The Lower Costs, More Transparency Act

Washington, D.C. — The House of Representatives today passed landmark bipartisan legislation to lower the cost of health care and increase price transparency for patients. Led by House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA), Ranking Member Frank Pallone, Jr. (D-NJ), House Ways and Means Committee Chair Jason Smith (R-MO), and House Education and the Workforce Committee Chair Virginia Foxx (R-NC), H.R. 5378, the Lower Costs, More Transparency Act, will lower health care costs by increasing transparency in the health care market.

“This bipartisan legislation delivers on our commitment to lowering health care costs and providing increased transparency for patients—something 95 percent of Americans support. It helps Americans save money on out-of-pocket expenses and seniors save millions on medicines through important Medicare payment reforms. I thank my colleagues for their hard work and support of the legislation and urge the Senate to consider it without delay,” said Chair Rodgers. 

“The Lower Costs, More Transparency Act does exactly what it says it does—it delivers lower health care costs for the American people and brings much-needed transparency to our nation’s complex health care system. This bipartisan bill is a victory for everyone who has ever struggled to navigate and understand the cost of a health care procedure or a prescription drug. I’m also pleased it will help make health care more accessible to American families by investing in Community Health Centers and programs to address the physician shortages across the nation,” said Ranking Member Pallone. 

“Millions of American families have struggled for far too long to afford the cost of their health care. What’s worse is they have been unable to anticipate those costs because our current system has left too many Americans at the mercy of nontransparent pricing on treatments, medicines, and procedures. By requiring nearly every corner of our health system to publicly disclose their prices, the Lower Costs More Transparency Act will empower patients and create incentives to lower prices across the board. Americans will no longer be left in the dark, struggling to understand the true price of their health care,” said Chair Smith. 

“The Lower Costs, More Transparency Act is all about empowering patients and their families. Every patient should be able to navigate the health care market with ease. This bill makes that vision a reality by building on the success of the Trump administration’s price transparency rules for plans and hospitals, making PBM activities more transparent, and ensuring employers have the information they need to make smart choices on behalf of their employees. I thank my colleagues on the Committees on Ways and Means and Energy and Commerce for working with us to develop a bill that is an enormous step forward to improving the American health care system,” said Chair Virginia Foxx. 

How the Lower Costs, More Transparency Act helps patients: 

Increases Price Transparency Throughout the Health Care System for Patients

• Empowers patients and employers to shop for health care and make informed health care decisions by providing timely and accurate information about the cost of care, treatment, and services 
• Makes health care price information public by ensuring hospitals, insurance companies, labs, imaging providers, and ambulatory surgical centers publicly list the prices they charge patients
• Lowers costs for patients and employers by requiring health insurers and pharmacy benefit managers (PBMs) to disclose negotiated drug rebates and discounts, revealing the true costs of prescription drugs 

Addresses the Cost of Prescription Drugs

• Lowers out-of-pocket costs for seniors who receive medication at a hospital-owned outpatient facility 
• Expands access to more affordable generic drugs 
• Equips employer health plans with the drug price information they need to get the best deal possible for their employees 

Supports Patients, Health Care Workers, Community Health Centers, and Hospitals

• Fully pays for expiring programs that strengthen the health care system by: 
• Supporting Community Health Centers, which are crucial for patients in rural and underserved areas 
• Supporting training programs for new doctors in communities 
• Preserving Medicaid for hospitals that take care of uninsured and low-income patients 
• Extending funding for research to find better treatments and a cure for diabetes, which affects more than 37 million Americans

NOTE: The bill contains portions of legislation sponsored by the following Members: 

