Health‑plan transparency bill advances after privacy fight over employer access to claims data

Chair introduced HR9228, the Health Data Access, Transparency, and Affordability Act, saying the bill would ensure employer‑sponsored plan fiduciaries can access claims, encounter and payment data and supporting documentation to audit network service providers and detect improper payments.

Sponsor testimony argued plan fiduciaries currently face obstacles — for example, edited reports rather than raw claims — that hide pricing spreads and lead to higher costs for employers and participants. "Bringing these prices into the light is the right thing to do for patients and it is the right thing to do for small business and the employees themselves paying for coverage," the sponsor said.

Opponents warned the bill, as drafted, could be read to permit employer access to sensitive personal medical records unless the language is tightened to require robust deidentification consistent with HIPAA and to limit access to audit purposes by fiduciaries only. Representative Takano offered an amendment to clarify the bill would limit data access to purpose‑bound fiduciary audits and add safeguards for privacy and cyber security; that amendment was not adopted in the recorded vote.

Process and enforcement: The bill includes enforcement mechanisms and attestation requirements for vendors and service providers, and it builds on earlier bipartisan work to limit contractual gag clauses. However, committee debate revealed disagreement over timing, format and the scope of required data, and whether the measure duplicates existing surveys or reporting mechanisms.

What’s next: HR9228 was advanced by the committee and reported to the House; floor consideration is likely to prompt further amendments seeking to narrow or clarify the privacy and audit provisions.