Sponsors (6)
The bill increases transparency and speeds some care decisions—helping consumers, regulators, and researchers—at the cost of added administrative, privacy, and legal burdens that may raise costs and disproportionately strain smaller insurers.
Consumers (including people with chronic conditions, Medicaid beneficiaries, and uninsured individuals) gain clearer, standardized, machine-readable information about plan processing times, denial rates, reasons for denial, and up-to-date plan details on Exchanges, making it easier to compare plans and choose appropriate coverage.
Patients with urgent or time-sensitive needs see faster decision-making because the bill establishes timeliness and expedited review standards for urgent requests, reducing delays in necessary care.
State governments, Exchanges, regulators, and researchers get standardized public reporting (including denial rates and appeal outcomes), improving oversight, enabling identification of problematic plan behavior, and targeting enforcement or policy responses.
Health insurers and issuers must bear new administrative and IT costs to collect, standardize, and publish detailed metrics and to submit data to Exchanges, costs that could be passed to consumers as higher premiums or borne by taxpayers.
Smaller insurers and small employers may face disproportionate compliance burdens from the reporting requirements, creating operational challenges and increasing the risk of market consolidation that could reduce competition.
Publishing more granular, plan-level data risks exposing patient information or proprietary insurer information if de-identification and aggregation protections are insufficient, potentially harming patient privacy or revealing competitive business data.
Based on analysis of 3 sections of legislative text.
Requires health plans to collect, publish, and submit detailed prior authorization and denial metrics to HHS and Exchanges; Exchanges must display issuer data for renewing plans starting 2029.
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 that use prior authorization to collect, publish, and submit detailed prior authorization metrics and denial rates to federal regulators and, when applicable, the relevant ACA Exchange. Sets timelines, data elements to report (approval/denial counts, appeals, decision times, AI use, lists of services subject to prior authorization), and enforcement provisions. Directs ACA Exchanges to include issuer-submitted prior authorization data for renewing qualified health plans on their comparison pages beginning with plan years starting January 1, 2029. Implements phased compliance dates: data collection and reporting start for plan years beginning January 1, 2027, and Exchange display begins for plan years beginning January 1, 2029.