Health Insurance Transparency for Patients Act
- Sponsor
- Rep. Hinson, Ashley [R-IA-2]
- Committees
- Ways and Means Committee (primary)
- Last action
- Aug 3, 2026
Bottom line
This bill aims to increase transparency in health insurance coverage decisions by requiring detailed public reporting on claim and prior authorization denials and appeals, including the role of automated review processes.
What it actually does
This bill mandates that health insurance issuers and Medicare Advantage (MA) organizations publicly disclose detailed, de-identified information regarding coverage request denials, approvals, and appeals. It requires this data to be disaggregated by factors such as the reason for denial, the review process used (including automated or AI-driven methods), and the time taken for decisions. Additionally, it requires these entities to publish a list of all covered items and services subject to prior authorization.
Proponents argue
Supporters argue this bill will empower consumers with critical information, foster greater accountability among health insurers, and potentially reduce arbitrary denials by shedding light on current practices, especially those involving opaque or automated review processes. This transparency is expected to help patients make more informed choices and advocate for their care.
Opponents contend
Opponents might contend that the extensive reporting requirements impose significant administrative burdens and costs on health insurance issuers and MA organizations. They may argue that these costs could ultimately be passed on to consumers through higher premiums, without a clear demonstration that the highly granular data will provide meaningful, actionable insights for the average consumer.
The bill is short and clearly written, making it accessible for a quick read and understanding of its core provisions within the time typically allotted for legislative review.
Section 2(a) (amending Public Health Service Act) and Section 2(b) (amending Social Security Act)
Mandated Public Disclosure of Coverage Request Data
This provision requires health insurance companies and Medicare Advantage (MA) plans to annually publish detailed, de-identified information about their coverage decisions. This includes the percentage and number of initial denials and approvals, as well as appeals and their reversals. The data must be disaggregated by the type of request, reason for denial, the review process used (e.g., automated, algorithmic, individual), the time taken for decisions, and whether an appeal was expedited. This information must be made publicly available on the issuer's website and submitted to the Secretary of HHS, who will also publish it.
Supporters argue
Supporters argue this transparency will empower patients to make informed decisions about their health plans, hold insurers accountable for denial practices, and potentially reduce the use of opaque or automated denial processes that may unfairly deny care. It aims to foster a more equitable and understandable healthcare system.
Critics contend
Critics may argue that the extensive disaggregation requirements are overly burdensome and costly for insurers, potentially leading to increased operational expenses that could be passed on to consumers through higher premiums. They might also claim that de-identified data, even when disaggregated, may not provide sufficient context for meaningful insights without further analysis.
Tradeoffs
The bill balances the public's right to information and insurer accountability against the administrative costs and potential complexity of collecting and publishing highly granular data across diverse health plans. There is a tension between the desire for comprehensive data and the practicalities of its collection and presentation.
Section 2(a)(1)(2) and Section 2(b)(7)(A)(ii)
Public List of Prior Authorization Requirements
This provision requires health insurance issuers and MA organizations to make publicly available a comprehensive list of all covered items or services that are subject to prior authorization. This aims to provide clear, upfront information to consumers and healthcare providers about which specific medical services or items require pre-approval from the insurer before they can be covered.