Sponsor
Craig A. Goldman
Representative · R-TX
Representative · R-TX
The bill increases transparency and speeds urgent coverage decisions for patients and improves consumers' ability to compare plans, but it imposes reporting burdens and costs that may raise premiums, strain small market participants, and create privacy and legal risks.
Patients (especially those with chronic conditions), Medicaid beneficiaries, and uninsured people will get clearer, faster coverage decisions because plans must report average processing times, approval/denial rates and reasons, and the bill requires timeliness and expedited review standards that should speed urgent decisions.
Consumers shopping on Exchanges (and advocates/taxpayers who analyze markets) will have standardized, machine-readable, issuer-submitted plan information (including up-to-date plan data starting 2029), making it much easier to compare plans and choose coverage that fits their needs.
State governments, regulators, and researchers will gain consistent public reporting of denial rates and appeal outcomes, improving oversight, enabling identification of problematic plan behavior, and helping target enforcement or policy fixes.
Health plans and issuers will incur meaningful administrative and IT costs to collect, standardize, and publish the required metrics, costs that could be passed to consumers as higher premiums or absorbed by taxpayers.
Publishing more granular, plan-level data risks exposing patient or proprietary information if de-identification or aggregation safeguards are insufficient, creating privacy and competitive harms for affected parties.
Smaller employers and insurers may struggle with the reporting burden and compliance costs, which could strain small-market participants and create pressure toward market consolidation.
Based on analysis of 3 sections of legislative text.
Requires health plans to collect, report, and publicly post detailed prior authorization metrics and requires Exchanges to display issuer-submitted prior authorization data for renewing plans.
Official title: To amend title XXVII of the Public Health Service Act, the Employee Retirement Income Security Act of 1974, and the Internal Revenue Code of 1986 to require the displaying of claim denial rates.
Introduced June 23, 2026 by Craig A. Goldman · Last progress June 23, 2026
Requires group and individual health plans subject to the Public Health Service Act (title XXVII) to collect, report, and publicly post detailed prior authorization metrics and denial information, and sets timing, appeals, and transparency standards. Exchanges must display issuer-submitted prior authorization data for renewing qualified health plans beginning with plan years on or after January 1, 2029. Reporting obligations for plans start for plan years beginning on or after January 1, 2027.