I 

112TH CONGRESS 

1ST SESSION H. R. 416 

To 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 

JANUARY 25, 2011 

Ms. SCHAKOWSKY (for herself, Mr. ANDREWS, Mrs. CAPPS, Ms. DELAURO, 

Mr. DOGGETT, Mr. ELLISON, Mr. FARR, Mr. FRANK of Massachusetts, 

Mr. GARAMENDI, Mr. GENE GREEN of Texas, Mr. GRIJALVA, Ms. HARMAN, Ms. HIRONO, Mr. KILDEE, Ms. LEE of California, Mr. LEVIN, Mr. 

MARKEY, Mr. GEORGE MILLER of California, Ms. MOORE, Mr. RANGEL, 

Ms. SPEIER, Mr. STARK, Ms. SUTTON, Mr. TONKO, Mr. WAXMAN, Ms. 

WOOLSEY, and Mr. PALLONE) 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 protections for consumers against excessive, unjustified, or unfairly discriminatory increases in premium rates. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Health Insurance Rate 

5 Review Act’’. 


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1 SEC. 2. PROTECTION OF CONSUMERS FROM EXCESSIVE, 

2 UNJUSTIFIED, OR UNFAIRLY DISCRIMINA3 TORY RATES. 

4 (a) PROTECTION FROM EXCESSIVE, UNJUSTIFIED, 

5 OR UNFAIRLY DISCRIMINATORY RATES.—The first sec6 tion 2794 of the Public Health Service Act (42 U.S.C. 

7 300gg–94), as added by section 1003 of the Patient Pro8 tection and Affordable Care Act (Public Law 111–148), 

9 is amended by adding at the end the following new sub10 section: 

11 ‘‘(e) PROTECTION FROM EXCESSIVE, UNJUSTIFIED, 

12 OR UNFAIRLY DISCRIMINATORY RATES.— 

13 ‘‘(1) AUTHORITY OF STATES.—Nothing in this 

14 section shall be construed to prohibit a State from 

15 imposing requirements (including requirements re16 lating to rate review standards and procedures and 

17 information reporting) on health insurance issuers 

18 with respect to rates that are in addition to the re19 quirements of this section and are more protective of 

20 consumers than such requirements. 

21 ‘‘(2) CONSULTATION IN RATE REVIEW PROC22 ESS.—In carrying out this section, the Secretary 

23 shall consult with the National Association of Insur24 ance Commissioners and consumer groups. 

25 ‘‘(3) DETERMINATION OF WHO CONDUCTS RE26 VIEWS FOR EACH STATE.—The Secretary shall deVerDate Mar 15 2010 02:48 Feb 02, 2011 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H416.IH H416

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1 termine, after the date of enactment of this section 

2 and periodically thereafter, the following: 

3 ‘‘(A) In which States the State insurance 

4 commissioner or relevant State regulator shall 

5 undertake the corrective actions under para6 graph (4), as a condition of the State receiving 

7 the grant in subsection (c), based on the Sec8 retary’s determination that the State is ade9 quately prepared to undertake and is ade10 quately undertaking such actions. 

11 ‘‘(B) In which States the Secretary shall 

12 undertake the corrective actions under para13 graph (4), in cooperation with the relevant 

14 State insurance commissioner or State regu15 lator, based on the Secretary’s determination 

16 that the State is not adequately prepared to un17 dertake or is not adequately undertaking such 

18 actions. 

19 ‘‘(4) CORRECTIVE ACTION FOR EXCESSIVE, UN20 JUSTIFIED, OR UNFAIRLY DISCRIMINATORY

21 RATES.—In accordance with the process established 

22 under this section, the Secretary or the relevant 

23 State insurance commissioner or State regulator 

24 shall take corrective actions to ensure that any ex25 cessive, unjustified, or unfairly discriminatory rates 


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1 are corrected prior to implementation, or as soon as 

2 possible thereafter, including through mechanisms 

3 such as— 

4 ‘‘(A) denying rates; 

5 ‘‘(B) modifying rates; or 

6 ‘‘(C) requiring rebates to consumers.’’. 

