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Congressmen Onder and Landsman Introduce Bipartisan Legislation to Protect Patients
Position: The release supports legislation, the Protecting Approved Care Act, that would bar Medicare Advantage plans from reversing approved coverage, recouping payment, or downcoding claims after approval, except for good cause or evidence of fraud.
FOR IMMEDIATE RELEASE
September 17, 2026
Contact: Brooke Morgan
WASHINGTON, D.C. – Today, Congressman Bob Onder (R-MO) and Congressman Greg Landsman (D-OH) introduced the bipartisan Protecting Approved Care Act.
This legislation ensures that when a Medicare Advantage plan approves care, that approval holds. It bars plans from reversing coverage, clawing back payment, or downcoding claims after the fact, giving patients and their doctors the certainty they need to move forward with treatment.
“As a physician, I know that when a plan approves a treatment, the doctor and the patient need to be able to count on it,” said Congressman Bob Onder, M.D. “Reaching back months later to claw back payment for care a plan already approved undermines that certainty and makes it harder for physicians to keep seeing their patients. This bill makes Medicare Advantage plans keep their word, and I’m glad to work with Rep. Landsman on it.”
“Even as health care costs rise, these insurance companies continue to take advantage of Americans by putting their business over patients. These predatory practices have to end. If coverage is approved, they need to keep their word,” said Congressman Greg Landsman.
"As an orthopaedic surgeon, I applaud Rep. Onder and my fellow Ohioan Rep. Landsman for taking action to bring accountability and stability to the Medicare Advantage program. The AAOS is proud to support the Protecting Approved Care Act and looks forward to working alongside Congress to strengthen the prior authorization system for patients and physicians,” said Joel L. Mayerson, M.D., Chair, American Academy of Orthopaedic Surgeons Advocacy Council.
ClickHERE to read the full bill text.
Background Information
The Protecting Approved Care Act provides greater certainty around prior authorization decisions made by Medicare Advantage plans and ensures providers can rely on an approval when delivering care to their patients.
Today, a Medicare Advantage plan can approve care before it’s delivered, then later reverse that decision or recoup payment from the physician or hospital. Providers absorb those clawbacks, which creates financial uncertainty for practices and can discourage them from treating Medicare Advantage patients, ultimately limiting patients’ access to care.
Under the Protecting Approved Care Act, once a Medicare Advantage plan approves an item or service, whether before treatment or while the patient is receiving care, the plan may not:
Deny coverage based on lack of medical necessity.
Reopen its coverage or payment decision, except for good cause or reliable evidence of fraud.
Downcode the claim to reduce payment, except for good cause or reliable evidence of fraud.
If services do not require prior authorization:
The service must be treated as if prior authorization was granted.
The same protections apply, including no denial of coverage after the fact.
The plan may not downcode a claim to reduce payment.
The plan may not reopen determinations except for good cause or fraud.
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Congressman Onder Examines Healthcare Regulations at Judiciary Field Hearing
Position: The release states that federal regulations, including the Affordable Care Act, have increased healthcare costs and limited competition, and that Congress should address anticompetitive practices and fraud in the healthcare market to make care more affordable.
FOR IMMEDIATE RELEASE
September 16, 2026
Contact: Brooke Morgan
WASHINGTON, D.C. – Earlier this week, Congressman Bob Onder (R-MO) attended a House Judiciary Committee field hearing in Charlotte, North Carolina, where he questioned witnesses Katherine Restrepo Martin of the UNC System; Brian Miller, M.D., M.B.A., M.P.H., of Johns Hopkins; and Brian Blase, Ph.D., of the Paragon Health Institute, about fraud and competition in the healthcare market and ways in which Congress can make healthcare more affordable for Americans.
As a physician for 30 years, Congressman Onder has seen firsthand how burdensome federal regulations like Obamacare have driven up healthcare costs, contributed to the consolidation of healthcare systems, limited competition, and left patients with fewer choices.
Read his full remarks from the hearing below:
“Thank you, Mr. Chairman, I’m happy to be here to talk about such an important aspect of the healthcare industry. Unfortunately, the United States healthcare sector has been overrun with debilitating government regulations that have fostered an anticompetitive market that limits options for patients and inflates the cost for quality healthcare.
Over the past 25 years, the healthcare market has witnessed an increasing consolidation through multiple hospital mergers that have resulted in less options for patients. Many states have laws and regulations that have actively encouraged this consolidation though Certificates of Need, requiring government approval for any entry or expansion of the healthcare market.
This is the landscape many medical residents are entering. They may have acquired certain specialties in medical school but are thrown into a medical residency system that discourages competition and caps the number of doctors allowed to proceed to residency every year, exacerbating the healthcare workforce shortage even more.