• H.R.3561 led by Reps. Rodgers (R-WA-5) and Pallone (D-NJ-6) and H.R. 4839 by led Rep. Steel (R-CA-45) (Sec. 101. Hospital Price Transparency) 
• H.R. 3248 led by Reps. Miller-Meeks (R-IA-1) and DeGette (D-CO-1) and H.R. 4882 led by Rep. Carol Miller (R-WV-1) (Sec. 102. Clinical Diagnostic Laboratory Test Price Transparency) 
• H.R. 4828 led by Rep. Carey (R-OH-15) (Sec. 103. Imaging Price Transparency) 
• H.R.4839 led by Rep. Steel (R-CA-45) (Sec. 104. Ambulatory Surgical Center Price Transparency) 
• H.R. 3561 led by Reps. Rodgers (R-WA-5) and Pallone (D-NJ-6) and H.R. 4905 led by Reps. Fitzpatrick (R-PA-1) and Lee (D-NV-3), and H.R. 4507 by Reps. Good (R-VA-5) and DeSaulnier (D-CA-10) (Sec. 105. Health Coverage Price Transparency) 
• H.R. 2679 led by Reps. Kuster (D-NH-2), Earl L. “Buddy” Carter (R-GA-1), Eshoo (D-CA-16), and Guthrie (R-KY-2), H.R. 4846 led by Rep. Arrington (R-TX-19), and H.R. 4507 led by Reps. Good (R-VA-5) and DeSaulnier (D-CA-10) 
• H.R. 3282 led by Reps. Harshbarger (R-TN-1) and Schrier (D-WA-8) and H.R. 4883 led by Rep. Murphy (R-NC-3) (Sec. 108. Report on Integration in Medicare) 
• H.R.4507 led by Reps. Good (R-VA-5) and DeSaulnier (D-CA-10) (Sec. 109. Advisory Committee) 
• H.R. 3284 led by Reps. Burgess (R-TX-26), Ferguson (R-GA-3), Bilirakis (R-FL-12), and Dingell (D-MI-6) (Sec. 110. Report on Impact of Medicare Regulations on Provider and Payer Consolidation) 
• H.R. led 3839 by Reps. Dunn (R-FL-2) and Kuster (D-NH-2) (Sec. 201. Increasing Transparency in Generic Drug Applications) 
• H.R. 1613 led by Reps. Carter (R-GA-1), Gonzalez (D-TX-34), Stefanik (R-NY-21), Ross (D-NC-2), Allen (R-GA-12), and Auchincloss (D-MA-4) (Sec. 202. Improving Transparency and Preventing the Use of Abusive Spread Pricing and Related Practices in Medicaid) 
• H.R. 3561 led by Reps. Rodgers (R-WA-5) and Pallone (D-NJ-6) (Sec. 203. Parity in Medicare Payments for Hospital Outpatient Department Services Furnished Off-Campus) 
• H.R. 3237 led by Reps. Joyce (R-PA-13) and Sarbanes (D-MD-3), H.R. 3417 by Reps. Hern (R-OK-1) and Kuster (D-NH-2) and H.R. 4509 led by Reps. Foxx (R-NC-5) and Scott (D-VA-3) (Sec. 204. Requiring a Separate Identification Number and an Attestation for Each Off-Campus Outpatient Department of a Provider) 
• H.R. 2559 led by Reps. Joyce (R-PA-13), Blunt Rochester (D-DE-At-Large), Stefanik (R-NY-21), and Fletcher (D-TX-7) (Sec. 301. Extension for Community Health Centers, the National Health Service Corps, and Teaching Health Centers that Operate GME Programs) 
• H.R. 2550 led by Reps. DeGette (D-CO-1) and Bilirakis (R-FL-12) and H.R. 2547 led by Reps. Cole (R-OK-4) and Ruiz (D-CA-25) (Sec. 302. Special Diabetes Programs) 
• H.R. 2665 led by Reps. Clarke (D-NY-9), Crenshaw (R-TX-2), DeGette (D-CO-1), and Burgess (R-TX-26) (Sec. 303. Delaying Certain Disproportionate Share Hospital Payment Reductions Under Medicaid) 
• H.R. 4527 led by Reps. Chavez-DeRemer (R-OR-5), Takano (D-CA-39), and Manning (D-NC-6) 
• H.R. 4508 led by Reps. Courtney (D-CT-2) and Houchin (R-IN-9) (Sec. 402. Hidden Fees Disclosure Requirements) 
• H.R.4507 led by Reps. Good (R-VA-5) and DeSaulnier (D-CA-10) (Sec. 403. Information on Prescription Drugs) 

CLICK HERE to read the text of the Lower Costs, More Transparency Act. 

