S. 3389: Lowering Health Care Costs for Americans Act

The "Lowering Health Care Costs for Americans Act" is legislation aimed at reducing healthcare expenses for individuals. It proposes a variety of measures designed to improve healthcare affordability and transparency while making some changes to existing coverage policies.

Healthcare Affordability Accounts

The bill establishes Healthcare Affordability Accounts, which are intended to provide financial assistance to individuals in need of healthcare services. This is part of a broader attempt to modify how premium assistance is provided under existing healthcare programs.

Price Transparency

One key feature of the bill is enhancing price transparency. Hospitals, laboratories, and ambulatory surgical centers will be required to publicly disclose their pricing starting in 2026 and 2027. This aims to help patients understand the costs of services before they receive care. The Secretary of Health will set uniform standards for these disclosures, and health plans will also need to provide detailed rate and payment information beginning in 2026.

State Innovation Waivers

Further, the bill introduces amendments to streamline state innovation waivers under the Affordable Care Act. This is designed to give states more flexibility and funding to implement innovative healthcare programs, such as reinsurance and high-risk pools, to provide better services to their populations.

Compliance Standards

The legislation includes strict regulations to ensure that all healthcare information disclosed by group health plans adheres to HIPAA regulations. Agreements that restrict disclosures of this information are prohibited. Additionally, healthcare providers must provide itemized bills to patients detailing the services rendered and their associated costs within 30 days of receiving payment.

Enforcement and Penalties

To enforce compliance, the bill introduces civil penalties for any violations. Providers will have a burden of proof to provide good faith estimates for costs, which, if not properly documented, will be deemed binding. Penalties for noncompliance could reach up to $10,000, and if a provider fails to comply with the estimation requirement, it will be assumed that their charges exceeded the estimate, thereby favoring patients in disputes.

Regulatory Framework

Lastly, the bill stipulates that regulations regarding the enforcement and implementation of these new transparency and pricing standards will be established through appropriate rulemaking processes.

Relevant Companies

• CVS: As a major healthcare provider that includes pharmacy services, CVS could be impacted by the price transparency requirements and the need to disclose more detailed pricing information.
• UHG: UnitedHealth Group may face repercussions due to the changes in premium assistance and the impacts on health plan disclosures.
• HCA: HCA Healthcare could be significantly affected by the new pricing transparency measures, which will require them to adjust their billing practices.
• MANU: McKesson Corporation may also experience shifts in operations related to the disclosure and compliance standards set by the new legislation.