Stop Deadly Denials Act
What happened
- Representatives Pramila Jayapal and Ro Khanna introduced legislation to ban prior authorization in Medicare Advantage programs. - The bill, called the “Stop Deadly Denials Act,” was announced April 22, 2026. - The proposal reframes prior authorization as a patient-safety problem and raises pressure on payer practices. (jayapal.house.gov)
Why it matters
House Democrats moved to outlaw most prior authorization in Medicare Advantage on April 22, with a bill that would bar insurers from demanding advance approval for many covered services. (jayapal.house.gov) Representatives Pramila Jayapal of Washington and Ro Khanna of California introduced the Stop Deadly Denials Act of 2026 in the House on Wednesday. The bill text says the ban would apply for plan years beginning on or after January 1, 2027. (jayapal.house.gov; khanna.house.gov) The proposal targets Medicare Advantage, the privately run version of Medicare, where insurers now use prior authorization to approve or block some care before it happens. The bill text carves out exceptions for services that Congress or Medicare law already subjects to prior authorization, and it does not apply to Part D prescription drugs or supplemental benefits. (khanna.house.gov) Prior authorization has become routine in the program. KFF reported in January that 99% of Medicare Advantage enrollees are in plans that require prior authorization for at least some services, most often higher-cost care such as inpatient hospital stays, skilled nursing facility stays, and chemotherapy. (kff.org) The scale is large and growing. KFF said Medicare Advantage insurers received nearly 53 million prior authorization requests in 2024, up from 49.8 million in 2023, and denied 4.1 million of them, or 7.7%. (kff.org) Few denials are formally challenged. KFF said only 11.5% of denied requests were appealed in 2024, but 80.7% of the appeals that were filed were overturned, a pattern that has fueled scrutiny from lawmakers and patient advocates. (kff.org) Federal investigators have already documented cases where the process blocked care that should have been covered. A 2022 Department of Health and Human Services inspector general report found that some Medicare Advantage organizations denied prior authorization requests that met Medicare coverage rules, including requests for MRIs and post-acute rehabilitation stays. (oig.hhs.gov) The bill goes further than the Biden-era regulatory changes CMS finalized in April 2023. Those rules tightened how Medicare Advantage plans can use prior authorization and said the agency was acting after “numerous inquiries” about delays in access to medically necessary care, but they did not ban the practice. (cms.gov) Insurers and their trade groups have argued for narrower changes instead of a ban. AHIP said this month that plans have made voluntary commitments with the Department of Health and Human Services and CMS to simplify prior authorization and reported an 11% reduction in requirements since June 2025 across participating plans. (ahip.org; beckershospitalreview.com) The measure now heads into the committee process in a Congress where Medicare Advantage oversight has drawn bipartisan attention but major health legislation still faces steep odds. For now, the bill puts a sharper question before Washington: whether delays in approval are a paperwork problem or a barrier to care. (khanna.house.gov; kff.org)
Key numbers
- The bill, called the “Stop Deadly Denials Act,” was announced April 22, 2026.
- (jayapal.house.gov) House Democrats moved to outlaw most prior authorization in Medicare Advantage on April 22, with a bill that would bar insurers from demanding advance approval for many covered services.
- (jayapal.house.gov) Representatives Pramila Jayapal of Washington and Ro Khanna of California introduced the Stop Deadly Denials Act of 2026 in the House on Wednesday.
- The bill text says the ban would apply for plan years beginning on or after January 1, 2027.
What happens next
- The bill text says the ban would apply for plan years beginning on or after January 1, 2027.
- (jayapal.house.gov; khanna.house.gov) The proposal targets Medicare Advantage, the privately run version of Medicare, where insurers now use prior authorization to approve or block some care before it happens.
- KFF reported in January that 99% of Medicare Advantage enrollees are in plans that require prior authorization for at least some services, most often higher-cost care such as inpatient hospital stays, skilled nursing facility stays, and chemotherapy.
Quick answers
What happened in Stop Deadly Denials Act?
Representatives Pramila Jayapal and Ro Khanna introduced legislation to ban prior authorization in Medicare Advantage programs. The bill, called the “Stop Deadly Denials Act,” was announced April 22, 2026. The proposal reframes prior authorization as a patient-safety problem and raises pressure on payer practices. (jayapal.house.gov)
Why does Stop Deadly Denials Act matter?
House Democrats moved to outlaw most prior authorization in Medicare Advantage on April 22, with a bill that would bar insurers from demanding advance approval for many covered services. (jayapal.house.gov) Representatives Pramila Jayapal of Washington and Ro Khanna of California introduced the Stop Deadly Denials Act of 2026 in the House on Wednesday. The bill text says the ban would apply for plan years beginning on or after January 1, 2027. (jayapal.house.gov; khanna.house.gov) The proposal targets Medicare Advantage, the privately run version of Medicare, where insurers now use prior authorization to approve or block some care before it happens. The bill text carves out exceptions for services that Congress or Medicare law already subjects to prior authorization, and it does not apply to Part D prescription drugs or supplemental benefits. (khanna.house.gov) Prior authorization has become routine in the program. KFF reported in January that 99% of Medicare Advantage enrollees are in plans that require prior authorization for at least some services, most often higher-cost care such as inpatient hospital stays, skilled nursing facility stays, and chemotherapy. (kff.org) The scale is large and growing. KFF said Medicare Advantage insurers received nearly 53 million prior authorization requests in 2024, up from 49.8 million in 2023, and denied 4.1 million of them, or 7.7%. (kff.org) Few denials are formally challenged. KFF said only 11.5% of denied requests were appealed in 2024, but 80.7% of the appeals that were filed were overturned, a pattern that has fueled scrutiny from lawmakers and patient advocates. (kff.org) Federal investigators have already documented cases where the process blocked care that should have been covered. A 2022 Department of Health and Human Services inspector general report found that some Medicare Advantage organizations denied prior authorization requests that met Medicare coverage rules, including requests for MRIs and post-acute rehabilitation stays. (oig.hhs.gov) The bill goes further than the Biden-era regulatory changes CMS finalized in April 2023. Those rules tightened how Medicare Advantage plans can use prior authorization and said the agency was acting after “numerous inquiries” about delays in access to medically necessary care, but they did not ban the practice. (cms.gov) Insurers and their trade groups have argued for narrower changes instead of a ban. AHIP said this month that plans have made voluntary commitments with the Department of Health and Human Services and CMS to simplify prior authorization and reported an 11% reduction in requirements since June 2025 across participating plans. (ahip.org; beckershospitalreview.com) The measure now heads into the committee process in a Congress where Medicare Advantage oversight has drawn bipartisan attention but major health legislation still faces steep odds. For now, the bill puts a sharper question before Washington: whether delays in approval are a paperwork problem or a barrier to care. (khanna.house.gov; kff.org)
