H.R. 9107: Patient Choice and Access Act of 2026

This bill, titled the Patient Choice and Access Act of 2026, proposes changes to the Patient Protection and Affordable Care Act (ACA) regarding health insurance plan requirements. Below are the key points of what the bill would do:

1. Removal of Provider Network Requirement

The bill amends the ACA to state that qualified health plans will not be required to maintain a provider network starting from January 1, 2027. Traditionally, health plans must have a specific network of providers that enrollees can use. This change would allow health plans to operate without being tied to a specific list of providers.

2. Exchange Certification Amendment

The certification process for health plans that are sold in exchanges (the online marketplaces for insurance) will also be modified. Plans can be certified even if they do not have a provider network, effective from the same date of January 1, 2027. This aims to expand the types of plans available to consumers, including those that may operate on a more flexible basis without a preset network.

3. Transparency Requirements

For health plans that do not maintain a provider network, the bill introduces new transparency requirements. Starting January 1, 2027, these plans will have to:

• Provide clear, easy-to-understand information to enrollees about expected out-of-pocket costs and the risk of balance billing (where a patient is billed for the difference between what the insurer paid and what the provider charges).
• Offer adequate customer service and tools to help enrollees find providers who will accept the plan's payment levels as full payment for items and services.

This aims to ensure that individuals have access to relevant information to make informed decisions about their healthcare options.

4. Overall Impact

The bill aims to enhance consumer choice and access in the healthcare market by eliminating mandatory provider networks and promoting different types of health plans. This could lead to increased competition among insurers and potentially lower costs for consumers, though it also raises considerations about the availability of care and provider accessibility.

Relevant Companies

• AET (Aetna) - As a major health insurance provider, Aetna could be significantly impacted by the removal of mandatory provider networks, as this may change how they structure their plans and manage provider relationships.
• UNH (UnitedHealth Group) - UnitedHealth Group may need to adjust its offerings to comply with new regulations regarding network requirements, potentially reshaping its strategy and competitive position.
• CNC (Centene Corporation) - Centene, which often operates in Medicaid and Managed Care markets, might see shifts in how it designs its plans in response to the legislation.