S-1552-119
Placed on Senate Legislative Calendar under General Orders. Calendar No. 352.
Sponsored by Tom Cotton (R-AR)
What it does
This bill would prohibit life, disability, and long-term care insurance carriers from denying, canceling, varying premiums, or otherwise restricting coverage based solely on an individual's status as a living organ donor. It would also clarify that recovery from organ-donation surgery qualifies as a "serious health condition" under the Family and Medical Leave Act (FMLA), entitling eligible employees to job-protected leave. Additionally, the Department of Health and Human Services would be required to update its public educational materials on living organ donation to include information about donation benefits, risks, and the bill's new insurance protections.
Who benefits
Current and prospective living organ donors — approximately 6,000–7,000 people per year in the U.S. — who may currently face insurance penalties or denial. Organ transplant recipients who may benefit from a larger pool of willing donors. Employers and HR departments who would receive clearer federal guidance on FMLA obligations. Patients on organ transplant waiting lists (over 100,000 as of 2025), who could benefit if the bill encourages more people to donate. Advocacy organizations focused on organ donation awareness.
Who is hurt
Life, disability, and long-term care insurance carriers, who would lose the ability to price policies based on the actuarial risk associated with organ donation surgery and its potential long-term health effects on donors. Policyholders broadly, who may see modest premium increases if insurers spread the added actuarial risk across their customer base. Insurers' shareholders and investors. Small insurance carriers with limited ability to absorb new risk mandates may face disproportionate compliance costs.
Supporters argue
Supporters argue that living organ donors perform a profound act of generosity that saves lives, yet many face real-world insurance penalties — including higher premiums, policy cancellations, or outright denial — that discourage donation. They contend that the U.S. has over 100,000 people on transplant waiting lists and that removing financial disincentives could meaningfully expand the donor pool. They further argue that FMLA clarification is necessary because current law's ambiguity leaves donors without guaranteed job protection during recovery, creating an inequitable burden that falls hardest on lower-income workers who cannot afford to risk their employment.
Opponents argue
Opponents argue that prohibiting insurers from considering organ donation status removes actuarially relevant health information, since donors do face documented long-term risks — such as reduced kidney function after nephrectomy — that legitimately affect life and disability risk profiles. They contend that mandating coverage of these risks without actuarial adjustment shifts costs onto all policyholders through higher premiums, effectively subsidizing a personal choice made by a small number of individuals. They further argue that the FMLA expansion, while narrow, sets a precedent for legislatively broadening "serious health condition" definitions in ways that could complicate employer leave administration over time.
Constitutional context
Congress regulates insurance markets and employment conditions under the Commerce Clause (Art. I, §8, cl. 3). The bill's insurance mandates on private carriers follow the same Commerce Clause authority upheld broadly in NFIB v. Sebelius (2012) for regulating existing commercial activity. The FMLA amendment is a modification of existing federal statute, raising no novel constitutional issues. No active constitutional tension areas are implicated.
Checks and balances
Congress gains authority to regulate insurance carrier underwriting practices and expand FMLA definitions; HHS gains a new administrative mandate to update educational materials; state insurance regulators retain enforcement roles, and insurers may challenge specific provisions through administrative or judicial review.
Historical precedent
Several states, including New York and California, have enacted living donor anti-discrimination laws covering insurance, providing partial analogues, though no prior federal statute has addressed this specific issue comprehensively.