CLICK HERE to read the full section by section-by-section summary.

"[M]aking prices more transparent polls at more than 80 percent, regardless of party or demographic. It brings both liberal and conservative advocacy groups together. Americans see prices everywhere they shop except in health care, and it makes sense to them that there should be a clear price for blood draws and X-rays, too."

Last month, the House passed the Lower Costs, More Transparency Act to drive down health care costs by increasing price transparency. Writing in the The Hill, journalist and commentator Mary Katharine Ham shared her experience as a patient and explains the importance of price transparency.

“When I was pregnant with my second child, in the years following the passage of the Affordable Care Act, I went to the doctor for routine prenatal testing. Despite promises to the contrary, I had lost several health insurance plans during those years, and at least one while pregnant. At the doctor that day, my new deductible was so high that I paid full freight up-front for all my care. 

“The practice offered me two tests—one a new-fangled version of the old test. When I noticed two tests listed, I told them I’d like to choose one and asked which was more cost-effective. The facility couldn’t even tell me. 

“On a different trip to the pediatrician, I asked for an estimate of the price. I was quoted about $250, but when I checked out, was presented with a bill almost three times that.” 

[…] 

“No matter what kind of insurance you have, you’ve probably run into this confusion. In ObamaCare exchanges, employer-based insurance, and government-run programs, figuring out even an approximate price for medical services can be a puzzle. In most of our system, cost is borne by a third payer, so customers and providers alike are disconnected from the actual price of services. As a result, even the same exact procedure can cost wildly different amounts, depending on something as simple as which building you visit to get it done. 

“A new bill overwhelmingly passed by the House […] (the vote was 320-71) aims to fix some of these problems. Dubbed the Lower Costs, More Transparency Act, the package had bipartisan backing and went through three different House committees. It aims to make changes to our complex health care system to make pricing clearer and site-neutral.” 

[…] 

“The health care debate has for too long been defined by utopian dreams and giant plans, many of which fall short for Americans. Maybe it’s time to start favoring the simple over the sweeping. In the words of Fat Joe, it’s not rocket science.” 

CLICK HERE to read the full piece. 

CLICK HERE to read more about the Lower Costs, More Transparency Act. 

Bipartisan PATIENT Act Gains Momentum as Experts Voice Support

Americans want more health care transparency and lower prices. The bipartisan PATIENT Act, led by House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) and Ranking Member Frank Pallone, Jr. (D-NJ), will help Americans get access to the right care, at the right time, at a price they can afford.

Solutions in the PATIENT Act—like increasing price transparency and addressing the cost of prescription drugs—are supported by the vast majority of Americans. Nearly 90% of Americans support strengthening price transparency requirements and nearly 85% of Americans favor solutions that prevent them from having to pay more for their prescription drugs than their insurance company.

Check out the below opinion pieces featured in Newsweek and RealClear Policy for more on support of the PATIENT Act.

Last month, the Energy and Commerce Committee of the U.S. House of Representatives unanimously reported out The Patient Act (H.R. 3561), which would require hospitals and health insurance companies to post the true prices of their medical services. Representatives Cathy McMorris Rodgers (R-Wash.) and Frank Pallone (D-N.J.) are sponsoring this legislation, one of six bipartisan committee measures to help patients and improve the functioning of the nation's troubled health care markets. 

