With the recent conclusion of the 2024 election, the focus now turns back to Congress as it enters the final weeks of the 118th session. Time is of the essence, yet Congress holds a crucial chance to reshape health care affordability, enhance transparency, and reduce costs. This can be achieved through the Lower Costs, More Transparency Act (LCMT) and the Health Care PRICE Transparency Act 2.0. Taking action during the lame-duck session could act as a catalyst for addressing issues like health care consolidation, cost disparities, and opaque pricing structures before a new legislative chapter begins.

Key Provisions and Their Significance

The LCMT's Central Provisions

The LCMT aims to build on the hospital and insurer price transparency rules enacted in 2019 and extend price transparency throughout the health care system. A poll conducted in September 2024 showed that 92% of likely electorate voters nationwide supported these requirements. There is strong bipartisan and bicameral support for these initiatives. The legislation mandates that hospitals and insurers disclose real prices, including cash rates and negotiated insurance rates, making data clearer and more accessible for researchers, consumers, and employers. It also extends these requirements to clinical labs, ambulatory surgical centers, and imaging service providers in Medicare.This is a significant step as, for decades, data on health care prices have been opaque. Rising health care costs often erode worker wages and other benefits, especially for lower-income Americans, and can strain government finances. Price transparency initiatives can inform policymakers and enable employers to design impactful programs to reduce spending.

Transparency in Medicare Advantage (MA)

The LCMT bill goes further by mandating that Medicare Advantage (MA) organizations disclose specific information to the Department of Health and Human Services regarding their shared ownership with health care providers, PBMs, and pharmacies. While it doesn't include full ownership transparency yet, this call for ownership transparency is a start. Full ownership transparency should be considered in the future as it can help prevent conflicts of interest, enhance accountability, and promote competition, as shown in research.

Addressing Site-of-Care Payment Differentials

One key provision of the LCMT not included in the Health Care PRICE Transparency Act 2.0 is addressing site-of-care payment differentials. The provision aims to ensure that Medicare beneficiaries and the Medicare program pay the same administration rates for physician-administered drugs in off-campus hospital outpatient departments as in physician offices. Our research has shown that these payment differentials contribute to the rise in Medicare spending and fuel provider consolidation. By mandating equal rates regardless of the care setting, this provision could help reduce unnecessary costs and prevent incentives to drive care to more expensive settings, opening up opportunities for broader site-neutral policy options in the future.Despite these payment differentials, our research has found that many non-hospital settings have equivalent or better quality. This shows the potential for these policies to not only control costs but also improve the quality of care.

The Importance of Passing These Bills

A busy legislative agenda and other pending priorities have pushed both bills to the lame-duck session. However, Congress has the opportunity to end on a high note in health care by passing provisions from the Lower Costs, More Transparency Act and the Health Care PRICE Transparency Act. These policies represent a crucial step toward potentially reducing costs, improving competition, and leveraging data to control health care spending growth. This presents a unique opportunity for Republicans and Democrats to unite on an important issue as we approach the new Congress and a new administration.Passing some of these provisions could provide immediate benefits while laying the groundwork for future reforms. Site-neutral payment initiatives, expanded reporting requirements on health care consolidation, and greater scrutiny of vertical integration could all build upon the foundation set by this legislation. The next Congress could further advance these efforts to ensure that our health care system remains accountable, competitive, transparent, and patient-centered.Jared Perkins is the director of Health Policy Strategy at the Center for Advancing Health Policy through Research (CAHPR) at the Brown University School of Public Health. Christopher M. Whaley is the associate director of CAHPR and associate professor of health, services, policy, and practice at the Brown University School of Public Health.