H.R. 9228, Healthcare Pricing Transparency & Data Access. Quorum's AI analysis reads it as a net benefit — and names who gains.
H.R. 9228 · Net good
What it does
This bill requires health insurance plans and their service providers (insurers, pharmacy benefit managers, third-party administrators, and networks) to give plan sponsors and fiduciaries immediate, unrestricted access to all claims data, pricing formulas, payment terms, and audit information. It bans 'gag clauses' that hide pricing or delay data access beyond 15 days, sets a $10,000-per-day penalty for violations, and voids any contract term that blocks this access.
The analysis names large employers and plan sponsors (via cost control and audit leverage) — and 2 more groups — among the beneficiaries.
The trade-off
Plan sponsors and fiduciaries gain leverage to audit and challenge claims in real time, potentially reducing payments to providers and PBMs — this may cascade into lower reimbursement rates across the market.
Transparency scores 75%, with a medium warning level and no provisions unrelated to the bill's subject.
Who is behind it
Filed by Robert Onder. Cosponsored by Diana Harshbarger and Victoria Spartz.