Premium Transparency Act

Bill Number

H.R. 9397

Origin Chamber

House

Congress

119th Congress, Session 2

Policy Area

Health

Status

Introduced

Latest Action

2026-06-25: Forwarded by Subcommittee to Full Committee by Voice Vote.

Last Updated

2026-07-08T18:49:59Z

AI-Generated Summary

Premium Transparency Act (H.R. 9397)

Purpose

This legislation aims to increase transparency in health insurance by requiring issuers and Medicare Advantage organizations to publicly disclose detailed information on premium revenue allocation, overhead costs, and claim payments. It also promotes easier comparison of qualified health plans on Exchanges and directs the development of standardized, consumer-friendly information on plan benefits and costs.

Key Provisions

• Section 2 amends the Public Health Service Act to require health insurance issuers offering group or individual coverage (including grandfathered plans) to submit and publish, starting with plan years beginning January 1, 2027:
• Percentages of total premium revenue spent on medical loss ratio categories.
• Explanations of claim payment processes.
• Percentage of premium revenue retained by the issuer.
• Data must be published at the coverage level (and possibly in aggregate) in a consumer-friendly format.
• Section 2 also amends the Social Security Act to impose similar requirements on Medicare Advantage plans, including disclosure of total revenue, amounts spent on claims and non-claims costs, and differences between MLR numerator and denominator, effective for plan years beginning January 1, 2027.
• Section 3 amends the Affordable Care Act to require Exchange websites to display the most recent issuer-submitted information under the new transparency rules for qualified health plans, starting with enrollments for plan years beginning January 1, 2029.
• Section 4 directs the Secretary of Health and Human Services (in consultation with the Secretaries of Labor and the Treasury) to issue guidance by January 1, 2028, on presenting plan benefits and coverage information in a standardized, plain English format. This covers premiums, deductibles, out-of-pocket limits, provider networks, cost-sharing for various services, referral policies, wellness programs, and other specified features.

Significant Changes to Existing Law

• Expands existing medical loss ratio reporting under Section 2718 of the Public Health Service Act by adding mandatory public disclosure of overhead and retained revenue details.
• Introduces new public reporting obligations for Medicare Advantage organizations under Section 1857(e) of the Social Security Act.
• Enhances Exchange comparative information requirements under the Affordable Care Act by linking them to the new issuer data.
• Establishes federal guidance standards for plain-language plan summaries, without mandating specific plan features.

Potential Impacts

• On government agencies: Increases administrative responsibilities for the Department of Health and Human Services in receiving, reviewing, and specifying formats for disclosures; may require updates to Exchange systems by 2029.
• On citizens: Provides consumers with more detailed information on how premiums are used and plan features, potentially aiding informed decision-making, though no direct changes to coverage or costs are mandated.
• No direct effects on international relations are outlined in the legislation.

Main Stakeholders Affected

• Health insurance issuers offering group or individual coverage.
• Medicare Advantage organizations.
• Health insurance Exchanges and qualified health plans.
• The Secretary of Health and Human Services (and consulting departments).
• Consumers and enrollees seeking plan information.

Notable Legal, Constitutional, or Political Implications

• The bill relies on existing regulatory frameworks under the Public Health Service Act and Social Security Act, with no explicit constitutional challenges addressed in the text.
• It builds on prior Affordable Care Act transparency rules without altering core insurance mandates or federal-state divisions of authority.
• Implementation timelines (2027 for reporting, 2028 for guidance, 2029 for Exchange integration) allow phased compliance.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Rep. Pfluger, August [R-TX-11]

Cosponsors (1)

Rep. Moran, Nathaniel [R-TX-1]

Recent Actions

• 2026-06-25: Forwarded by Subcommittee to Full Committee by Voice Vote.
• 2026-06-25: Subcommittee Consideration and Mark-up Session Held
• 2026-06-23: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2026-06-23: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
• 2026-06-23: Referred to the Subcommittee on Health.
• 2026-06-23: Introduced in House
• 2026-06-23: Introduced in House

Bill Versions

• Premium Transparency Act — issued 2026-06-23 — PDF (10 pages)