As hospitals and medical providers struggle to fill residencies, the marketplace as a whole has had to adjust to the rampant fraud committed through the Affordable Care Act. The Government Accountability Office found evidence that both individuals and insurance companies fraudulently enrolled the same social security numbers for various different healthcare plans. The Trump Administration has tackled this head on – the DOJ has effectively prosecuted individuals who engaged in this shameless Obamacare subsidy fraud. And their work is just beginning.
Congress is striving to make healthcare more affordable to Americans, and that must start by addressing the anticompetitive practices that pervade the healthcare market and rooting out the fraud that has cost the government and taxpayers millions. Thank you.”
To watch a clip from the hearing, click HERE.
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Rep. Onder Introduces Bill to Hold Union Leaders Accountable for Withheld Financial Info
Position: Representative Onder introduced the Improving CTU Act to strengthen financial transparency requirements for labor organizations, citing undisclosed audits and denied member requests for records at the Chicago Teachers Union.
FOR IMMEDIATE RELEASE
July 27, 2026
Contact: Brooke Morgan
WASHINGTON, D.C. – Today, following the Education and Workforce Committee’s investigation that uncovered years of financial secrecy at the Chicago Teachers Union (CTU), Representative Bob Onder (R-MO) introduced the Improving Clarity and Transparency for Unions Act, or “Improving CTU Act,” to hold union leaders accountable and ensure American workers have access to information about how their dues are spent.
For the past five years, CTU failed to disclose required financial audits to their members, despite collecting nearly $150 million in member dues during that period. The Committee found that CTU repeatedly denied workers’ requests for financial information about how the union is spending dues collected from its own members.
“Transparency should not depend on whether a worker can take time off to review hundreds of pages of financial records at a union office,” Representative Bob Onder continued. “I introduced this legislation because union members deserve the same accountability and disclosure standards they expect from any organization entrusted with millions of dollars in member dues.”
“Too many workers are paying union dues while union leaders are spending lavishly at their own members’ expense or financing political causes workers may not support. Workers deserve to know how their money is being spent. But when unions like CTU fail to disclose their own financial audits, workers are robbed of that right. I am thankful Rep. Onder is introducing this critical legislation to promote transparency for workers so they can hold their own leaders accountable,” said Education and Workforce Committee Chairman Tim Walberg (R-MI).
Click HERE to read the Education and Workforce Committee’s press release.
Background Information
The legislation follows a November 20, 2025, Committee on Education and Workforce investigation into CTU, which uncovered years of delayed audits, repeated denials of member requests for financial records, and policies that limited workers' ability to review information. These actions violated CTU’s own governing documents regarding financial transparency.
The Committee also found that, despite collecting nearly $150 million in member dues over a five-year period, CTU leadership devoted less than 17 percent of its spending to collective bargaining and member services. This amounted to members receiving less than 18 months of collective bargaining and member services for the five years of dues they paid. These findings underscore the importance of ensuring workers have clear visibility into how union leadership allocates member resources.
The Improving CTU Act would strengthen financial transparency requirements for labor organizations and help ensure workers have timely access to the financial information they need to hold union leadership accountable.
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Congressman Onder’s Chloe Cole Act Advances Out of House Judiciary Committee
Position: Supports the Chloe Cole Act (H.R. 7651), which would strengthen legal protections for minors, impose accountability on medical providers for gender-affirming care, and allow victims to pursue civil claims; the release criticizes puberty blockers, cross-sex hormones, and surgeries for minors and calls for the bill to pass the House.
FOR IMMEDIATE RELEASE
July 20, 2026
Contact: Brooke Morgan
WASHINGTON, D.C. – Today, Congressman Bob Onder (R-MO) issued the following statement after his bill, H.R. 7651, the Chloe Cole Act, which was transmitted to Congress by the Department of Justice, advanced through the House Judiciary Committee and now awaits consideration for a vote on the House floor.
The legislation strengthens legal protections for minors, ensures accountability within the medical system, and provides an avenue for individuals and families to pursue justice where harm has occurred under the guise of so-called “gender affirming care.”
