Fair Pricing Act (NY)
Over the last two decades, massive hospital systems have merged and bought up independent practices at an alarming rate. As a result, patients have fewer options and are directed to seek care in Hospital Outpatient Departments (HOPDs) instead of their neighborhood doctor’s office. However, the average price for low-complexity services is 4x more in an HOPD than a non-hospital setting. That could mean higher co-pays and co-insurances for patients, and higher costs for payors, without a viable alternative for more affordable care. In 2024, 66% of New Yorkers delayed or went without healthcare due to cost, and 80% reported that they worry about affording healthcare in the future. The Fair Pricing Act ensures that all patients, whether or not they have insurance, are paying lower prices for routine care, like flu shots or x-rays.
Source: New York – Healthcare Value Hub
What is the Fair Pricing Act?
The Fair Pricing Act establishes fair pricing for routine medical care that can be safely delivered in a doctor’s office or a medical facility that does not require an overnight stay, providing the same procedure at the same price, regardless of setting.
The Fair Pricing Act would:
- Cap prices for certain routine services at 150% of Medicare’s prices.
* Doctors’ offices already provide these services at 130% of Medicare’s prices, on average. - Ban facility fees on covered services—which are an additional bill on top of the total cost of providing the service.
- Exempt public hospitals, critical access hospitals, sole community hospitals, rural emergency hospitals, safety net hospitals, and federally qualified health centers.
- Empower patients and payers (including employers and unions) to seek consumer protection if they suffer losses due to violations of The Fair Pricing Act.
- Hold hospitals and other healthcare providers accountable for data collection and annual reporting on rates charged and paid for covered services.
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If passed, this legislation could save New York over $1.1 billion annually and protect families, workers, and taxpayers from excessive costs. Passing the Fair Pricing Act isn’t just about cutting costs—it’s about restoring fairness and access to healthcare for every New Yorker. As healthcare costs skyrocket while wages barely rise, families are delaying or forgoing essential care. The Fair Pricing Act levels the playing field by capping hospital charges, banning unnecessary facility fees, and ensuring patients pay the same fair price no matter where they receive treatment. By passing this legislation, New York can take a decisive step toward a more transparent, affordable, and equitable healthcare system—one that puts patients, not profits, first.
The Fair Pricing Act is currently being considered by the New York State Legislature
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New York Coalition
Health Care Accountability Law (NJ)
In November 2022, state leaders announced that premiums for the State Health Benefits Program (SHBP) would increase by more than 20% the following year. For tens of thousands of public workers, that meant higher payroll deductions, higher taxes, and fewer dollars for wages, pensions, and essential services. Our Coalition expanded to New Jersey following these rate increases to advocate for long-term solutions to rising healthcare costs.
New Jersey is facing a healthcare affordability crisis. 85% of New Jerseyans, even those with insurance, say they’re worried about affording healthcare in the future and 49% of New Jerseyans have delayed or gone without care due to cost. This year, the State Health Benefit Plan (which provides benefits to teachers, police officers, and local government employees), announced rate hikes between 20-36%. Commercial payors, including cities and towns, unions, and nonprofits, are paying almost 3x what Medicare pays for the same hospital services. These high and rising costs don’t guarantee higher quality care, they just drain budgets and working families’ wallets. In fact, prices vary wildly across and within hospital systems. For example, a childbirth that costs $47,000 at one high-quality hospital costs $16,000 at another hospital of the same quality– and there isn’t enough publicly available information to explain why. Furthermore, fewer than 50% of New Jersey hospitals are fully compliant with federal hospital price transparency requirements, making it nearly impossible for patients to uncover how much they will be billed.
What is the Health Care Accountability Law
The Health Care Accountability Law will expand on the work of the New Jersey Office of Health Care Affordability and Transparency by creating an independent commission to examine drivers of, and enforce limits on, healthcare cost growth and hospital price growth.
This Health Care Accountability Law:
- Puts healthcare spending on a budget.
- Caps annual healthcare spending growth at roughly 3%, ensuring it doesn’t outpace the growth of New Jerseyans’ incomes.
- Establishes a hospital price growth benchmark.
- Sets a clear limit on how much hospital prices can increase each year — holding the largest cost drivers accountable.
- Creates an independent watchdog.
- Establishes a Health Care Affordability Commission to monitor prices, enforce benchmarks, and make sure hospitals are doing their part to keep care affordable.
How It Will Be Enforced:
- The legislation ensures real accountability, not just reports and recommendations.
- Hospitals that consistently exceed benchmarks will be required to develop Performance Improvement Plans.
