REPRESENTATIVES PAT RYAN, ANGIE CRAIG INTRODUCE LEGISLATION TO HOLD HEALTH INSURANCE COMPANIES ACCOUNTABLE FOR SKY-HIGH DENIAL RATES, REFUND PATIENTS FOR UNFAIR HEALTH CARE COSTS

The following information was released by the office of New York Rep. Pat Ryan:

The "Patient Refunds for Bad Denials Act" would create financial penalties for health insurers that deny more than 25% of claims/ year; the penalties would be paid directly back to affected patients

WASHINGTON, DC Today, U.S. Representatives Pat Ryan and Angie Craig (MN-02) introduced their new bill to hold health insurance companies accountable for above-average denial rates and refund patients for medical payments that should have been covered by insurance.

ThePatient Refunds for Bad Denials Actwould create financial penalties for health insurers that deny more than 25% of claims in a given year according to an annual audit by the Department of Health and Human Services (HHS). The penalty would total $10 million plus an additional $2 million for each percentage point above the 25% denial threshold. These penalties would be paid back to affected enrollees.

In plan year 2024, the in-network denial rate for qualified health plans (QHPs) sold on HealthCare.gov ranged from three percent to 36 percent, with significant variation by insurer and by state. According to aJanuary 2026 Kaiser Family Foundation (KFF) poll, two-thirds of insured adults believe delays and denials of health care services by health insurance companies are a "major problem" and one-third of insured adults say they have had a health insurance company deny coverage for a service or medication prescribed by their doctor in the past two years. Nearly 40 percent of participants who reported having trouble paying medical bills said that denied claims contributed to their medical debt.

"For too long, massive insurance companies have been allowed to exploit patients and deny coverage for life-saving care, all while raking in record-breaking profits. It's a fundamental abuse of their power," said Congressman Pat Ryan. "This legislation finally holds greedy insurance companies accountable, fining them for their wrongful claim denial rates and returning hard-earned money back to patients across the Hudson Valley. With the Patient Refunds for Bad Denials Act, we're making sure insurers can't keep lining their pockets at your expense because nobody should struggle to afford high quality care while billionaires in boardrooms get richer."

"Every Minnesotan knows someone who has been burdened by medical debt, despite being covered by insurance," said Rep. Craig. "That's because for too long, massive health insurance companies have been allowed to exploit patients while raking in record profits. That stops now. My bill with Rep. Ryan will finally penalize health insurers for sky-high denial rates and most importantly, it will put that money back into Minnesotans' pockets. It's time to hold Big Insurance accountable, and our legislation will do that."

Congressman Ryan has been a consistent advocate for patients screwed over by greedy insurance companies, leading the fight againstcost-raising healthcare consolidation in the Hudson Valley and introducing thePatients Over Profits Act.

As founding members of the Congressional Monopoly Busters Caucus, Reps. Craig and Ryan have worked together in Congress to take on corporate greed, lower health care costs and expand access to care for folks in rural communities.