"It is unacceptable that politics and woke ideology have been allowed to override sound medical judgment, leaving vulnerable children to undergo irreversible procedures without a comprehensive psychological evaluation, treatment of underlying mental health conditions, or truly informed parental consent. Children deserve medical care grounded in scientific evidence, not experimental interventions driven by biased agendas. The Chloe Cole Act would allow families to hold clinics and hospitals accountable and ensure victims have adequate time to seek justice. This legislation is urgently needed, and I am proud that the House Judiciary Committee has advanced this critical bill so we can continue fighting to protect children and hold those who harmed them accountable." — Congressman Bob Onder
“While we’ve made significant strides in raising awareness and enacting protections in recent years, the fight is far from over. Too many children remain at risk of irreversible harm from puberty blockers, cross-sex hormones, and surgical procedures pushed on them before they can fully understand the consequences. The Chloe Cole Act advancing out of Judiciary Committee is a vital step in our mission to ensure that no minor in America ever endures the kind of lasting, irreparable damage I experienced. We must finish what we’ve started and safeguard the next generation from these experimental and barbaric treatments.” — Chloe Cole
“The Department of Justice has been proud to work with Rep. Bob Onder on the Chloe Cole Act. This bill takes a necessary step towards restoring justice and protecting children from harm by giving victims of so-called “gender affirming” procedures the ability to have their day in court. We hope to see Congress move this vital legislation forward.” — Acting Attorney General Todd Blanche
“I applaud Rep. Onder’s leadership on guiding the Chloe Cole Act through our committee. This crucial bill will protect vulnerable children.”— House Judiciary Committee Chairman Jim Jordan (R-OH)
Click HERE to read statements from organizations supporting the legislation.
Chloe’s Story
This legislation is inspired by courageous young women like Chloe Cole. At just 15 years old, Chloe underwent a double mastectomy. By age 16, she deeply regretted it. In 2023, she testified before the House Judiciary Committee, describing her experience as part of “one of the biggest medical scandals in the history of the United States of America.”
Chloe is one of thousands of children who have been harmed and misled by medical practitioners who prioritize ideological beliefs over patient care. These children are left with irreversible consequences, including sterilization, permanent scarring, and lifelong emotional and physical burdens, while activists and hospitals profit from their suffering.
Chloe’s story is not isolated—it is a warning. Children deserve careful, evidence-based care grounded in sound science, not irreversible medical experimentation driven by politics.
Background Information
The widespread use of puberty blockers, cross-sex hormones, and sex-trait altering surgeries on children presenting with gender dysphoria is not grounded in sound science or supported by high-quality, peer-reviewed research. That is why multiple European countries, including Sweden, Finland, and England, have reversed course and restricted these interventions for minors after concluding they cause more harm than good.
The physical risks are also significant and permanent. Long-term use of puberty blockers in otherwise healthy children can cause splintered bones and osteoporosis. When followed by cross-sex hormones, children can become permanently infertile and face increased risks of cardiovascular disease and metabolic disorders. The evidence shows serious, lifelong harm with little demonstrated psychological benefit.
Claims that these medical interventions reduce suicidality or resolve gender dysphoria largely rest on a single, deeply flawed study that has never been successfully replicated. That study selectively excluded patients with poor outcomes, including at least one participant who died. A 2022 follow-up study of the same cohort revealed troubling results:
• 44% of females and 35% of males regretted the loss of their fertility
• 20% reported a change in their gender identity over time
These findings, paired with extensive medical research with similar findings, directly contradict the assertion that these interventions reliably improve long-term psychological well-being.
In February 2026, the American Society of Plastic Surgeons and the American Medical Association reversed their previous positions on transgender surgeries for minors, citing insufficient evidence to recommend surgeries for individuals under age 19.
The Chloe Cole Act would:
• Protect minors from medical transgender interventions—including puberty blockers, cross-sex hormones, or surgical procedures—by placing full liability on clinics and hospitals;
• Establish a private right of action, allowing affected individuals and their families to pursue civil damages, including detransition medical expenses and damages for emotional distress, pain and suffering;
• Provide a lengthy statute of limitations to ensure individuals have sufficient time to seek legal recourse.
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Committee Advances Rep. Onder’s Bill to Transfer CCAMPIS Administration to HHS
Position: Representative Onder supports transferring day-to-day administration of the CCAMPIS child care grant program from the Department of Education to HHS, as part of a broader package codifying interagency agreements, and argues this reduces bureaucracy and departmental administrative costs.
FOR IMMEDIATE RELEASE
July 16, 2026
Contact: Brooke Morgan
WASHINGTON, D.C. – Today, Representative Bob Onder (R-MO) issued the following statement after his bill, the Less Bureaucracy, Better Child Care for Student Parents Act, advanced out of the House Education & Workforce Committee.
This legislation transfers the day-to-day administrative responsibilities of the Child Care Access Means Parents in School (CCAMPIS) program from the Department of Education’s (ED) Office of Postsecondary Education to the Administration for Children and Families within the Department of Health and Human Services (HHS) as part of a broader legislative package to codify recent interagency agreements between the Department of Education and various federal agencies.
