Texas Policy Research recommends that lawmakers vote YES on SB 331 as a measured, market-reinforcing response to a persistent problem in Texas healthcare: the lack of pricing transparency across many types of healthcare facilities. While previous federal and state legislation focused on hospitals, a significant portion of Texas residents receive care from freestanding ERs, outpatient clinics, and ambulatory surgical centers—many of which remain outside the scope of transparency regulations. SB 331 seeks to close this gap, enabling more Texans to make informed decisions about their care and costs.

The bill requires qualifying facilities to disclose standard and negotiated prices online, including rates for 300 "shoppable" services defined by CMS. Crucially, it includes a $7 million revenue threshold, ensuring that only large and financially capable providers are subject to these requirements. This provision protects small and rural facilities from administrative burdens they may not have the resources to meet, thereby preserving local access to care while still expanding transparency where it matters most.

That said, the bill does bring about a modest expansion of the size and scope of state government. The Health and Human Services Commission (HHSC) will require up to 16.5 new full-time employees by FY2027 to enforce compliance, at an estimated General Revenue cost of $2.72 million over the 2026–27 biennium. These costs are real and should not be dismissed. However, they are limited in scope, tied directly to a discrete function (compliance and enforcement), and do not represent a systemic expansion of regulatory authority. In time, revenue from administrative penalties may partially offset these expenses, and the long-term gains from increased market efficiency may benefit taxpayers and consumers alike.

A core concern arises from the fact that the bill imposes regulatory requirements on private, for-profit healthcare businesses. This includes mandates to disclose service pricing—something not typically required in other sectors. Critics might rightly argue that this sets a precedent for further state intervention or imposes new compliance costs on businesses that should be free to operate without interference. These concerns reflect deeply held principles of limited government and free enterprise.

However, it's important to note that healthcare is not a normal market. Consumers often cannot "shop" effectively due to the lack of price transparency, and patients frequently receive care from out-of-network facilities without knowing costs upfront. By requiring only disclosure—not price controls, service mandates, or operational oversight—SB 331 strengthens the function of the market itself. Patients, insurers, and employers can make better decisions when armed with clearer cost information. This is not an expansion of government for its own sake, but a targeted correction to support consumer empowerment and market competition.

The bill also does not apply universally. Its targeted nature—limiting applicability to facilities with over $7 million in annual gross revenue—demonstrates a commitment to regulatory proportionality. It carefully avoids imposing sweeping burdens on small clinics or practices. This threshold ensures that only those entities with the scale and capacity to manage compliance are held to the new standard.

In sum, while SB 331 does increase regulatory oversight, it does so in a constrained, focused, and justified way. It addresses a recognized market failure, applies only to large providers, avoids price setting, and strengthens consumer choice. It is consistent with the principles of individual liberty, personal responsibility, and free enterprise while remaining mindful of the risks of government overreach and taxpayer impact.

Accordingly, SB 331 represents a smart, liberty-conscious policy solution in a sector that demands transparency.

• Individual Liberty: The bill enhances individual liberty by empowering patients with access to meaningful healthcare price information. In a market where patients are often unaware of costs until after receiving treatment, this bill helps restore autonomy by equipping individuals with the data needed to make informed, voluntary choices about where and how to seek care. Patients deserve to know what they are paying for, just as they do in nearly every other aspect of the marketplace. Requiring large facilities to disclose prices publicly strengthens the patient’s role in decision-making and reduces their vulnerability to unexpected or predatory billing.
• Personal Responsibility: By making pricing information more accessible, the bill enables consumers to take greater ownership of their healthcare choices. Rather than relying on opaque insurance networks or post-service billing, patients are given the opportunity to compare services, weigh costs, and decide what works best for their budget and medical needs. This bolsters the idea that individuals—not government or corporations—should be primarily responsible for their choices and outcomes, a foundational element of personal responsibility.
• Free Enterprise: This is where the impact is more nuanced. On one hand, the bill imposes a regulatory requirement on private businesses, which can be seen as a constraint on how those entities operate. However, the requirement is limited to price disclosure—not price control, service mandates, or staffing requirements. On the other hand, transparency fosters market competition, which is a core tenet of free enterprise. When prices are hidden, there is little incentive for providers to compete. When prices are public, businesses that offer better value can attract more patients. In this way, the bill actually strengthens the integrity of the free market by enabling it to function more effectively.
• Private Property Rights: The bill does not seize, restrict, or reassign private property. It does not limit ownership, facility use, or profits. What it does is require businesses of a certain scale to make specific information about their services publicly available. While one could argue that disclosure obligations are a modest imposition on operational freedom, they do not interfere with actual property rights. Therefore, the bill’s impact here is best characterized as neutral.
• Limited Government: The bill does expand the role of state government in two ways. It broadens the authority of the Health and Human Services Commission (HHSC) to enforce pricing disclosures among a wider array of healthcare providers. It requires additional staff and funding—about $2.72 million over the first biennium and 16.5 new full-time employees. However, this expansion is narrow, mission-specific, and tied to a defined public interest—increased market transparency and consumer protection. The bill avoids broad regulatory creep by limiting applicability to facilities with $7M+ in revenue, exempting small or rural providers, applying only to pricing disclosures and not service models or pricing itself. Thus, while it technically increases the scope of government, it does so in a way that many advocates of limited government would view as justified and contained, especially given the dysfunctional state of the healthcare pricing market.