S.Amdt. 3030

SA 3030. Mrs. FEINSTEIN (for herself, Mr. Rockefeller, and Mr.
Whitehouse) submitted an amendment intended to be proposed to amendment
SA 2786 proposed by Mr. Reid (for himself, Mr. Baucus, Mr. Dodd, and
Mr. Harkin) to the bill H.R. 3590, to amend the Internal Revenue Code
of 1986 to modify the first-time homebuyers credit in the case of
members of the Armed Forces and certain other Federal employees, and
for other purposes; which was ordered to lie on the table; as follows:
On page 37, strike line 10 through line 14 and insert the
following:
``(1) In general.--
``(A) Establishment.--The Secretary, in conjunction with
States, shall establish a uniform process for the annual
review, beginning with the 2010 plan year and subject to
subsection (b)(2)(A), of unreasonable increases in premiums
for health insurance coverage.
``(B) Electronic reporting.--The process established under
subparagraph (A) shall include an electronic reporting system
established by the Secretary through which health insurance
issuers shall report to the Secretary and State insurance
commissioners the information requested by the Secretary
pursuant to this subsection.

On page 37, between lines 24 and 25, insert the following:
``(3) Health insurance rate authority.--
``(A) In general.--The Secretary shall establish a Health
Insurance Rate Authority (referred to in this paragraph as
the `Authority') to be composed of 7 members to be appointed
by the Secretary, of which--
``(i) at least 2 members shall be a consumer advocate with
expertise in the insurance industry;
``(ii) at least 1 member shall be an individual who is a
medical professional;
``(iii) at least 1 member shall be a representative of
health insurance issuers; and
``(iv) such remaining members shall be individuals who are
recognized for their expertise in health finance and
economics, actuarial science, health facility management,
health plans and integrated delivery systems, reimbursement
of health facilities, and other related fields, who provide
broad geographic representation and a balance between urban
and rural members.
``(B) Role.--In addition to the other duties of the
Authority set forth in this subsection, the Authority shall
advise and make recommendations to the Secretary concerning
the Secretary's duties under this subsection.
``(4) Corrective action for unjustified rate increases.--
``(A) In general.--Pursuant to the procedures set forth in
this paragraph, the Secretary or the relevant State insurance
commissioner shall--
``(i) review potentially unreasonable rate increases and
determine whether such increases are justified; and
``(ii) take action to ensure that any rate increase found
to be unjustified under clause (i) is corrected, through
mechanisms including--

``(I) denial of the rate increase;
``(II) modification of the rate increase;
``(III) ordering rebates to consumers; or
``(IV) any other actions that correct for the unjustified
increase.

``(B) Required report.--The Secretary shall ensure that,
not later than 6 months after the date of enactment of the
Patient Protection and Affordable Care Act, the National
Association of Insurance Commissioners (referred to in this
section as the `Association'), in conjunction with States, or
other appropriate body, will provide to the Secretary and the
Authority a report on--
``(i) State authority to review rates in each insurance
market, and methodologies used in such reviews;
``(ii) rating requests received by the State in the
previous 12 months and subsequent actions taken by States to
approve, deny, or modify such requests; and
``(iii) justifications by insurance issuers for rate
requests.
``(C) Determination of who conducts reviews for each
state.--Using the report submitted pursuant to subparagraph
(B), the Secretary shall determine not later than 1 year
after the date of enactment of the Patient Protection and
Affordable Care Act--
``(i) for which States the State insurance commissioner
shall undertake the actions described in subparagraph (A)--

``(I) based on the Secretary's determination that the State
has sufficient authority and capability to deny rates, modify
rates, provide rebates, or take other corrective actions; and
``(II) as a condition of receiving a grant under subsection
(c)(1); and

``(ii) for which States the Secretary shall undertake the
actions described in subparagraph (A), based on the
Secretary's determination that such States lacks the
authority and capability described in clause (i).
``(D) Transition period.--Until the Secretary makes the
determinations described in subparagraph (C), the relevant
State insurance commissioner shall, as a condition of
receiving a grant under subsection (c)(1), carry out the
action described in subparagraph (A).
``(E) Sunset.--Beginning on the date on which subsection
(b)(2)(A) applies, the requirements of this paragraph shall
no longer have force or effect.
``(5) Prioritizing proposed premium increases for review.--
In determining which proposed premium increases to review
under this subsection, the Secretary or the relevant State
insurance commissioner may prioritize--
``(A) rate increases which exceed market averages;
``(B) rate increases that will impact large numbers of
consumers; and
``(C) rate reviews requested from States, if applicable.
``(6) Annual report.--
``(A) Uniform data collection system.--The Secretary, in
consultation with the Association and the Authority, shall
develop a uniform data collection system for rate
information, which shall include information on rates,
medical loss ratios, consumer complaints, solvency, reserves,
and any other relevant factors of market conduct.
``(B) Preparation of annual report.--Using the data
obtained in accordance with subparagraph (A), the Authority
shall annually produce a single, aggregate report on
insurance market behavior, which includes--
``(i) State-by-State information on rate increases from one
year to the next, including by issuer and by market and
including medical trends, benefit changes, and relevant
demographic changes; and
``(ii) a national growth rate percentage for every issuer,
which shall be based on aggregated data of such issuer from
premiums sold in the each market.
``(C) Distribution.--The Authority shall share the annual
report described in subparagraph (B) with States, and include
such report in the information disclosed to the public.
``(7) Recommendation on exchange participation.--
``(A) In general.--Based on the information provided
pursuant to this subsection and other relevant information,
the official described in subparagraph (B) shall make
recommendations to State Exchanges about whether particular
health insurance issuers should be excluded from
participation in the Exchange based on a pattern of excessive
premium increases, low medical loss ratios, or market
conduct.
``(B) Reviewing official.--Either the Secretary or the
relevant State insurance commissioner or commissioners, based
on the determination in paragraph (4)(C), shall make the
recommendations described in subparagraph (A).
On page 144, line 12, strike ``may'' and insert ``shall''.
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