7 (b) CLARIFICATION OF REGULATORY AUTHORITY.— 

8 Such section is further amended— 

9 (1) in subsection (a)— 

10 (A) in the heading, by striking ‘‘PRE11 MIUM’’ and inserting ‘‘RATE’’; 

12 (B) in paragraph (1), by striking ‘‘unrea13 sonable increases in premiums’’ and inserting 

14 ‘‘potentially excessive, unjustified, or unfairly 

15 discriminatory rates, including premiums,’’; and 

16 (C) in paragraph (2)— 

17 (i) by striking ‘‘an unreasonable pre18 mium increase’’ and inserting ‘‘a poten19 tially excessive, unjustified, or unfairly dis20 criminatory rate’’; 

21 (ii) by striking ‘‘the increase’’ and in22 serting ‘‘the rate’’; and 

23 (iii) by striking ‘‘such increases’’ and 

24 inserting ‘‘such rates’’; 

25 (2) in subsection (b)— 


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1 (A) by striking ‘‘premium increases’’ each 

2 place it appears and inserting ‘‘rates’’; and 

3 (B) in paragraph (2)(B), by striking ‘‘pre4 mium’’ and inserting ‘‘rate’’; and 

5 (3) in subsection (c)(1)— 

6 (A) in the heading, by striking ‘‘PRE7 MIUM’’ and inserting ‘‘RATE’’; 

8 (B) by inserting ‘‘that satisfy the condition 

9 under subsection (e)(3)(A)’’ after ‘‘award 

10 grants to States’’; and 

11 (C) in subparagraph (A), by striking ‘‘pre12 mium increases’’ and inserting ‘‘rates’’. 

13 (c) CONFORMING AMENDMENT.—Title XXVII of the 

14 Public Health Service Act (42 U.S.C. 300gg et seq.) is 

15 amended— 

16 (1) in section 2723 (42 U.S.C. 300gg–22), as 

17 redesignated by the Patient Protection and Afford18 able Care Act— 

19 (A) in subsection (a)— 

20 (i) in paragraph (1), by inserting 

21 ‘‘and section 2794’’ after ‘‘this part’’; and 

22 (ii) in paragraph (2), by inserting ‘‘or 

23 section 2794’’ after ‘‘this part’’; and 

24 (B) in subsection (b)— 


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1 (i) in paragraph (1), by inserting 

2 ‘‘and section 2794’’ after ‘‘this part’’; and 

3 (ii) in paragraph (2)— 

4 (I) in subparagraph (A), by in5 serting ‘‘or section 2794 that is’’ after 

6 ‘‘this part’’; and 

7 (II) in subparagraph (C)(ii), by 

8 inserting ‘‘or section 2794’’ after 

9 ‘‘this part’’; and 

10 (2) in section 2761 (42 U.S.C. 300gg–61)— 

11 (A) in subsection (a)— 

12 (i) in paragraph (1), by inserting 

13 ‘‘and section 2794’’ after ‘‘this part’’; and 

14 (ii) in paragraph (2)— 

15 (I) by inserting ‘‘or section 

16 2794’’ after ‘‘set forth in this part’’; 

17 and 

18 (II) by inserting ‘‘and section 

19 2794’’ after ‘‘the requirements of this 

20 part’’; and 

21 (B) in subsection (b)— 

22 (i) by inserting ‘‘and section 2794’’ 

23 after ‘‘this part’’; and 

24 (ii) by inserting ‘‘and section 2794’’ 

25 after ‘‘part A’’. 


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1 (d) APPLICABILITY TO GRANDFATHERED PLANS.— 

2 Section 1251(a)(4)(A) of the Patient Protection and Af3 fordable Care Act (Public Law 111–148), as added by sec4 tion 2301 of the Health Care and Education Reconcili5 ation Act of 2010 (Public Law 111–152), is amended by 

6 adding at the end the following: 

7 ‘‘(v) Section 2794 (relating to reason8 ableness of rates with respect to health in9 surance coverage).’’. 

10 (e) EFFECTIVE DATE.—The amendments made by 

11 this section shall take effect on the date of enactment of 

12 this Act. 

Æ 


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