A Democratic bill with 1 Democratic cosponsor · See the cosponsor
Last activity — Referred to the House Committee on Energy and Commerce.
In committee
Introduced and handed to a committee in the chamber it started in.
The committee holds it, and most bills are never heard from again. A hearing or a committee vote would be news; silence is the usual outcome, and it kills the bill without anyone voting against it.
Its path through Congress
- Introduced
- In Committee
What this bill would do
The Patient Refunds for Bad Denials Act of 2026 seeks to amend the Public Health Service Act to hold health insurance issuers accountable for high rates of denied claims. If an issuer's claims denial percentage reaches 25 percent or higher, the Secretary may impose a significant civil monetary penalty. These collected penalties are to be distributed to the individuals enrolled in those specific insurance plans. Additionally, the bill requires issuers to provide specific transparency regarding denied claims based on medical necessity. The Act also mandates that insurers report their annual claims denial rates to the Secretary.
Yes· 3 of 8
- Scored +7
Does this give people more protection from unfair business practices?
The bill increases accountability for insurance issuers by penalizing high rates of denied claims and requiring transparency.
- Scored +5
Does this strengthen the Affordable Care Act?
The bill strengthens consumer protections within the health insurance market regulated under the Public Health Service Act.
- Scored +5
Does this make what the government does easier for the public to see?
The bill mandates that insurance issuers report annual claims denial rates to the Secretary.
The opposite
No question was scored the opposite.
Who it would affect, and how
Potential Positive Impacts for People
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Financial Relief through Penalty Redistribution: The Secretary will distribute collected civil penalties to individuals enrolled in the affected insurance plans on a pro rata basis (Section 2, subsection a, part F, SEC. 2799C-1 (d)).
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Increased Transparency for Denied Claims: If a claim is denied because it was not deemed medically necessary, the issuer must provide the individual with their medical necessity standards and an explanation of why the service failed to meet them (Section 2, subsection b, SEC. 2730 (a)).
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Accountability for High Denial Rates: The bill allows the Secretary to penalize issuers with a claims denial percentage of 25 percent or greater, which could serve to reduce high rates of denials (Section 2, subsection a, part F, SEC. 2799C-1 (a)).
Potential Negative Impacts for People
- Burden of Proof on Fraud Claims: When an issuer claims a denial was due to fraud, they must provide sufficient information to the Secretary to demonstrate the claim was indeed fraudulent to avoid it being counted against their denial percentage (Section 2, subsection a, part F, SEC. 2799C-1 (b)(3)).
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Tap or hover a score for the reason it gave.
- Healthcare
- Does this strengthen the Affordable Care Act? — The bill strengthens consumer protections within the health insurance market regulated under the Public Health Service Act. Does this make health care easier to get in general? — By penalizing high denial rates and requiring explanations of medical necessity, the bill seeks to reduce barriers to covered services.
- Demographic And Interest Groups
- Would households on low incomes be better off under this? — The redistribution of penalties to plan enrollees may provide financial assistance to those on insurance plans. Would middle-income households be better off under this? — The bill provides financial recourse to individuals through the redistribution of insurance company penalties. Would people in cities be better off under this? — The bill benefits plan enrollees through the potential redistribution of collected civil penalties.
- Economy And Finance
- Does this give people more protection from unfair business practices? — The bill increases accountability for insurance issuers by penalizing high rates of denied claims and requiring transparency.
- Governance And Ideology
- Does this make what the government does easier for the public to see? — The bill mandates that insurance issuers report annual claims denial rates to the Secretary.
- Social Issues And Justice
- Is this likely to lift people out of poverty? — The bill provides a mechanism for distributing penalty funds back to insured individuals, which may provide modest financial relief.
- 4/22/2026
- Referred to the House Committee on Energy and Commerce.
- 1 Cosponsor added.
- Introduced in House
Patrick RyanDemocrat · New York