Hinson introduces bill requiring insurers to disclose healthcare claim denial data
WASHINGTON —
Patients could soon get a clearer picture of how often health insurance companies deny coverage under legislation introduced Tuesday by U.S. Rep. Ashley Hinson, R-Iowa.
The Republican congresswoman introduced the Health Insurance Transparency for Patients Act, which would require health insurers to publicly report how often they deny coverage requests, how long patients wait for decisions, how often denials are overturned on appeal and which treatments require prior authorization. The proposal would also require that information to be published in a consumer-friendly format, allowing patients and employers to compare health plans.
Hinson said the goal is to make insurers more accountable by bringing greater transparency to the coverage approval process.
Q&A: Rep. Ashley Hinson on the Health Insurance Transparency for Patients Act
Q: Where did the idea for this bill come from?
Hinson: “I’ve actually been traveling across the state, visiting with hospitals and also meeting with patients who are, frankly, very frustrated with our big health insurance companies. And they know they’ve been playing games with health coverage. We’ve heard stories of insurance companies that are purposely finding ways to delay care by denying a claim based on a technicality in many cases. And then they’re getting away with it right now because nobody can really see what they’re doing.”
Q: Why focus on transparency instead of changing how insurers make coverage decisions?
Hinson: “I think that just providing some actual accountability here is all we really need. I think that there’s nothing like a little sunshine to fix a problem. And I think the health insurance companies, when they’re actually forced to put out data on how many claims they’re denying and why… actually having some of the statistics out there publicly, I think will do a lot to make sure that, number one, the accountability is there. And number two, that patients are not as frustrated.”
Q: How would patients benefit from seeing this information?
Hinson: “You should be able to see, as a patient, when you’re making that choice for what health care plan you’re choosing, which of these companies are good actors and which are bad actors.”
Q: Many people don’t choose their insurer because they receive coverage through their employer. How does this help them?
Hinson: “I think it benefits employers as they’re making decisions on what benefits to provide to their employees… they can say, ‘I want the best benefits possible. It’s a recruitment tool for them as employers to say, ‘Hey, I provide really great health care coverage for you, and we know we’re doing business with a good company, and you’re going to get the care you need and deserve.'”
Q: If the reporting eventually shows insurers are routinely denying medically necessary care, what’s next?
Hinson: “If the data is showing us that, yes, we do have insurer A who is using this as a business practice, strategically denying claims as a part of their bottom line and to protect their bottom line, then number one, I think we may need to look at a legislative solution. And at the very least, we may need to call them before Congress to answer some very tough questions, to explain themselves.”
Q: You’re running for Senate, so your time in the House is limited. Where does this bill fit among your remaining priorities?
Hinson: “I’ve been able to deliver for Iowans on health care investment in my congressional district, making sure we’re providing for infrastructure investment and, of course, helping solve problems just like this one with health care and the cost of health care. So this is top of the list. I hear from Iowans every single day that we need to do more to help make life more affordable and easier. So this is, again, a common-sense solution that I think could help solve that problem for a lot of people.”
Democrats criticize Hinson’s healthcare record
The proposal comes as healthcare has become a central issue in Iowa’s U.S. Senate race, where Hinson is facing Democrat and former Iowa congressman Josh Turek.
Healthcare has been a cornerstone of Turek’s Senate campaign, with an emphasis on protecting Medicaid coverage and expanding access to care.
Democrats have criticized Hinson’s support for the federal budget law approved earlier this year, arguing changes to Medicaid could make healthcare less affordable and reduce access to care, particularly in rural communities.
Josh Turek’s campaign responded to Hinson’s proposal, saying:
“Ashley Hinson voted to raise healthcare costs, kick Iowans off their insurance, jeopardize rural health facilities, and make it more expensive to see a doctor — all so she could give tax breaks to her billionaire donors. Josh Turek first ran for office after seeing firsthand the devastating impact of Iowa’s privatization of Medicaid, including a 1,000% increase in denial rates for necessary care, and has fought tirelessly to hold insurance companies accountable for denying care. As Iowa’s next U.S. Senator, Josh will take on Hinson’s corporate donors so that doctors decide care, not insurance companies.”
Hinson has roughly 12 weeks remaining in the current House session before her term ends in January. The legislation would need to advance through committee and pass both the House and Senate before it could become law.