"Every student deserves access to a quality education, and decisions that affect school funding can have a significant impact on the educational experience. Right now, too much funding allocated to the Department of Education is diverted to administrative costs instead of directly supporting students' education. As a member of the House Education and Workforce Committee, I am proud to be on the front lines of advancing President Trump's goal of depowering the Department of Education and returning education decisions to state and local governments. Today, my bill, as part of a broader legislative package, passed out of committee, and my colleagues and I are one step closer to reducing unnecessary bureaucracy and ensuring American families receive the resources they need," said Representative Bob Onder.
Following the markup, Education and Workforce Committee Chairman Tim Walberg (R-MI) said: “For too long, Washington has accepted outcomes that should be unacceptable. Too many children can’t read or do math at grade level. Too many students leave college without a degree or the skills they need to succeed. And the federal government has mismanaged a $1.7 trillion student loan portfolio, leaving more than 9 million borrowers in default. The question before the Committee today was simple: do we defend the bureaucracy that produced those results, or do we pursue reforms that put students, families, and workers first? Committee Republicans chose reform because we believe every American deserves the opportunity to succeed.”
Background Information
The Child Care Access Means Parents in School (CCAMPIS) program provides grants to colleges and universities to help low-income student parents access affordable, campus-based child care while pursuing postsecondary education.
In 2026, the Department of Education (ED) and the Department of Health and Human Services (HHS) entered into an interagency agreement to transfer the administration of CCAMPIS from the ED to HHS. HHS already oversees some of the federal government’s largest child care programs, including Head Start.
Because child care programs are currently being administered across multiple federal agencies, states and institutions must navigate duplicative administrative processes and reporting requirements. Transferring CCAMPIS administration to HHS will help reduce unnecessary administrative burdens, improve coordination among federal child care programs, and ensure resources are more effectively directed toward supporting low-income student parents and their families.
Rep. Onder's legislation builds on this broader effort by permanently transferring administration of the CCAMPIS program to HHS. By placing the program within the federal agency primarily responsible for child care programs, the legislation would reduce duplicative administrative functions, improve efficiency and accountability, and help ensure that more federal resources are directed toward supporting low-income student parents and their families.
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Rep. Onder Introduces Legislation to Transfer CCAMPIS Administration to HHS
Position: Rep. Bob Onder introduced legislation to transfer day-to-day administration of the CCAMPIS child care grant program from the Department of Education to HHS's Administration for Children and Families, as part of a package to reduce duplicative federal administration and shift education authority toward states and localities.
FOR IMMEDIATE RELEASE
July 10, 2026
Contact: Brooke Morgan
WASHINGTON, D.C. – This week, Representative Bob Onder (R-MO) introduced legislation to transfer the day-to-day administrative responsibilities of the Child Care Access Means Parents in School (CCAMPIS) program from the Department of Education’s Office of Postsecondary Education to the Administration for Children and Families within the Department of Health and Human Services (HHS).
The Less Bureaucracy, Better Child Care for Student Parents Act, is one of ten bills included in a broader legislative package to codify recent interagency agreements between the Department of Education and various federal agencies. Collectively, the package is designed to reduce bureaucratic barriers, eliminate duplicative processes, and improve the delivery of certain services and resources.
"Every student deserves access to a quality education, and decisions that affect school funding can have a significant impact on the educational experience. Right now, too much funding allocated to the Department of Education is diverted to administrative costs instead of directly supporting students’ education. As a member of the House Education and Workforce Committee, I am proud to be on the front lines of helping advance President Trump’s goal of depowering the Department of Education and returning education decisions to state and local governments. My colleagues and I are advancing this legislative package to reduce unnecessary bureaucracy and ensure American families receive the resources they need," said Congressman Bob Onder.
Chairman Walberg said: "For decades, Washington has measured success by how much government grows instead of how well students do. The legislative package reflects a simple principle: education policy should be focused on helping students succeed—not preserving a federal bureaucracy for its own sake. Rather than allowing unnecessary layers of Washington bureaucracy to stand between families and the services they rely on, the bills would transfer key statutory authorities to agencies better equipped to carry them out while maintaining continuity for students.”
Background Information
The Child Care Access Means Parents in School (CCAMPIS) program provides grants to colleges and universities to help low-income student parents access affordable, campus-based child care while pursuing postsecondary education.
In 2026, the Department of Education (ED) and the Department of Health and Human Services (HHS) entered into an interagency agreement to transfer the administration of CCAMPIS from the ED to HHS. HHS already oversees some of the federal government’s largest child care programs, including Head Start.
