HR-9228-119
Ordered to be Reported (Amended) by the Yeas and Nays: 18 - 15.
Sponsored by Robert Onder (R-MO)
What it does
This bill would amend the Employee Retirement Income Security Act (ERISA) to require that any contract between an employer-sponsored group health plan and a service provider — such as a third-party administrator, insurer, or pharmacy benefit manager — give plan fiduciaries full access to claims and encounter data, pricing terms, fee disclosures, and audit rights. It would void any existing contract provisions that restrict or delay that access, require annual compliance attestations, and allow the Department of Labor to impose civil penalties of up to $10,000 per day on service providers that violate these requirements. The bill would take effect one year after enactment and would apply to all plan years beginning on or after that date.
Who benefits
Employers who sponsor group health plans and would gain visibility into how their health spending is managed. Plan fiduciaries (HR administrators, benefits managers, trustees) who would have clearer legal standing to audit and challenge claims. Employees covered by employer-sponsored plans who may benefit if employers use the data to reduce costs or identify billing errors and fraud. Independent auditors and health data analytics firms that would gain a new market for plan-level data review services. Smaller employers who currently lack the negotiating leverage to demand data access from large insurers and third-party administrators.
Who is hurt
Third-party administrators (TPAs), pharmacy benefit managers (PBMs), and health insurers who currently use contractual "gag clauses" to restrict data access and who would face new compliance costs and civil penalty exposure. Network service providers whose pricing arrangements, fee structures, and payment methodologies would become visible to plan sponsors. Insurers and PBMs that profit from opaque pricing and repricing arrangements that could be challenged once disclosed. Potentially, healthcare providers whose negotiated rates with insurers could become more visible to plan sponsors, creating indirect pricing pressure.
Supporters argue
Supporters argue that employer plan sponsors have a fiduciary duty to act in plan members' best interests but are routinely blocked from seeing the very data needed to fulfill that duty — including how claims are priced, what fees are charged, and whether overpayments occurred. They contend that "gag clauses" in TPA and insurer contracts have allowed billions of dollars in hidden fees and billing errors to go unchallenged, citing the Consolidated Appropriations Act of 2021, which banned gag clauses but lacked enforcement teeth. This bill, they argue, adds the specific data standards, timelines, and civil penalties necessary to make that prohibition meaningful and to drive down costs through transparency.
Opponents argue
Opponents argue that mandating broad disclosure of proprietary pricing formulas, network contract terms, and payment methodologies could undermine the competitive negotiations that insurers and PBMs use to secure discounted rates from providers — ultimately raising costs for plans and their members. They contend that the bill's daily civil penalty structure and broad definition of "network service provider" could expose entities to significant liability for technical or administrative delays, and that the 15-day data delivery window may be operationally unworkable for complex claims systems. Critics also argue that existing HIPAA and ERISA frameworks already provide fiduciaries with meaningful oversight tools, making the additional regulatory layer duplicative and burdensome.
Constitutional context
Congress regulates employer-sponsored health plans under ERISA through its Commerce Clause authority (Art. I, §8, cl. 3). ERISA's broad preemption of state insurance regulation is well-established, and this bill operates squarely within that framework. Post-Loper Bright (2024), the rulemaking authority delegated to the Secretary of Labor to set data standards and timelines would face independent judicial scrutiny rather than automatic deference, meaning courts would assess whether the statutory language clearly authorizes specific agency rules.
Checks and balances
The executive branch (Department of Labor) gains new enforcement and rulemaking authority; checks include notice-and-comment rulemaking requirements under the APA, judicial review of agency rules under the post-Loper Bright independent judgment standard, and civil penalty challenges through ERISA's existing enforcement framework.
Historical precedent
The Consolidated Appropriations Act of 2021 (CAA) included a prohibition on gag clauses in group health plan contracts and required annual attestations of compliance, making this bill a direct enforcement expansion of that existing statutory framework.