REP. SUMMER LEE JOINS EDUCATION AND WORKFORCE DEMS IN INTRODUCING BILLS TO PROTECT AMERICANS FROM WRONGFUL HEALTH CLAIM DENIALS

The following information was released by the office of Pennsylvania Rep. Summer Lee:

Today,Congresswoman Summer L. Lee (PA-12) alongside House Committee on Education and Workforce Democrats, introduced legislation to protect workers and families from wrongful health insurance claim denials and hold insurers accountable when they deny consumers a fair opportunity to appeal.

Congresswoman Lee'sConsumer Appeal Rights Enforcement Act would give the Department of Labor the authority to impose civil monetary penalties against insurance companies, health plans, and other entities that violate federal requirements governing the review and appeal of denied health claims.

The legislation would strengthen enforcement of the full and fair review and internal appeal protections established under the Employee Retirement Income Security Act and the Affordable Care Act's external review requirements.

"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."

Congresswoman Lee introduced the legislation alongside Committee on Education and Workforce Democratic colleagues as part of a four-bill package designed to strengthen transparency, oversight, accountability, and consumer assistance for workers and families facing wrongful health claim denials.

The package follows Committee Democrats' recent report,Denied: 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," said Committee 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."

The Consumer Health Claim Assistance Act, Health Claim Denial Transparency Act, Consumer Appeal Rights Enforcement Act, and CLINIC Assistance Act directly 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.

Congresswoman Lee has made health care affordability, access, and corporate accountability central to her work in Congress. She haspressed pharmacy benefit manager executives over practices that increase prescription drug costs for patients,challenged nonprofit hospital monopolies over their impact on workers, patients, and taxpayers, andconvened federal health officials and community advocates to address rising health care costs for Western Pennsylvania seniors.

Lee has alsofought to protect Affordable Care Act premium tax credits and continues to advocate forMedicare for All and a health care system that guarantees coverage regardless of a person's employment, income, immigration status, or medical history. The Consumer Appeal Rights Enforcement Act builds on that work by ensuring insurers and health plans can face meaningful consequences when they violate federal protections governing patients' reviews and appeals.

Congresswoman Summer Lee serves on the House Committee on Judiciary and the Committee on Education and Workforce. Since taking office in January 2023, she has delivered historic levels of federal investment totaling over $2.7 Billion brought back to Western PA, including over $580 million for infrastructure, over $110 million for affordable transit, over $500 million to keep clean energy manufacturing at home in Pennsylvania, and over $55 million on clean energy efforts in and around schools to help keep our kids and communities safe. These investments will help improve Western Pennsylvania's infrastructure and transit, ensure cleaner air and drinking water, lower housing costs, fund research institutions, fuel clean manufacturing, fund STEM innovation and entrepreneurship, boost workforce development, and create thousands of good paying union jobs. Lee and her team have also delivered casework and constituent services to over 4,000 constituents with issues ranging from helping our seniors and disabled community access Medicare and social security to helping folks secure housing and helping families with immigration support and passports.