Congress forces health insurers to show their math on what they pay doctors
H.R. 9228 — Health Data Access, Transparency, and Affordability Act of 2026 · Filed by Robert Onder (R-MO) · 2 cosponsors · Introduced Jun 9, 2026 · Reported out
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What it does
This bill amends ERISA to require health plan fiduciaries (the people managing retirement and group health plans) to have access to detailed claims data, pricing information, and payment methodologies from insurers, pharmacy benefit managers, and other network service providers. Plans can now demand this data within 15 days, audit providers, and challenge erroneous payments—and providers cannot charge fees for providing it or hide pricing formulas. Violations carry civil penalties up to $10,000 per day, and any contract clause blocking this access is void.
Why we flagged it
The bill's core mechanism is a transparency mandate: it strips away contractual gag clauses and forces network service providers to disclose claims data, pricing formulas, and payment methodologies to plan fiduciaries. This is fundamentally about shifting information asymmetry and enforcement power toward plan sponsors and away from opaque intermediaries.
What the text implies
- Plan fiduciaries may use disclosed pricing data to benchmark and renegotiate rates with competing providers, potentially shifting negotiating leverage away from consolidated insurers and PBMs toward large employers and union plans.
- De-identified data disclosure (permitted under the bill) could enable plans to identify patterns of overpayment or fraud across the network, creating pressure on providers to justify pricing and potentially reducing provider margins.
The full analysis lists 5 implications of this text.
Who stands to gain
large self-insured employers and plan sponsors (reduced administrative opacity, better negotiating l; union health plans and multiemployer plans (enhanced fiduciary oversight and cost-control tools); plan auditors and consultants (increased demand for claims analysis and benchmarking services)