Protecting Consumers from Unreasonable Rates Act of 2020

I 116TH CONGRESS 2D SESSION H. R. 6136 To amend the Public Health Service Act to provide protections for consumers against excessive, unjustified, or unfairly discriminatory increases in pre- mium rates. IN THE HOUSE OF REPRESENTATIVES MARCH 9, 2020 Ms. SCHAKOWSKY introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend the Public Health Service Act to provide protec- tions for consumers against excessive, unjustified, or un- fairly discriminatory 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 ‘‘Protecting Consumers 4 from Unreasonable Rates Act of 2020’’. 5 VerDate Sep 11 2014 23:12 Mar 13, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6136.IH H6136 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 6136 IH SEC. 2. PROTECTION OF CONSUMERS FROM EXCESSIVE, 1 UNJUSTIFIED, OR UNFAIRLY DISCRIMINA- 2 TORY RATES. 3 (a) PROTECTION FROM EXCESSIVE, UNJUSTIFIED, 4 OR UNFAIRLY DISCRIMINATORY RATES.—The first sec- 5 tion 2794 of the Public Health Service Act (42 U.S.C. 6 300gg–94), as added by section 1003 of the Patient Pro- 7 tection and Affordable Care Act (Public Law 111–148), 8 is amended by adding at the end the following new sub- 9 section: 10 ‘‘(e) PROTECTION FROM EXCESSIVE, UNJUSTIFIED, 11 OR UNFAIRLY DISCRIMINATORY RATES.— 12 ‘‘(1) AUTHORITY OF STATES.—Nothing in this 13 section shall be construed to prohibit a State from 14 imposing requirements (including requirements re- 15 lating to rate review standards and procedures and 16 information reporting) on health insurance issuers 17 with respect to rates that are in addition to the re- 18 quirements of this section and are more protective of 19 consumers than such requirements. 20 ‘‘(2) CONSULTATION IN RATE REVIEW PROC- 21 ESS.—In carrying out this section, the Secretary 22 shall consult with the National Association of Insur- 23 ance Commissioners and consumer groups. 24 ‘‘(3) DETERMINATION OF WHO CONDUCTS RE- 25 VIEWS FOR EACH STATE.—The Secretary shall de- 26 VerDate Sep 11 2014 23:12 Mar 13, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6136.IH H6136 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 6136 IH termine, after the date of enactment of this section 1 and periodically thereafter, the following: 2 ‘‘(A) In which markets in each State the 3 State insurance commissioner or relevant State 4 regulator shall undertake the corrective actions 5 under paragraph (4), based on the Secretary’s 6 determination that the State regulator is ade- 7 quately undertaking and utilizing such actions 8 in that market. 9 ‘‘(B) In which markets in each State the 10 Secretary shall undertake the corrective actions 11 under paragraph (4), in cooperation with the 12 relevant State insurance commissioner or State 13 regulator, based on the Secretary’s determina- 14 tion that the State is not adequately under- 15 taking and utilizing such actions in that mar- 16 ket. 17 ‘‘(4) CORRECTIVE ACTION FOR EXCESSIVE, UN- 18 JUSTIFIED, OR UNFAIRLY DISCRIMINATORY 19 RATES.—In accordance with the process established 20 under this section, the Secretary or the relevant 21 State insurance commissioner or State regulator 22 shall take corrective actions to ensure that any ex- 23 cessive, unjustified, or unfairly discriminatory rates 24 VerDate Sep 11 2014 23:12 Mar 13, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6136.IH H6136 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 6136 IH are corrected prior to implementation, or as soon as 1 possible thereafter, through mechanisms such as— 2 ‘‘(A) denying rates; 3 ‘‘(B) modifying rates; or 4 ‘‘(C) requiring rebates to consumers. 5 ‘‘(5) NONCOMPLIANCE.