Because child care programs are currently being administered across multiple federal agencies, states and institutions must navigate duplicative administrative processes and reporting requirements. Transferring CCAMPIS administration to HHS will help reduce unnecessary administrative burdens, improve coordination among federal child care programs, and ensure resources are more effectively directed toward supporting low-income student parents and their families.
Rep. Onder's legislation builds on this broader effort by permanently transferring administration of the CCAMPIS program to HHS. By placing the program within the federal agency primarily responsible for child care programs, the legislation would reduce duplicative administrative functions, improve efficiency and accountability, and help ensure that more federal resources are directed toward supporting low-income student parents and their families.
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Rep. Onder Earns 2025 Club for Growth Defender of Economic Freedom Award
Position: The release describes the rep's receipt of a Club for Growth award based on a voting scorecard and states support for pro-growth, limited-government economic policies, including keeping taxpayers' money and promoting fiscal responsibility.
FOR IMMEDIATE RELEASE
July 2, 2026
Contact: Brooke Morgan
WASHINGTON, D.C. – This week, Representative Bob Onder (R-MO) issued the following statement after receiving the 2025 Club for Growth Defender of Economic Freedom Award. The award is based on the Club for Growth's Congressional Economic Scorecard, the gold standard for measuring Members of Congress' voting records on issues related to limited government and economic growth.
This award required Representatives and Senators to score at least 90% on votes cast during the year, as well as maintain a lifetime rating of at least 90%. Representative Onder earned a 100%, meeting both the annual voting score and lifetime rating requirements.
"Economic freedom is the foundation of prosperity, opportunity, and innovation. By advancing pro-growth policies that empower Americans to start businesses, invest in their futures, and promote fiscal responsibility, we can build a stronger economy while ensuring taxpayers keep more of their hard-earned money. I am honored to receive this prestigious award and grateful to Club for Growth President David McIntosh for this recognition," said Representative Bob Onder.
“We congratulate Rep. Onder for earning Club for Growth’s Defender of Economic Freedom Award for fighting for policies that advance limited government and prosperity,” said Club for Growth President David Mcintosh. “Meanwhile Democrats have become more socialist than ever despite many of them claiming to be ‘moderate.’”
Background Information
The Club for Growth is a national network of more than 500,000 pro-growth, limited-government Americans who believe prosperity and opportunity are rooted in economic freedom. Each year, the Club for Growth Foundation publishes its Congressional Economic Scorecard, which tracks how Members of Congress vote on key economic legislation and evaluates votes related to the organization's core policy priorities, as well as legislation that would directly undermine those fiscal goals
Members of Congress who earn a score of 90 percent or higher in a given calendar year and maintain a lifetime score of at least 90 percent are recognized by the Club for Growth with the "Defender of Economic Freedom Award."
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Rep. Onder's Bill to Strengthen Transparency in Employer-Sponsored Health Plans Passes Committee
Position: Rep. Onder's bill, H.R. 9228, would amend ERISA to require that employer-sponsored health plan fiduciaries have access to de-identified claims data, prohibiting service providers such as third-party administrators from delaying or restricting that access. The release describes the bill as having passed committee and awaiting House floor consideration.
FOR IMMEDIATE RELEASE
June 26th, 2026
Contact: Brooke Morgan
(Washington, D.C.) – Today, U.S. Congressman Bob Onder (R-MO) released the following statement after his bill, H.R. 9228, the Health Data Access, Transparency, and Affordability Act of 2026, passed out of the Education and Workforce Committee and now awaits consideration on the House floor.
This legislation amends the Employee Retirement Income Security Act of 1974 to ensure plan fiduciaries have access to de-identified information relating to health claims and important data.
“Employers need access to all the information necessary to manage health plans, control costs, and protect workers’ benefits. Employer-sponsored health plans often face barriers when trying to obtain critical data and information, which is why my bill, the Health Data Access, Transparency, and Affordability Act of 2026, is so important. It strengthens clarity and accountability in employer-sponsored group health plans by prohibiting service providers, such as third-party administrators, from delaying, restricting, or otherwise limiting access to plan data. As a physician and a Congressman, I am proud to do my part to ensure timely access to the information needed for employers to properly conduct audits and evaluate health plan performance,” said Congressman Bob Onder.
“When employers have access to timely, complete health plan data, they can make smarter decisions and design benefits that best meet the needs of their workforce. H.R. 9228 is a commonsense, transparency-focused measure that gives employers a clearer picture of health care costs. By breaking down these costs, this legislation will drive accountability, reduce waste, and help deliver more affordable, high-quality health care for employees and their families,” said Education and Workforce Committee Chairman Tim Walberg (R-MI).
