For years, health care debates have circled the same stale arguments: expand subsidies, restrict insurers, adjust regulations at the margins. What has been missing, however, is a recognition that two structural failures drive most of the dysfunction Americans face.
The first is that patients cannot see the price of care before receiving it. The second is that insurance is tied to jobs, states and enrollment calendars that prevent people from choosing the coverage that best fits their lives. Without addressing both, no reform can meaningfully lower costs or expand choice for Americans.
Congress now has practical legislation that targets each failure directly.
The Patients Deserve Price Tags Act, introduced by Sens. Roger Marshall (R-Kan.) and John Hickenlooper (D-Colo.), enforces the transparency Americans were promised years ago. And the More Affordable Care Act, recently introduced by Sen. Rick Scott (R-Fla.), creates a path for portable, consumer-centered insurance that people actually can take with them.
These proposals solve different problems, but they are complementary. One provides information. The other provides freedom. Neither can fully succeed without the other.
Transparency is the most basic expectation in any functioning market. Airline tickets, hotel rooms, financial services, and retail all list prices in advance. Health care stands alone in asking consumers to commit to services without knowing the cost.
Hospitals and insurers know their negotiated rates and cash prices; patients do not. Prices for the same MRI or surgery can vary ten-fold among providers in the same city, and the public has no way to see or compare those differences before receiving a bill. But the Marshall-Hickenlooper goes further than just hospitals and insurers – it requires prices from labs, imaging centers, and ambulatory surgical centers. When those facilities are independent they often provide much less expensive services than hospital-based facilities.
The Affordable Care Act included transparency requirements, but enforcement was so weak that compliance in practice was optional. Hospitals posted partial or unusable files; insurers buried pricing data behind layers of formats no person or employer could decipher. The result: the same opacity Americans have lived with for decades.
The Patients Deserve Price Tags Act finally enforces what Congress required long ago. It mandates clear, standardized and comparable prices. It eliminates loopholes that allowed hospitals and insurers to disclose information in ways no one could use. And it establishes penalties meaningful enough to ensure compliance.
This is not a new system. It is the fulfillment of a promise that was never kept.
But information, on its own, is not enough. Even with perfect transparency, most Americans remain locked into coverage chosen by employers or constrained by a once-yearly enrollment cycle. If people cannot act on price information, transparency cannot deliver the competitive pressure it is meant to create.
That is where the More Affordable Care Act enters the picture. The proposal expands portability so that insurance becomes something people own rather than something assigned to them. Americans should not lose coverage because they change jobs, move across state lines or want a fresh start. The current system was built in an era when updating insurance plans took months of software integration, and annual enrollment calendars were necessary. Those technical barriers no longer exist, but the policy structure remains frozen in place. The result is a system that limits mobility and ties people to employer plans even when better, more affordable options exist elsewhere.
Portability restores the American expectation that opportunity requires the freedom to move. It treats insurance the way we treat every other essential product: something individuals choose, not something contingent on employment or geography. It also allows real competition among insurers because people can finally vote with their feet — a pressure that has been absent from the market for decades.
Transparency and portability reinforce each other. Transparency exposes prices and portability gives consumers the ability to act on them. Portability expands choices and transparency ensures those choices are informed. One without the other leaves the system half-reformed. Information without choice is powerless. Choice without information is meaningless. Together, they create the foundation of a functioning market.
The Affordable Care Act was built around insurers, not individuals. It centralized subsidies, locked enrollment into narrow windows, and allowed pricing disclosures to go unenforced. These proposals do not replace the Affordable Care Act but help it fulfill its promise. They give families and employers the tools they need and the freedom to use them. They reduce waste without cutting benefits. And they do so without forcing anyone to abandon coverage they already have.
Congress rarely has the chance to pass reforms that are both practical and transformative. These two bills offer that opportunity. Lawmakers should seize the chance to give Americans what they have always expected but never received: the ability to know what they are buying and the freedom to choose it.