—Failure to comply with 6 any corrective action taken by the Secretary under 7 this subsection may result in the application of civil 8 monetary penalties under section 2723 and, if the 9 Secretary determines appropriate, make the plan in- 10 volved ineligible for classification as a qualified 11 health plan.’’. 12 (b) CLARIFICATION OF REGULATORY AUTHORITY.— 13 Such section is further amended— 14 (1) in subsection (a)— 15 (A) in the heading, by striking ‘‘PRE- 16 MIUM’’ and inserting ‘‘RATE’’; 17 (B) in paragraph (1), by striking ‘‘unrea- 18 sonable increases in premiums’’ and inserting 19 ‘‘potentially excessive, unjustified, or unfairly 20 discriminatory rates, including premiums,’’; and 21 (C) in paragraph (2)— 22 (i) by striking ‘‘an unreasonable pre- 23 mium increase’’ and inserting ‘‘a poten- 24 VerDate Sep 11 2014 23:12 Mar 13, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6136.IH H6136 pamtmann on DSKBC07HB2PROD with BILLS 5 •HR 6136 IH tially excessive, unjustified, or unfairly dis- 1 criminatory rate’’; 2 (ii) by striking ‘‘the increase’’ and in- 3 serting ‘‘the rate’’; and 4 (iii) by striking ‘‘such increases’’ and 5 inserting ‘‘such rates’’; and 6 (2) in subsection (b)— 7 (A) by striking ‘‘premium increases’’ each 8 place it appears and inserting ‘‘rates’’; and 9 (B) in paragraph (2)(B), by striking ‘‘pre- 10 mium’’ and inserting ‘‘rate’’. 11 (c) CONFORMING AMENDMENTS.—Title XXVII of 12 the Public Health Service Act (42 U.S.C. 300gg et seq.) 13 is amended— 14 (1) in section 2723 (42 U.S.C. 300gg–22), as 15 redesignated by the Patient Protection and Afford- 16 able Care Act— 17 (A) in subsection (a)— 18 (i) in paragraph (1), by inserting 19 ‘‘and section 2794’’ after ‘‘this part’’; and 20 (ii) in paragraph (2), by inserting ‘‘or 21 section 2794’’ after ‘‘this part’’; and 22 (B) in subsection (b)— 23 (i) in paragraph (1), by inserting 24 ‘‘and section 2794’’ after ‘‘this part’’; and 25 VerDate Sep 11 2014 23:12 Mar 13, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6136.IH H6136 pamtmann on DSKBC07HB2PROD with BILLS 6 •HR 6136 IH (ii) in paragraph (2)— 1 (I) in subparagraph (A), by in- 2 serting ‘‘or section 2794 that is’’ after 3 ‘‘this part’’; and 4 (II) in subparagraph (C)(ii), by 5 inserting ‘‘or section 2794’’ after 6 ‘‘this part’’; and 7 (2) in section 2761 (42 U.S.C. 300gg–61)— 8 (A) in subsection (a)— 9 (i) in paragraph (1), by inserting 10 ‘‘and section 2794’’ after ‘‘this part’’; and 11 (ii) in paragraph (2)— 12 (I) by inserting ‘‘or section 13 2794’’ after ‘‘set forth in this part’’; 14 and 15 (II) by inserting ‘‘and section 16 2794’’ after ‘‘the requirements of this 17 part’’; and 18 (B) in subsection (b)— 19 (i) by inserting ‘‘and section 2794’’ 20 after ‘‘this part’’; and 21 (ii) by inserting ‘‘and section 2794’’ 22 after ‘‘part A’’. 23 (d) APPLICABILITY TO GRANDFATHERED PLANS.— 24 Section 1251(a)(4)(A) of the Patient Protection and Af- 25 VerDate Sep 11 2014 23:12 Mar 13, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6136.IH H6136 pamtmann on DSKBC07HB2PROD with BILLS 7 •HR 6136 IH fordable Care Act (Public Law 111–148), as added by sec- 1 tion 2301 of the Health Care and Education Reconcili- 2 ation Act of 2010 (Public Law 111–152), is amended by 3 adding at the end the following: 4 ‘‘(v) Section 2794 (relating to reason- 5 ableness of rates with respect to health in- 6 surance coverage).’’. 7 (e) AUTHORIZATION OF APPROPRIATIONS.—There 8 are authorized to be appropriated to carry out this Act, 9 such sums as may be necessary. 10 (f) EFFECTIVE DATE.—The amendments made by 11 this section shall take effect on the date of enactment of 12 this Act and shall be implemented with respect to health 13 plans beginning not later than January 1, 2021. 14 Æ VerDate Sep 11 2014 23:12 Mar 13, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6301 E:\BILLS\H6136.IH H6136 pamtmann on DSKBC07HB2PROD with BILLS