House Passes Healthcare Transparency Bill

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House Passes Healthcare Transparency Bill

If signed into law, ASCs will need to release standard charges and prices starting January 2026

BY DAVID OPONG-WADEE | DECEMBER 2023

On December 11, the US House of Representatives overwhelmingly passed the Lower Costs, More Transparency Act (H.R. 5378) by a vote of 320–71. If enacted, effective January 1, 2026, the bill will require ASCs to disclose to the public all standard charges and prices, including information relevant to ASCs on the list of 300 shoppable services or an indication that such service is not furnished by the ASC. This price transparency provision is similar to the price transparency legislation H.R. 4822 that ASCA reported on over the summer.

While supporters of H.R. 5378 suggest that this bipartisan legislation represents a significant step toward increased transparency in healthcare pricing and aims to empower patients to make informed decisions about their care, ASCA remains concerned that the ASC-specific provision will not provide useful information to patients.

The bill got significant bipartisan support due to the cost savings projected by the Congressional Budget Office (CBO). The detailed CBO score indicates the legislation would result in an $833 million reduction in the federal deficit over 10 years (2024–2033).

Key Features of the Bill

  • Increased Price Transparency: The legislation requires hospitals and pharmacy benefit managers (PBM) to publicly disclose their negotiated rates with health insurance companies. This information will be available in a standardized format, allowing patients to compare prices across different providers.
  • $4.4 Billion for Community Health Centers: The legislation extends funding for community health centers by two years, ensuring continued access to affordable healthcare in underserved communities.
  • ASC Reporting: As mentioned above, pertinent to Title I, Sec. 104 (Ambulatory Surgical Center Price Transparency), effective January 1, 2026, ASCs will need to disclose all standard charges and prices. The information shall include:
    • plain language description of each item or service, accompanied by the HCPCS code
    • gross charge, as applicable, in dollar amount for each item or service
    • discounted cash price or median cash price if there is no discount for self-pay individuals for each item or service
    • current payer-specific negotiated charges with the name of the third-party payer and plan and dollar amount for each item or service
    • the de-identified maximum and minimum negotiated charges, as applicable, for each such item or service.

The bill is enforceable through civil monetary penalties of up to $300 per day for ASCs that fail to comply but could be waived or reduced for ASCs serving rural areas.

Strong Bipartisan Support

The bill received broad support from Democrats and Republicans, with key leaders from various committees voicing their approval.

Energy & Commerce (E&C) Chair Cathy McMorris Rodgers (R-WA), Ways & Means (W&M) Chair Jason Smith (R-MO), E&C Subcommittee on Health Chair Brett Guthrie (R-KY), Representative Buddy Carter (R-GA), Representative John Joyce (R-PA) and Representative Larry Bucshon (R-IN) led the push for passage out of the House majority. During floor speeches, W&M Subcommittee on Health Ranking Member Lloyd Doggett (D-TX) spoke against the legislation, citing issues with private equity investment in nursing homes. Doggett disagreed that the bill goes far enough to be transparent. However, Committee on Energy & Commerce Ranking Member Frank Pallone (D-NJ), refuted Doggett and offered full support for the legislation. Pallone has been an outspoken supporter of hospital and PBM transparency and is particularly supportive of the inclusion of the $4.4 billion, two-year extension package for community health centers through 2025. This represents a compromise where Republicans offered more money over fewer years than initially requested.

The unity across high-ranking members in both committees of jurisdiction signals a strong push from the House to pressure the Senate Committee on Finance to pass such wide-reaching legislation on transparency in healthcare.

Next Steps

The bill will now move to the Senate for consideration. ASCA continues to advocate for a more patient-centered approach to price transparency and encourages the Senate to consider alternative solutions that focus on providing consumers with easily accessible price information.

Additional Developments

  • House Speaker Mike Johnson announced a floor vote next week to authorize a formal impeachment inquiry against President Biden.
  • Healthcare legislation—including a bill to increase the Medicare Physician Fee Schedule—is expected to be a key focus in the second week of January.
  • ASCA is pushing for its co-pay cap provision as an alternative to MedPAC's proposed site-neutrality measures.

Questions? Write David Opong-Wadee at dopongwadee@ascassociation.org.