II
113th CONGRESS
1st Session
S. 482
IN THE SENATE OF THE UNITED STATES
March 6, 2013
Mrs. Feinstein (for herself, Mrs. Boxer, Mr. Lautenberg, Mr. Sanders, and Mr. Tester) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions
A BILL
To amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates.
Short title
This Act may be cited as
the Health Insurance Rate Review
Act
.
Protection of consumers from excessive, unjustified, or unfairly discriminatory rates
Protection from excessive, unjustified, or unfairly discriminatory rates
The first section 2794 of the Public Health Service Act (42 U.S.C. 300gg–94), as added by section 1003 of the Patient Protection and Affordable Care Act (Public Law 111–148), is amended by adding at the end the following new subsection:
Protection from excessive, unjustified, or unfairly discriminatory rates
Authority of States
Nothing in this section shall be construed to prohibit a State from imposing requirements (including requirements relating to rate review standards and procedures and information reporting) on health insurance issuers with respect to rates that are in addition to the requirements of this section and are more protective of consumers than such requirements.
Consultation in rate review process
In carrying out this section, the Secretary shall consult with the National Association of Insurance Commissioners and consumer groups.
Determination of who conducts reviews for each State
The Secretary shall determine, after the date of enactment of this section and periodically thereafter, the following:
In which markets in each State the State insurance commissioner or relevant State regulator shall undertake the corrective actions under paragraph (4), as a condition of the State receiving the grant in subsection (c), based on the Secretary’s determination that the State regulator is adequately undertaking and utilizing such actions in that market.
In which markets in each State the Secretary shall undertake the corrective actions under paragraph (4), in cooperation with the relevant State insurance commissioner or State regulator, based on the Secretary’s determination that the State is not adequately undertaking and utilizing such actions in that market.
Corrective action for excessive, unjustified, or unfairly discriminatory rates
In accordance with the process established under this section, the Secretary or the relevant State insurance commissioner or State regulator shall take corrective actions to ensure that any excessive, unjustified, or unfairly discriminatory rates are corrected prior to implementation, or as soon as possible thereafter, through mechanisms such as—
denying rates;
modifying rates; or
requiring rebates to consumers.
Noncompliance
Failure to comply with any corrective action taken by the Secretary under this subsection may result in the application of civil monetary penalties and, if the Secretary determines appropriate, make the plan involved ineligible for classification as a Qualified Health Plan.
.
Clarification of Regulatory Authority
Such section is further amended—
in subsection (a)—
in the heading, by
striking premium
and inserting
rate
;
in paragraph (1),
by striking unreasonable increases in premiums
and inserting
potentially excessive, unjustified, or unfairly discriminatory rates,
including premiums,
; and
in paragraph (2)—
by
striking an unreasonable premium increase
and inserting a
potentially excessive, unjustified, or unfairly discriminatory
rate
;
by
striking the increase
and inserting the rate
;
and
by
striking such increases
and inserting such
rates
;
in subsection (b)—
by striking
premium increases
each place it appears and inserting
rates
; and
in paragraph
(2)(B), by striking premium
and inserting rate
;
and
in subsection (c)(1)—
in the heading, by
striking Premium
and inserting
Rate
;
by inserting
that satisfy the condition under subsection (e)(3)(A)
after
award grants to States
; and
in subparagraph
(A), by striking premium increases
and inserting
rates
.
Conforming amendment
Title XXVII of the Public Health Service Act (42 U.S.C. 300gg et seq.) is amended—
in section 2723 (42 U.S.C. 300gg–22), as redesignated by the Patient Protection and Affordable Care Act—
in subsection (a)—
in paragraph (1),
by inserting and section 2794
after this part
;
and
in paragraph (2),
by inserting or section 2794
after this part
;
and
in subsection (b)—
in paragraph (1),
by inserting and section 2794
after this part
;
and
in paragraph (2)—
in subparagraph
(A), by inserting or section 2794 that is
after this
part
; and
in subparagraph (C)(ii), by inserting
or section 2794
after this part
; and
in section 2761 (42 U.S.C. 300gg–61)—
in subsection (a)—
in
paragraph (1), by inserting and section 2794
after this
part
; and
in paragraph (2)—
by inserting
or section 2794
after set forth in this part
;
and
by inserting
and section 2794
after the requirements of this
part
; and
in subsection (b)—
by
inserting and section 2794
after this part
;
and
by
inserting and section 2794
after part A
.
Applicability to grandfathered plans
Section 1251(a)(4)(A) of the Patient Protection and Affordable Care Act (Public Law 111–148), as added by section 2301 of the Health Care and Education Reconciliation Act of 2010 (Public Law 111–152), is amended by adding at the end the following:
Section 2794 (relating to reasonableness of rates with respect to health insurance coverage).
.
Authorization of appropriations
There are authorized to be appropriated to carry out this Act, such sums as may be necessary.
Effective date
The amendments made by this section shall take effect on the date of enactment of this Act and shall be implemented with respect to health plans beginning not later than January 1, 2014.