- Persistent violators may be compelled to testify publicly at annual hearings and face financial penalties for noncompliance.
- Hospitals that fail to meet federal price transparency requirements will be barred from collecting medical debt from patients treated during their period of noncompliance.
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How have cost growth benchmark programs lowered healthcare costs in other states?
When Massachusetts implemented a cost-growth benchmark program in 2012, its healthcare spending had been rising faster than the national average. In the five years that followed, the state slowed its healthcare spending growth dramatically — saving employers and consumers an estimated $7.2 billion compared to what they would have paid if trends had continued. The Health Care Accountability Legislation would bring that same proven strategy to New Jersey by finally putting the state’s healthcare spending on a sustainable, transparent budget.
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The Health Care Accountability Law is currently being considered by the New Jersey State Legislature
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Learn More
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New Jersey Coalition
Legislative Wins
New York has some of the highest commercial hospital prices in the country, averaging more than 3x the Medicare rates, and significantly more expensive than hospitals in other major cities like Boston. Yet, higher prices don’t mean higher quality. That’s why our coalition is fighting for fairness and delivering results. Working with New York City and State legislators, we’ve helped pass landmark legislation to promote transparency, prevent anti-competitive behavior, and strengthen accountability in healthcare spending. Check out some of our key legislative accomplishments.
Health Care Accountability and Consumer Protection Act
Creating the first citywide Office of Health Care Accountability
The Healthcare Accountability and Consumer Protection Act (HACPA) established the New York City Office of Healthcare Accountability (OHA), the first municipal office of its kind in the United States.
In December 2022, the Coalition for Affordable Hospitals partnered with Councilmember Julie Menin to introduce HACPA. The New York City Council unanimously passed HACPA in June 2023, and Mayor Adams signed it later that month.
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The OHA is a groundbreaking initiative designed to give New York City the tools to monitor and manage its healthcare spending.
It is responsible for:
- Collecting and analyzing hospital price data from across the five boroughs.
- Publishing public reports on hospital prices and city healthcare expenditures.
- Evaluating the city’s health plan costs and identifying opportunities for savings.
- Recommending reforms to reduce excessive costs and improve affordability.
- The OHA brings transparency to one of the city’s largest budget items: healthcare for municipal employees and retirees.
- It allows the city to negotiate smarter contracts and hold hospitals accountable for unjustified prices.
- It empowers policymakers and the public to see where their healthcare dollars are going and demand better value.
This is a first-of-its-kind model for local healthcare oversight and a powerful step toward systemic change.
Hospital Equity and Affordability Law (HEAL)
Promoting Transparency and Fair Competition
The Hospital Equity and Affordability Law (HEAL) tackles one of the biggest drivers of rising hospital prices: anti-competitive contracting practices that keep purchasers, insurers, and patients out of the loop.
Before HEAL, hospitals could use contract clauses that allowed them to:
- Hide prices from the employers, unions, and insurers who pay for care.
- Prohibit purchasers from discussing or comparing hospital pricing publicly.
- Use “Most Favored Nation” clauses to lock in high prices and prevent discounts for other payers.
In June 2022, HEAL passed the New York State Legislature. Governor Kathy Hochul signed it into law in December 2022, and HEAL became effective in July 2023.
- HEAL banned these secretive and restrictive practices, ensuring that hospital pricing information can be shared openly and fairly. Employers and unions can now see what they’re paying and negotiate better deals. This law enhanced transparency and accountability in the contracting process and is a critical step in creating a more competitive, affordable healthcare marketplace.
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Health Care Data Transparency Act
Shedding light on hospital pricing across New York State
- The Health Care Data Transparency Act gives New York the power to track, benchmark, and report hospital costs statewide. It specifically focuses on NYSHIP, the New York State Health Insurance Program, that covers hundreds of thousands of state and local government employees, retirees, and their families.
- In January 2023, the Coalition partnered with Senator Andrew Gounardes and Assemblymember Michaelle Solages to introduce the Health Care Data Transparency Act. The New York Legislature passed the bill in June 2023, and was signed by Governor Hochul in December 2023.
The Act requires the state to:
- Collect and publish data on how much NYSHIP pays hospitals for care.
- Analyze price variation among hospitals across the state.
- Issue annual reports on pricing trends and hospital utilization.
- This law brings accountability to hospital pricing, so public dollars are spent responsibly. It empowers policymakers, purchasers, and patients with data-driven insight into how costs are growing and where intervention is needed. With this transparency, we can finally begin to slow the unchecked growth of hospital prices and ensure that healthcare spending benefits patients, not profit margins.