CONGRESSMAN DESAULNIER INTRODUCES BILL TO PROTECT WORKERS FROM WRONGFUL HEALTH CLAIM DENIALS

The following information was released by the office of California Rep. Mark DeSaulnier:

Today, Subcommittee on Health, Employment, Labor, and Pensions (HELP) Ranking Member Mark DeSaulnier (CA-10), and Committee on Education and Workforce Members Rep. Joe Courtney (CT-02), Rep. Lucy McBath (GA-06), and Rep. Summer Lee (PA-12), introduced a series of bills designed to protect consumers from wrongful health claim denials by health insurers and group health plans.

The legislation follows the Committee Democrats' recent report, titledDenied: How the Health Care Industry Stacks the Deck Against Working Families,which examined the growing problem of wrongful health claim denials and the consequences for workers and their families.

Health insurance is, fundamentally, a promise between consumers and their health plan,"saidCommittee on Education and Workforce Ranking Member Robert C. "Bobby" Scott (VA-03)."When working people do their part by paying thousands of dollars every year for coverage they expect their plan to cover the care they need. Too often, insurers break that promise by denying legitimate claims and shifting costs onto families who can least afford it."

TheConsumer Health Claim Assistance Act, Health Claim Denial Transparency Act,Consumer Appeal Rights Enforcement Act,andCLINIC Assistance Actdirectly respond to the report's call for stronger transparency, oversight, and accountability to ensure insurance companies and health plans honor the coverage they promise and that families can access and afford the care they need.

TheConsumer Health Claim Assistance Act,introduced byHELP Subcommittee Ranking Member DeSaulnier, establishes a program within the Employee Benefits Security Administration (EBSA) within the Department of Labor (DOL) to support consumers whose health claims are wrongfully denied. The bill directly addresses budgetary and staffing issues at EBSA by establishing a dedicated funding stream to support the program through an annual fee that will be paid by certain plans.

"Americans' ability to access quality, affordable healthcare is being undermined by corporate greed and improper denials of legitimate medical claims,"said HELP Ranking Member DeSaulnier."I am proud to introduce the Consumer Health Claim Assistance Act that would help ensure the agency responsible for overseeing employer-sponsored health insurance is well equipped to assist consumers. It is past time we take decisive action to put the American people above profits."

TheHealth Claim Denial Transparency Act,introduced by Rep. McBath, sheds light on claim denial rates by forcing the Trump Administration's DOL to implement a longstanding requirement of theAffordable Care Act(ACA) and recommendation from the DOL Office of the Inspector General for health plans to disclose how many claims for benefits they deny each year, as well as the number of claims subject to prior authorization and the use of artificial intelligence.

"For too long, insurance companies have been able to deny claims behind closed doors. They have had no obligation to tell patients or regulators how often it happens or why,"said Rep. McBath."The Health Claim Denial Transparency Act requires health plans to finally disclose their rates and explain more of their reasoning. The Affordable Care Act has required this kind of disclosure for years, but the Department of Labor has never enforced it. Families deserve to know that the health insurance that they pay into is actually working on their behalf."

TheConsumer Appeal Rights Enforcement Act,introduced by Rep. Lee, gives DOL the ability to impose civil monetary penalties to hold insurance companies, plans, and other actors accountable for violations of the full and fair review and internal appeal requirements of theEmployee Retirement Income Security Act(ERISA) and the ACA's external review requirement.

"Families pay thousands of dollars every year for health insurance with the expectation that it will be there when they need it. But instead, too many people are forced to fight through confusing appeals, endless paperwork, and corporate bureaucracy while they are sick, injured, or caring for someone they love,"said Rep. Lee. "Insurance companies should not be able to wrongfully deny care and then face no consequences for violating patients' rights. This legislation gives the Department of Labor the power to hold bad actors accountable and makes clear that denying working people a fair appeal is not simply the cost of doing business."

TheCLINIC Assistance Act,introduced by Rep. Courtney, will supplement the DOL's work and help rebuild access to consumer assistance by establishing a grant program through which the Secretary of Labor can provide funding to law schools to create programs to assist consumers whose benefits have been denied by health insurers and employee welfare benefit plans, directly helping working people and training a new generation of consumer advocates.

"One of the disturbing trends in health care is the rising number of claim denials that patients seeking urgently needed medically necessary treatment are left with,"said Rep. Courtney."By establishing a federal grant program through the Department of Labor to support law clinics that specialize in navigating the complex insurance appeals process, we can provide American patients, at no expense, with the expertise and people on their side when they're wrongfully denied coverage."

Background

On June 18, 2024, HELP Subcommittee Ranking MemberDeSaulnier and Full Committee Ranking Member Scotturgedthe Department of Labor to improve transparency for consumers afteralarming reportsof widespread denials of benefits by employment-based health plans. These plans cover more than 130 million Americans and are subject to important consumer protections under ERISA.

On November 18, 2025, Ranking MembersDeSaulnier and Scott ledHouse health leaders inurgingthe Trump Administration to tackle wrongful claim denials by group health plans and insurance companies and secure coverage for working people under ERISAthe largest source of health insurance in the U.S.

On April 8, 2026, Education and Workforce Committee Democratsreleaseda Committee report titled "Denied: How the Health Care Industry Stacks the Deck Against Working Families," examining the growing problem of wrongful health claim denials and the consequences for workers and their families.