Today, few health care policy proposals attract broad bipartisan support. Health care price transparency, however, is one of those rare "unicorns." In this case, the bipartisanship has been given a boost, because the Biden administration has largely embraced and continued the Trump administration's groundbreaking regulatory efforts to require hospitals and health insurance companies to reveal their real prices. 

Nearly 90 percent of Americans support health care price transparency, Washington has a golden opportunity to improve the lives of millions of Americans through a more affordable and competitive health care marketplace. In a recent report for The Heritage Foundation, we outlined several policy options for Congress to consider, which would benefit all Americans. 

CLICK HERE to continue reading more from David N. Bernstein and Robert E. Moffit in Newsweek.

Next up: The PATIENT Act (Promoting Access to Treatments and Increasing Extremely Needed Transparency Act) to tackle health care costs by increasing transparency and competition. After numerous hearings, the bill passed through the Energy and Commerce Committee 49-0, and a House floor vote is expected in July. Here is a section-by-section summary.

One reason for this progress is that the legislative process is going through “regular order” for the first time in years.

That means that a Member proposes a legislative idea, hearings are held, and the relevant subcommittee considers and reports the bill to the full committee. The full committee then debates the measure and, if approved, it goes to the Floor for a vote, after passing through the Rules Committee which decides the process for offering amendments.

This is what’s happening now, straight out of Civics 101.

CLICK HERE to continue reading from Grace-Marie Turner in RealClear Policy.

The People’s House is set to consider bipartisan legislation from Energy and Commerce, Ways and Means, and Education and the Workforce that will bring much needed transparency to the health care sector to drive down costs.  

NEW POLLING by a nonpartisan nonprofit confirms that Americans support crucial provisions in the Lower Costs, More Transparency Act.  

This data shows Americans overwhelmingly want a more transparent and accountable health care system. Specifically, Americans are upset with facility fees and hospital upcharges for services that would be cheaper if they were performed in other sites, like physician offices.     

Here’s what Americans think when it comes to health care costs and the need for greater transparency. 

• 84% of participants think that health care is a high priority issue for Congress to address this year. 
• 81% of voters support lawmakers requiring big corporate hospitals to report data on facility fees, including how much revenue they are collecting from facility fees. 
• 74% of voters support banning facility fees everywhere for outpatient, same-day services, regardless of the service or where it is being performed.
• 95% of the public says it is important for Congress to pass a law to make health care costs more transparent to patients.

Bottom line: Americans want transparency, and they don’t want to pay more out of pocket for services just because they’re provided by a hospital-owned doctor’s office. 

The Lower Costs, More Transparency Act accomplishes these critical goals by:  

• Requiring hospitals to disclose their actual prices.  
• Requiring insurance companies to show patients what they will actually pay BEFORE they receive their care.  
• Implementing a modest, but critical, “site neutral” reform to end the upcharge for Medicare and senior citizens when a Medicare patient is administered a drug in a doctor’s office that is owned by a hospital.    
• At a bipartisan hearing this year, the Energy and Commerce Committee hearing testimony about a senior from Ohio who suffered from arthritis. 
• She saw her out-of-pocket cost for her annual steroid injection increase from $30 to $1,400 after her doctor's office was reclassified as hospital department. 
• She was receiving the exact same service from the exact same doctor in the exact same building as before. 
• The Lower Costs, More Transparency Act prevents this exorbitant price increase from happening, saving both seniors and Medicare significant sums of money. 

READ: 

• Bipartisan Lower Costs, More Transparency Act Saves Seniors Money, Strengthens Medicare 
• How the Lower Costs, More Transparency Act Helps Patients 
• Former Speaker Newt Gingrich: The one health care solution to protect everyone from outrageous medical bills 
• CLICK HERE to read more about the H.R. 5378, the Lower Costs, More Transparency Act. 
• CLICK HERE to read a section-by-section summary of the bill. 
• CLICK HERE to read the bill text.