinical decision-making.

The Lower Costs, More Transparency Act requires disclosure of direct or indirect ownership, partnership interests, managing control, and mortgage or security interests. Unlike the Senate’s Patients Deserve Price Tags, it sets a quantitative threshold for disclosure, applying the requirements to ownership, partnership, control, mortgage, and security interests that exceed 5%. Furthermore, HHS could require entities to report ownership changes or transactions that occurred in the previous year.

An important feature of the ownership disclosures is that health care entities must make this information available to the public. In some cases, this information would be included in the online machine-readable files that hospitals and other providers must post to fulfill price transparency requirements. Ensuring this new ownership information is publicly available is essential to enable researchers and consumers to access and analyze this data. 

Finally, both bills generally establish a process for HHS to monitor health care providers’ compliance with ownership disclosure requirements and outline civil monetary penalties that apply for noncompliance. Compliance with the hospital price transparency requirements is an ongoing challenge and illustrates the need for effective monitoring and enforcement tools. These bills bolster enforcement of Hospital Price Transparency and establish enforcement tools for the other provider types that the bills expand transparency requirements to. Both bills apply these enforcement tools to the new ownership disclosures as well. 

The House and Senate bills also have different approaches to health insurers’ ownership disclosures and reporting requirements for HHS. 

Health Plan Monitoring

Neither proposal grants HHS explicit auditing or enforcement power over ownership disclosures that group health plans and insurers must submit, though the Lower Costs, More Transparency Act requires plans and insurers to annually attest to their compliance. 

Disclosures by TPAs and Other Health Plan Service Providers

The Patients Deserve Price Tags Act requires third-party administrators, pharmacy benefit managers, and other health plan service providers to make two ownership-related disclosures to self-funded employer plans and insurers (but not publicly). First, service providers must disclose significant equity investors and entities that hold an ownership, investment, or controlling interest, mirroring requirements placed on other entities in the bill. Second, the bill separately requires service providers to disclose whether they own or control—or serve as a management services organization or significant equity investor for—any health care provider that files claims under the plan. These provisions would give employers greater visibility into relationships that could create conflicts of interest. While service providers are only required to share this information with employers and insurers (rather than directly with HHS, the DOL, or other agencies) they are prohibited from restricting disclosure of this data to the federal government. 

Annual HHS Report on Provider Ownership

While both legislative efforts require most ownership information to be available to the public, the Lower Costs, More Transparency Act further directs HHS to publish an annual report on provider ownership. This report would synthesize information from providers subject to the new reporting requirements described above, as well as certain physician practices. Extending beyond aggregated disclosure information, the report would provide insights into the market, detailing providers’ organizational information, including business structures, organizational types, shifts in ownership or tax status, and parent company affiliations. The report would also include an analysis of horizontal and vertical integration trends, helping researchers and policymakers understand the evolving market landscape.

As Congress considers increasing ownership transparency, there are a few design and implementation considerations that could affect how useful these new data are for policymakers, researchers, consumers, and others. 

Uniform Method and Format for Reporting

Standardizing these disclosures would help regulators monitor compliance. While the bills direct HHS to develop a manner by which the information must be disclosed, it’s unclear if the intent of the bills is to require all entities to submit ownership information using a uniform method and format, similar to current price transparency requirements. Implementing a uniform reporting format for all health care entities and their ownership and control relationships would substantially enhance the capacity to aggregate and analyze this data across the health care system.

Inclusion of Physician Practice Disclosures

A noteworthy omission in these bills is that they exclude physician practices from the set of providers required to disclose their ownership and control interests. Including physicians would close an important knowledge gap. There is currently little visibility into physician ownership despite the fact that physician practices have been increasingly acquired by hospital systems, insurance companies, PE firms, and other entities in recent years. 

While the Lower Costs, More Transparency Act requires physician information to be included in the annual HHS report on provider ownership and consolidation trends, it does not specify which data they will use to fulfill that requirement in the absence of new disclosure requirements for physician practices, and the accuracy and completeness of those data are unknown. The Patients Deserve Price Tags Act requires TPAs and other service providers to disclose to employers whether they own or control providers, including physician practices, that file claims under the plan, but there is no requirement for this information to be reported to the federal government. 

Identification of the Ultimate Corporate Parent

While health plans and providers must report on immediate ownership and control relationships, the bills do not require disclosure of those entities’ ultimate corporate parent company. For instance, an ASC may report that it is owned by a physician practice, but would not need to disclose that the physician practice is owned by an insurance conglomerate. Providers may be owned or controlled by an insurance company or private equity firm through a web of subsidiaries, and seemingly independent providers or plans may belong to the same parent company. Requiring disclosure of the ultimate corporate parent enables a clearer picture of ownership and control structures as entities continue to consolidate and relationships become more complex. 

While further legislative effort is required to finalize a transparency package, the progress achieved during this session is promising. These ownership disclosure requirements are a foundational first step towards unmasking the complex organizational structures in our health care system and improving our understanding of how they affect health care spending, affordability, and access to high-quality care.

Table 1

Note: Table includes ownership transparency provisions only from sections 1-6 of the Patients Deserve Price Tags Act. Ownership-related disclosures in sections 7-8, related to group health plan data access and administrative service providers, are not summarized here.