To read the full bill, click here: H.R. 9228
Background Information
Under current federal law, employers that sponsor self-funded health plans are legally and financially responsible for how employee health care dollars are spent. Yet, in many cases, insurers and third-party administrators (TPAs) deny employers access to the raw claims data needed to verify those costs and ensure plan funds are being used appropriately.
Without that transparency, TPAs and other administrative entities can impose hidden markups on medical procedures and prescription drugs, charging an employer one price, paying the provider or pharmacy a much lower amount, and pocketing the difference. The Health Data Access, Transparency, and Affordability Act would make clear that claims data generated by an employer-funded health plan belongs to the plan itself and the employer paying the bills, not the insurance company or administrator managing the plan.
Recent litigation has highlighted the consequences of this lack of transparency. Below are a few examples:
Kraft Heinz Co. v. Aetna (2023): Kraft Heinz sued Aetna for hiding its raw claims data and providing only "edited" reports. The lawsuit explicitly alleged that Aetna used its leverage to negotiate lower rates with doctors but did not pass those savings back to the employee, instead pocketing the spread between what Kraft was charged and what providers received.
Owens & Minor v. Anthem: Global logistics firm Owens & Minor attempted to audit its health plan to verify accurate billing and eliminate overcharges. Anthem refused to provide line-by-line data, claiming its negotiated hospital rates were "proprietary trade secrets."
Lewandowski v. Johnson & Johnson (2024–2026): Employees sued Johnson & Johnson for failing to police their plan, proving that employers face significant legal liability if they cannot audit drug costs. Because of a lack of transparency and hidden spread pricing, the J&J plan paid $10,239 for a generic drug that costs just $28 retail.
The Health Data Act would restore accountability to the employer-sponsored health insurance system by ensuring that those who pay the bills have access to the data necessary to monitor spending, identify waste, and prevent abusive pricing practices.
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Rep. Onder Leads Letter Calling for Greater Transparency in Medicare Advantage
Position: Urges the Centers for Medicare & Medicaid Services to establish minimum national standards for Medicare Advantage drug coverage and to restrict step therapy requirements that force patients to try insurer-preferred drugs before physician-prescribed treatments.
FOR IMMEDIATE RELEASE
June 4th, 2026
Contact: Brooke Morgan
(Washington, D.C.) – Today, U.S. Congressman Bob Onder (R-MO) released the following statement after leading a letter from certain members of the Doctors Caucus to the Centers for Medicare & Medicaid Services (CMS) encouraging the agency to protect Medicare Advantage beneficiaries who are being blocked from lifesaving physician-administered treatments. The letter urges CMS to establish minimum national standards for drug coverage in Medicare Advantage to address restrictive “step therapy” policies that require seniors to try insurer-preferred drugs, even when there is no access to the drug in their region.
“One of the most concerning trends in Medicare Advantage is the growing use of step therapy requirements. In traditional Medicare, physicians can quickly pivot to an alternative treatment if a drug is unavailable, but many plans force patients to try their preferred drug first - even if the drug is unavailable where they live. As members of the Doctors Caucus, we regularly hear about this from patients and physicians, and many of us have witnessed firsthand how patients are harmed when insurers restrict access to life-saving treatments,” said Congressman Bob Onder, M.D.
“Our country should be moving toward a health care system that puts patients, not profits, first. Seniors who have paid into Medicare their entire lives deserve reasonable access to the treatments they need.”
"Americans deserve reliable access to the treatments their doctors know work best. Washington bureaucrats and insurance companies shouldn’t force seniors through unnecessary hurdles or disrupt care to cut costs. We must protect patient choice, support physicians, and ensure Medicare beneficiaries can get the care they need when they need it,” said Rep. Brian Babin, D.D.S.
"As a physician, I believe treatment decisions should be made by doctors—not insurance companies. Physicians use their training, clinical experience, and knowledge of a patient's medical history to determine the best course of treatment. Yet Medicare Advantage plans often require patients to try an insurer-selected therapy before they can receive the medication prescribed by their doctor. CMS should put an end to these unnecessary insurance hurdles and allow physicians to exercise their medical judgment," said Congressman Andy Harris, M.D.
"As a physician, I know all too well the unnecessary barriers that step therapy puts between a patient and the care they need. Right now, the structure of certain Medicare Advantage plans is forcing seniors onto failed alternative drugs while squeezing local clinics so hard they can’t even afford to provide the actual treatments patients need. This is a preventable bureaucratic failure, and CMS should step in and protect patient access to the care they need," said Congressman Mike Kennedy, M.D.
