Sponsor
Mark Takano
Representative · D-CA
Representative · D-CA
The bill strengthens plan oversight, pricing transparency, and participant protections (including quicker access to courts), but does so at the cost of increased compliance obligations, privacy and re‑identification risks, heavy penalties, and greater litigation and regulatory uncertainty for providers and employers.
Group health plans and sponsors can audit de-identified claims and encounter data, select auditors, and enforce audits (including penalties for obstruction), improving oversight of vendors and contract compliance.
Employers and plan participants get greater pricing transparency (disclosure of pricing in value‑based or capitated arrangements), which can strengthen bargaining and help control costs for employers and middle‑class families.
Data access and audit requirements must comply with HIPAA‑consistent protections, which helps preserve patient privacy when plans handle de‑identified or protected health information.
Hospitals, PBMs, TPAs and other providers will face new compliance burdens and costs (producing, de‑identifying, and attesting to large datasets and responding to audits), which may strain budgets and network participation—especially for smaller or rural providers.
Patients (especially those with chronic conditions or disabilities) face an ongoing risk that supposedly de‑identified data could be re‑identified or misused despite protections.
Large statutory penalties (e.g., $10,000/day for obstructing audits and $100/day per affected participant for violations) combined with expanded private suits can create disproportionate financial exposure and encourage litigation, imposing heavy burdens on providers and employers.
Based on analysis of 4 sections of legislative text.
Requires plan vendor contracts to allow audits of de‑identified claims/encounter data, creates civil penalties for noncompliance, changes ERISA fiduciary wording, and bars participant retaliation.
Official title: To amend the Employee Retirement Income Security Act of 1974 to increase transparency of group health plan data, prevent discrimination, and for other purposes.
Introduced June 25, 2026 by Mark Takano · Last progress June 25, 2026
Requires group health plan contracts with providers, networks, PBMs, TPAs and similar service vendors to allow plan access to de‑identified claims and encounter data for audits and price/compensation review, limits contractual barriers to such audits, and creates civil penalties for vendor noncompliance. It also amends an ERISA fiduciary-definition provision (changing statutory wording) and creates an ERISA anti‑retaliation/discrimination remedy for participants who exercise rights or disclose certain plan data, with daily civil penalties and expedited enforcement options.