Recent weeks have brought something rare to Washington: meaningful, bipartisan progress on health care costs—progress built on a simple idea that should extend across the entire system.
Congress included significant pharmacy benefit manager (PBM) reforms in the 2026 spending package that strengthened transparency and rebate pass-through requirements—policies that shift financial incentives from industry middleman toward patient care.
The Trump Department of Justice quickly reinforced this direction, with the Trump administration securing a high-profile settlement with Express Scripts that targeted secret pricing practices and misaligned incentives. At the same time, the Trump Department of Labor (DOL) has proposed new rules to expand disclosure of PBM compensation and potential conflicts of interest, giving employer health plans clearer oversight tools. Market-driven innovations such as TrumpRx have demonstrated the benefits of transparent drug pricing made available directly to consumers.
Taken together, these developments represent remarkable momentum toward accountability and price visibility in a sector long defined by opacity.
That’s real progress. But it addresses only part of the cost equation.
In the commercial market, drug spending is substantial. Yet hospital and facility services account for the largest share of medical expenditures—and therefore represent the greatest financial exposure for self-insured employers. Understanding why requires a closer look at how these employer plans work.
Roughly two-thirds of workers with employer-sponsored insurance are enrolled in self-insured plans. In these arrangements, employers pay medical claims directly from their own funds, typically relying on insurers to rent provider networks and act as third-party administrators (TPAs). The TPAs then process claims and withdraw funds to pay providers.
Yet despite bearing the financial risk, employers often lack full visibility into how payments are calculated. Insurers and TPAs control the contracted rates, pricing methodologies, and discount structures, but often classify these mechanics as proprietary. Employers may receive summary reports but lack insight into the line-level claims data needed to help control costs. Audit rights can be limited, and data delivery is often delayed or incomplete.
The imbalance is shocking: the party paying the bill has the least insight into how the bill is calculated. In no other area of business would a company spend millions of dollars without receiving an itemized invoice and the ability to audit the bill. Yet this is effectively how many employers purchase health care today. As a result, many executives treat health care costs as an unavoidable expense rather than a controllable one because they lack the information needed to manage it effectively.
Better information would also allow employers to design health benefits around how their employees receive care. A company might steer workers toward high-value hospitals closer to their jobs, contract with local providers for more convenient access, or expand workplace clinics and onsite physicians. But these kinds of innovations require visibility into costs and outcomes — information employers currently lack.
Insurer networks are supposed to steer patients toward efficient providers, but the incentives are out of whack. When insurers act as TPAs for self-insured plans, they bear no direct financial risk. Even as insurers, revenue tends to rise along with premium volume. Employers, by contrast, do not benefit from enrollment growth and instead absorb rising health care costs through reduced margins, constrained hiring, and slower wage growth.
The economic implications are enormous. Employer-sponsored insurance covers about 160 million Americans, and national health expenditures exceed $4 trillion annually—nearly one-fifth of GDP. Economists have long documented that rising benefit costs crowd out wages. Recent research from the Federal Reserve Bank of New York found that insurance costs for regional businesses rose by more than 13 percent over the last year, and that without that, wage growth would have been almost a full percentage point higher. Health care inflation doesn’t just affect premiums; it suppresses take-home pay and leads to higher prices throughout the economy.
There is a practical, market-oriented solution already on the table.
The Patients Deserve Price Tags Act, sponsored by Sen. Roger Marshall and Rep. John James, would expand transparency by strengthening access to pricing and claims data. Critically, it would give employer health plans clearer audit and visibility rights —allowing plan sponsors to review payment accuracy, understand pricing variation and better safeguard plan assets.
The Trump administration could also build on the PBM reforms and proposed DOL rules by exploring whether similar transparency standards should apply to TPAs and claims administrators.
This isn’t a call for price controls or government micromanagement. It is a call for information symmetry. Employers should be able to see how their own health plan dollars are spent.
Transparent access to full claims data would allow employers to function as what they already are: the nation’s largest purchasers of health care. With visibility into price variation and payment mechanics, plan sponsors could conduct meaningful audits, correct errors and reward efficient providers.
Even modest improvements matter. Independent oversight often uncovers meaningful overpayments that otherwise go unnoticed. For self-insured health plans, recoveries from audits and payment integrity reviews can total roughly 1 percent to 1.5 percent of all claims processed and paid. This is tens of billions of dollars applied across the entire market. Shifting utilization toward lower-cost, high-quality providers introduces competition and can generate far larger savings—resources that could flow back into wages, hiring and investment.
PBM reforms have shown that transparency and accountability can gain traction across party lines. Extending these same principles to claims data would empower employers, sharpen competition, and discipline costs across the largest segment of health spending. Congress should build on this bipartisan momentum by extending the same principles to the claims data that drive the majority of health care spending.
Bobby Jindal (@BobbyJindal) was the governor of Louisiana from 2008-2016 and a candidate for the 2016 Republican presidential nomination. For more commentary from Newt Gingrich, visit Gingrich360.com. Gingrich 360 consults with various companies in the health care industry that would be affected by health care transparency reforms.
The views expressed in this article are the writers’ own.