"To improve patient outcomes, we must ensure efficient and effective care is readily available. Oftentimes, "fail-first" practices are harmful to patients and ultimately more costly on the American taxpayer. I am proud to join my physician colleagues in addressing this shortcoming with CMS,” said Rep. Neal Dunn, M.D.
“We thank Rep. Bob Onder (R-MO) and his colleagues for bringing attention to a growing problem that threatens patient access to physician-administered biosimilar medications,” said Madelaine Feldman, M.D., FACR, Vice President of Advocacy & Government Affairs for the Coalition of State Rheumatology Organizations (CSRO), a Co-Chair organization of the Underwater Biosimilars Coalition. “Over-rebating has created a growing number of ‘underwater’ biosimilars, where Medicare reimbursement falls below provider acquisition cost. At the same time, Medicare Advantage plans continue to impose step therapy requirements for these products without regard for whether physicians can afford to administer them. Biosimilars should be a cost-effective option that expands patient access and lowers healthcare spending, but the current system risks limiting access, forcing care into potentially higher-cost settings. A formulary adequacy standard would help end ‘ghost formularies’ and ensure that Medicare Advantage plans cannot require beneficiaries to ‘fail first’ a preferred biosimilar that is effectively unavailable.”
To read the full letter, click here: Letter.
Background Information
Under the Medicare Advantage (MA) program, the federal government pays private insurance companies a fixed amount to provide beneficiaries with Medicare-covered services. By law, Medicare Advantage plans must cover at least the same services available under traditional Medicare. Despite these requirements, physicians and patients continue to report significant barriers to accessing medically necessary treatments, particularly physician-administered Part B drugs such as biologics and biosimilars used to treat chronic conditions including rheumatoid arthritis and inflammatory bowel disease. Providers have raised concerns that step therapy requirements and restrictive formulary policies in some Medicare Advantage plans can delay or limit access to these therapies, even when they would otherwise be covered under traditional Medicare.
Physicians are increasingly being reimbursed at rates below the amount they must pay to acquire certain Part B medications, creating financial challenges that can make it difficult to continue offering these treatments. According to a 2025 survey of nearly 200 physicians, reimbursement rates for some commonly prescribed biosimilars frequently fell below acquisition costs. Physicians reported that the actual purchase price for Inflectra exceeded reimbursement rates by 30 to 260 percent, while the purchase price for Avsola exceeded reimbursement by approximately 30 to 80 percent below acquisition cost. Rheumatologists and gastroenterologists have identified these drugs among the most common examples of medications for which providers are operating at a loss.
In traditional Medicare, physicians may be able to prescribe alternative therapies when reimbursement rates make certain drugs unavailable. However, providers report that Medicare Advantage step therapy requirements can limit those options, leaving some patients without timely access to treatment in their communities.
My colleagues and I are asking the Centers for Medicare & Medicaid Services (CMS) to improve transparency and establish safeguards that ensure Medicare Advantage plans maintain adequate formularies and provide beneficiaries with meaningful access to medically necessary Part B medications.
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Rep. Onder’s Bill to Strengthen Accountability in Child Care Monitoring Passes the House
Position: Rep. Onder supports passage of H.R. 7722, the Child Care Integrity Monitoring Act, which would codify HHS triennial audits of state CCDBG funds and designate states with repeated audit failures as high-risk for enhanced federal monitoring.
FOR IMMEDIATE RELEASE
June 4th, 2026
Contact: Brooke Morgan
(Washington, D.C.) – Today, U.S. Congressman Bob Onder (R-MO) released the following statement after the House passed his bill, H.R. 7722, the Child Care Integrity Monitoring Act, as part of H.R. 7726, the Stop Child Care Scams Act, a package of eight commonsense reforms to crack down on abuse, restore accountability, and protect taxpayer dollars from being siphoned off by bad actors.
The Child Care Integrity Monitoring Act strengthens oversight of federal child care funding by codifying the Department of Health and Human Services’ (HHS) practice of auditing states’ CCDBG funds every three years. Also, under this legislation, any state with repeated audit failures would be designated as “high-risk” and subjected to enhanced monitoring as determined by HHS.
“Recent investigations in Democrat-run states have exposed widespread fraud in child care assistance programs, with millions of taxpayer dollars funneled to services that were never provided,” said Congressman Bob Onder. “This blatant abuse underscores the urgent need for stronger oversight, and the Child Care Integrity Monitoring Act will hold states with repeated audit failures accountable and help ensure public funds are spent responsibly. Families deserve child care programs they can trust, and taxpayers deserve full transparency about where their hard-earned dollars are going. I am proud that the House has passed this legislation as part of the Stop Child Care Scams Act, a package of eight commonsense reforms designed to crack down on fraud, strengthen oversight, and restore accountability to the child care assistance system.”
