Health Insurance Consumer Protection Act

I 117TH CONGRESS 1ST SESSION H. R. 1890 To amend the Patient Protection and Affordable Care Act to require Ex- changes to establish network adequacy standards for qualified health plans and amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates. IN THE HOUSE OF REPRESENTATIVES MARCH 12, 2021 Ms. SCHAKOWSKY introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend the Patient Protection and Affordable Care Act to require Exchanges to establish network adequacy standards for qualified health plans and amend the Pub- lic Health Service Act to provide protections for con- sumers against excessive, unjustified, or unfairly dis- criminatory increases in premium rates. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Health Insurance Con- 4 sumer Protection Act’’. 5 VerDate Sep 11 2014 23:05 May 12, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1890.IH H1890 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 1890 IH TITLE I—NO MORE NARROW 1 NETWORKS 2 SEC. 101. SHORT TITLE. 3 This title may be cited as the ‘‘No More Narrow Net- 4 works Act of 2021’’. 5 SEC. 102. REQUIRING EXCHANGES TO ESTABLISH NET- 6 WORK ADEQUACY STANDARDS FOR QUALI- 7 FIED HEALTH PLANS. 8 (a) IN GENERAL.—Section 1311(d) of the Patient 9 Protection and Affordable Care Act (42 U.S.C. 18031(d)) 10 is amended by adding at the end the following new para- 11 graph: 12 ‘‘(8) NETWORK ADEQUACY STANDARDS.— 13 ‘‘(A) CERTAIN EXCHANGES.—In the case 14 of an Exchange operated by the Secretary pur- 15 suant section 1321(c)(1) or an Exchange de- 16 scribed in section 155.200(f) of title 42, Code 17 of Federal Regulations (or a successor regula- 18 tion), the Exchange shall require each qualified 19 health plan offered through such Exchange to 20 meet such quantitative network adequacy stand- 21 ards as the Secretary may prescribe for pur- 22 poses of this subparagraph. 23 ‘‘(B) STATE EXCHANGES.—In the case of 24 an Exchange not described in subparagraph 25 VerDate Sep 11 2014 23:05 May 12, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1890.IH H1890 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 1890 IH (A), the Exchange shall establish quantitative 1 network adequacy standards with respect to 2 qualified health plans offered through such Ex- 3 change and require such plans to meet such 4 standards.’’. 5 (b) EFFECTIVE DATE.—The amendment made by 6 this section shall apply with respect to plan years begin- 7 ning on or after January 1, 2023. 8 TITLE II—PROTECTING CON- 9 SUMERS FROM UNREASON- 10 ABLE RATES 11 SEC. 201. SHORT TITLE. 12 This title may be cited as the ‘‘Protecting Consumers 13 from Unreasonable Rates Act’’. 14 SEC. 202. PROTECTION OF CONSUMERS FROM EXCESSIVE, 15 UNJUSTIFIED, OR UNFAIRLY DISCRIMINA- 16 TORY RATES. 17 (a) PROTECTION FROM EXCESSIVE, UNJUSTIFIED, 18 OR UNFAIRLY DISCRIMINATORY RATES.—The first sec- 19 tion 2794 of the Public Health Service Act (42 U.S.C. 20 300gg–94), as added by section 1003 of the Patient Pro- 21 tection and Affordable Care Act (Public Law 111–148), 22 is amended by adding at the end the following new sub- 23 section: 24 VerDate Sep 11 2014 23:05 May 12, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1890.IH H1890 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 1890 IH ‘‘(e) PROTECTION FROM EXCESSIVE, UNJUSTIFIED, 1 OR UNFAIRLY DISCRIMINATORY RATES.— 2 ‘‘(1) AUTHORITY OF STATES.—Nothing in this 3 section shall be construed to prohibit a State from 4 imposing requirements (including requirements re- 5 lating to rate review standards and procedures and 6 information reporting) on health insurance issuers 7 with respect to rates that are in addition to the re- 8 quirements of this section and are more protective of 9 consumers than such requirements. 10 ‘‘(2) CONSULTATION IN RATE REVIEW PROC- 11 ESS.—In carrying out this section, the Secretary 12 shall consult with the National Association of Insur- 13 ance Commissioners and consumer groups. 14 ‘‘(3) DETERMINATION OF WHO CONDUCTS RE- 15 VIEWS FOR EACH STATE.—The Secretary shall de- 16 termine, after the date of enactment of this section 17 and periodically thereafter, the following: 18 ‘‘(A) In which markets in each State the 19 State insurance commissioner or relevant State 20 regulator shall undertake the corrective actions 21 under paragraph (4), based on the Secretary’s 22 determination that the State regulator is ade- 23 quately undertaking and utilizing such actions 24 in that market. 