HR-9644-119
Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 42 - 0.
Sponsored by Nathaniel Moran (R-TX)
What it does
This bill would require Medicare Advantage organizations, starting with plan years beginning in 2029, to submit to the Secretary of Health and Human Services and publish on their websites detailed financial data for each plan, including total revenue, amounts and percentages spent on claims versus non-claims (overhead) costs, and the medical loss ratio calculation. It would also require electronic plan comparison information to eventually follow the same uniform format used by group health plans and insurers under existing law.
Who benefits
Medicare Advantage enrollees and prospective enrollees (over 30 million people) who would gain access to standardized cost and spending data to compare plans; consumer advocacy groups and researchers studying Medicare Advantage spending; CMS in its oversight role; and potentially lower-overhead plans that could use transparency to compete for enrollees.
Who is hurt
Medicare Advantage organizations, especially those with higher administrative or overhead costs, would face new compliance and reporting burdens and potential competitive or reputational exposure. Plans may pass compliance costs to enrollees through premiums, and organizations may need new administrative systems to track and publish this data in the specified format.
Supporters argue
Supporters argue that Medicare Advantage plans currently lack the transparency required of other insurance markets, making it difficult for the roughly 30 million enrollees to compare how much of their premium dollars go to actual medical care versus administrative overhead and profit. They contend that standardized public reporting, similar to medical loss ratio disclosures already required elsewhere in the insurance market, would help beneficiaries make informed choices and give regulators better tools to identify outlier plans.
Opponents argue
Opponents argue that the new reporting requirements would impose significant administrative costs on Medicare Advantage organizations, particularly smaller or regional plans, which could be passed on to enrollees through higher premiums or reduced benefits. They contend that plan-level reporting in a "consumer-friendly format" specified by the Secretary gives HHS broad discretion over disclosure requirements without clear statutory limits, and that the data disclosed may be difficult for average consumers to meaningfully interpret despite the stated transparency goal.
Constitutional context
Congress has broad authority under the Spending Clause to attach reporting conditions to participation in the Medicare Advantage program, which is a federally funded system that private insurers voluntarily join by contract. Because compliance is a condition of a voluntary federal contract rather than a mandate on the general public, this bill does not raise the Commerce Clause concerns addressed in NFIB v. Sebelius.
Checks and balances
Congress directs the reporting requirement by statute while delegating implementation details, including the "consumer-friendly format," to the HHS Secretary, whose resulting regulations would be subject to post-Loper Bright judicial review for reasonable interpretation of the statute rather than automatic deference.
Historical precedent
The Affordable Care Act's medical loss ratio requirements for private insurers established a similar model of mandated public disclosure of the share of premiums spent on medical claims versus administrative costs.