“Fraud is running rampant across our nation—and Americans are sick of it. That is why the Committee on Education and Workforce passed eight bills in March to fight fraud and restore Americans’ faith in our federal child care programs. Every dollar stolen by fraudsters is a dollar that cannot help innocent children in need. I am grateful to Rep. Onder for sponsoring the Child Care Integrity Monitoring Act, which is included in H.R. 7726. His bill implements common-sense accountability measures to ensure states are putting our children—and not fraudsters—first.”—Education and Workforce Committee Chairman Tim Walberg (R-MI)
To read the full bill, click here: H.R. 7722
Background Information
Enacted in 1990 and subsequently amended, the Child Care and Development Block Grant (CCDBG) Act is the primary federal law providing child care assistance to low-income families. The law authorizes grant funding to state, territorial, and tribal lead agencies to help eligible families access child care services.
Following the passage of the Improper Payments Information Act of 2002, the CCDBG program was identified as being at risk for significant improper payments. In response, the Department of Health and Human Services (HHS) established a three-year audit cycle for all grantees beginning in 2007.
Despite these oversight measures, misuse of CCDBG funds persists. In May 2025, the HHS Inspector General reported that 38 of 200 randomly selected child care assistance payments in Minnesota failed to meet requirements related to attendance and payment for services. A separate report from the Minnesota Office of the Legislative Auditor also highlighted widespread noncompliance within the state’s child care assistance program.
The Child Care Integrity Monitoring Act is included in the House Education and Workforce Committee’s Stop Child Care Scams Act, a package of eight reforms designed to combat fraud, strengthen oversight, and increase accountability in child care assistance programs.
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Top PAC donors · 2026 cycle
Political action committees that gave the most to this rep's principal campaign committee this cycle. PAC giving is direct organizational support — industry, ideological, or leadership.
1.AMERICAN SOCIETY OF ANESTHESIOLOGISTS PAC (ASA PAC)2 contributions$10,000
2.NATIONAL PORK PRODUCERS COUNCIL PORK PAC2 contributions$10,000
3.MR. SOUTHERN MISSOURIAN IN THE HOUSE PACLeadership2 contributionsMember-of-Congress leadership PAC — supports allied candidates and Democratic causes, likely affiliated with a House member representing southern Missouri.AI$10,000
4.AMERICAN ACADEMY OF OTOLARYNGOLOGY-HEAD AND NECK SURGERY ENT PAC5 contributions$10,000
5.AMEREN CORPORATION FEDERAL PAC (AMEREN FEDPAC)2 contributions$10,000
6.ALLIED PILOTS ASSOCIATION PAC4 contributions$10,000
7.AMERICAN COLLEGE OF RADIOLOGY ASSOCIATION PAC4 contributions$8,500
8.ASSOCIATED BUILDERS AND CONTRACTORS, INC. PAC (ABC PAC)Business4 contributionsTrade-association PAC for non-union construction contractors — backs candidates supporting regulatory relief, tax incentives, and infrastructure spending favorable to commercial and industrial builders.AI$8,500
9.PAC OF THE AMERICAN ASSOCIATION OF ORTHOPAEDIC SURGEONS--PAC OF AAOS7 contributions$8,000
10.TEACHERS INSURANCE ANNUITY ASSOCIATION OF AMERICA PAC (TIAA PAC)5 contributions$7,500
Source: OpenFEC (api.open.fec.gov) Schedule A receipts where contributor type is “committee.” Aggregated by contributing committee. Self-transfers from joint-fundraising / victory committees are excluded.
Top individual contributors · 2026 cycle
Itemized individual contributions over $200 to this rep's campaign committee, aggregated by donor employer. PAC giving is shown above; this section is people, not organizations.
1.SELF$16,219
2.GREY IRIS HOLDINGS$7,652
3.PATRIOT MACHINE INC$7,500
4.O'BRIEN INDUSTRIAL HOLDINGS$7,000
5.HUNTER ENGINEERING CO.$7,000
6.JERRY KELLY HEATING AND AC$7,000
7.PHELPS HEALTH$7,000
8.PARTNER$7,000
9.DIAMOND PET FOOD$7,000
10.NATURAL GAS FUEL SOLUTIONS$7,000
Source: OpenFEC Schedule A receipts where contributor type is “individual,” aggregated by the donor's self-reported employer. This is a geographic / industry correlation, not a corporate endorsement.