25 VerDate Sep 11 2014 23:05 May 12, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1890.IH H1890 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 1890 IH ‘‘(B) In which markets in each State the 1 Secretary shall undertake the corrective actions 2 under paragraph (4), in cooperation with the 3 relevant State insurance commissioner or State 4 regulator, based on the Secretary’s determina- 5 tion that the State is not adequately under- 6 taking and utilizing such actions in that mar- 7 ket. 8 ‘‘(4) CORRECTIVE ACTION FOR EXCESSIVE, UN- 9 JUSTIFIED, OR UNFAIRLY DISCRIMINATORY 10 RATES.—In accordance with the process established 11 under this section, the Secretary or the relevant 12 State insurance commissioner or State regulator 13 shall take corrective actions to ensure that any ex- 14 cessive, unjustified, or unfairly discriminatory rates 15 are corrected prior to implementation, or as soon as 16 possible thereafter, through mechanisms such as— 17 ‘‘(A) denying rates; 18 ‘‘(B) modifying rates; or 19 ‘‘(C) requiring rebates to consumers. 20 ‘‘(5) NONCOMPLIANCE.—Failure to comply with 21 any corrective action taken by the Secretary under 22 this subsection may result in the application of civil 23 monetary penalties under section 2723 and, if the 24 Secretary determines appropriate, make the plan in- 25 VerDate Sep 11 2014 23:05 May 12, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1890.IH H1890 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 1890 IH volved ineligible for classification as a qualified 1 health plan.’’. 2 (b) CLARIFICATION OF REGULATORY AUTHORITY.— 3 Such section is further amended— 4 (1) in subsection (a)— 5 (A) in the heading, by striking ‘‘PRE- 6 MIUM’’ and inserting ‘‘RATE’’; 7 (B) in paragraph (1), by striking ‘‘unrea- 8 sonable increases in premiums’’ and inserting 9 ‘‘potentially excessive, unjustified, or unfairly 10 discriminatory rates, including premiums,’’; and 11 (C) in paragraph (2)— 12 (i) by striking ‘‘an unreasonable pre- 13 mium increase’’ and inserting ‘‘a poten- 14 tially excessive, unjustified, or unfairly dis- 15 criminatory rate’’; 16 (ii) by striking ‘‘the increase’’ and in- 17 serting ‘‘the rate’’; and 18 (iii) by striking ‘‘such increases’’ and 19 inserting ‘‘such rates’’; and 20 (2) in subsection (b)— 21 (A) by striking ‘‘premium increases’’ each 22 place it appears and inserting ‘‘rates’’; and 23 (B) in paragraph (2)(B), by striking ‘‘pre- 24 mium’’ and inserting ‘‘rate’’. 25 VerDate Sep 11 2014 23:05 May 12, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1890.IH H1890 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 1890 IH (c) CONFORMING AMENDMENTS.—Title XXVII of 1 the Public Health Service Act (42 U.S.C. 300gg et seq.) 2 is amended— 3 (1) in section 2723 (42 U.S.C. 300gg–22)— 4 (A) in subsection (a)— 5 (i) in paragraph (1), by inserting ‘‘, 6 section 2794,’’ after ‘‘this part’’; and 7 (ii) in paragraph (2), by inserting ‘‘, 8 section 2794,’’ after ‘‘this part’’; and 9 (B) in subsection (b)— 10 (i) in paragraph (1), by inserting ‘‘, 11 section 2794,’’ after ‘‘this part’’; and 12 (ii) in paragraph (2)— 13 (I) in subparagraph (A), by in- 14 serting ‘‘, section 2794,’’ after ‘‘this 15 part’’; and 16 (II) in subparagraph (C)(ii), by 17 inserting ‘‘, section 2794,’’ after ‘‘this 18 part’’; and 19 (2) in section 2761 (42 U.S.C. 300gg–61)— 20 (A) in subsection (a)— 21 (i) in paragraph (1), by inserting 22 ‘‘and section 2794’’ after ‘‘this part’’; and 23 (ii) in paragraph (2)— 24 VerDate Sep 11 2014 23:05 May 12, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1890.IH H1890 pamtmann on DSKBC07HB2PROD with BILLS 8 •HR 1890 IH (I) by inserting ‘‘or section 1 2794’’ after ‘‘set forth in this part’’; 2 and 3 (II) by inserting ‘‘and section 4 2794’’ after ‘‘the requirements of this 5 part’’; and 6 (B) in subsection (b)— 7 (i) by inserting ‘‘and section 2794’’ 8 after ‘‘this part’’; and 9 (ii) by inserting ‘‘and section 2794’’ 10 after ‘‘part A’’. 11 (d) APPLICABILITY TO GRANDFATHERED PLANS.— 12 Section 1251(a)(4)(A) of the Patient Protection and Af- 13 fordable Care Act (Public Law 111–148), as added by sec- 14 tion 2301 of the Health Care and Education Reconcili- 15 ation Act of 2010 (Public Law 111–152), is amended by 16 adding at the end the following: 17 ‘‘(v) Section 2794 (relating to reason- 18 ableness of rates with respect to health in- 19 surance coverage).’’. 20 (e) AUTHORIZATION OF APPROPRIATIONS.—There 21 are authorized to be appropriated to carry out this Act, 22 such sums as may be necessary. 23 (f) EFFECTIVE DATE.—The amendments made by 24 this section shall take effect on the date of enactment of 25 VerDate Sep 11 2014 23:05 May 12, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H1890.IH H1890 pamtmann on DSKBC07HB2PROD with BILLS 9 •HR 1890 IH this Act and shall be implemented with respect to health 1 plans beginning not later than January 1, 2023. 2 Æ VerDate Sep 11 2014 23:05 May 12, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H1890.IH H1890 pamtmann on DSKBC07HB2PROD with BILLS