I 
111TH CONGRESS 
2D SESSION 
H. R. 4757 
To provide for the establishment of a Health Insurance Rate Authority 
to establish limits on premium rating, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 4, 2010 
Ms. SCHAKOWSKY (for herself, Ms. BALDWIN, Mrs. CAPPS, Mr. CONYERS, Ms. 
DELAURO, Mr. FILNER, Mr. FRANK of Massachusetts, Mr. AL GREEN 
of Texas, Mr. GENE GREEN of Texas, Mr. GRIJALVA, Ms. HARMAN, Mr. 
HARE, Ms. LEE of California, Ms. MOORE of Wisconsin, Ms. SUTTON, 
Mr. WEINER, Ms. WATSON, Ms. WOOLSEY, and Mr. MARKEY of Massa-
chusetts) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce 
A BILL 
To provide for the establishment of a Health Insurance Rate 
Authority to establish limits on premium rating, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Insurance Rate 
Authority Act of 2010’’. 
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SEC. 2. ENSURING THAT CONSUMERS GET VALUE FOR 
THEIR DOLLARS. 
(a) IN GENERAL.—Part C of title XXVII of the Pub-
lic Health Service Act (42 U.S.C. 300gg–91 et seq.) is 
amended by adding at the end the following: 
‘‘SEC. 2793. ENSURING THAT CONSUMERS GET VALUE FOR 
THEIR DOLLARS. 
‘‘(a) INITIAL RATE REVIEW PROCESS.— 
‘‘(1) IN GENERAL.— 
‘‘(A) ESTABLISHMENT.—The Secretary, in 
conjunction with States, shall establish a uni-
form process for the review, beginning with the 
2011 plan year, of potentially unreasonable in-
creases in rates for health insurance coverage, 
which shall include premiums. 
‘‘(B) ELECTRONIC REPORTING.—The proc-
ess established under subparagraph (A) shall 
include an electronic reporting system estab-
lished by the Secretary through which health in-
surance issuers shall— 
‘‘(i) report to the Secretary and State 
insurance commissioners the information 
requested by the Secretary pursuant to 
this subsection; and 
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‘‘(ii) submit data to the uniform data 
collection system in accordance with para-
graph (6)(A). 
‘‘(C) AUTHORITY OF STATES.—Nothing in 
subparagraph (A) or (B) shall be construed to 
prohibit a State from imposing additional re-
quirements on health insurance issuers with re-
spect to increases in rates for health insurance 
coverage, including with respect to reporting in-
formation to a State. 
‘‘(2) JUSTIFICATION
AND
DISCLOSURE.—The 
process established under paragraph (1) shall re-
quire health insurance issuers to submit to the Sec-
retary and the relevant State a justification for a po-
tentially unreasonable rate increase prior to the im-
plementation of the increase. Such issuers shall 
prominently post such information on their Internet 
websites. The Secretary shall ensure the public dis-
closure of information on such increases and jus-
tifications for all health insurance issuers. 
‘‘(3) HEALTH INSURANCE RATE AUTHORITY.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
establish a Health Insurance Rate Authority 
(referred to in this paragraph as the ‘Author-
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ity’) to be composed of 7 members to be ap-
pointed by the Secretary, of which— 
‘‘(i) at least 2 members shall be a 
consumer advocate with expertise in the in-
surance industry; 
‘‘(ii) at least 1 member shall be an in-
dividual 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 manage-
ment, 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 du-
ties of the Authority set forth in this sub-
section, the Authority shall advise and make 
recommendations to the Secretary concerning 
the Secretary’s duties under this subsection. 
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‘‘(4) CORRECTIVE ACTION FOR UNREASONABLE 
RATE INCREASES.— 
‘‘(A) IN GENERAL.—Pursuant to the pro-
cedures set forth in this paragraph, the Sec-
retary or the relevant State insurance commis-
sioner shall— 
‘‘(i) in accordance with the process es-
tablished under paragraph (1), review po-
tentially unreasonable increases in rates 
and determine whether such increases are 
unreasonable; and 
‘‘(ii) take action to ensure that any 
rate increase found to be unreasonable 
under clause (i) is corrected, through 
mechanisms including— 
‘‘(I) denial of the rate increase; 
‘‘(II) modification of the rate in-
crease; 
‘‘(III) ordering rebates to con-
sumers; or 
‘‘(IV) any other actions that cor-
rect for the unreasonable increase. 
‘‘(B) REQUIRED
REPORT; DEFINITION.— 
The Secretary shall ensure that, not later than 
6 months after the date of enactment of this 
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section, 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 Sec-
retary and the Authority— 
‘‘(i) a report on— 
‘‘(I) State authority to review 
rates and take corrective action in 
each insurance market, and meth-
odologies 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; and 
‘‘(ii)(I) a recommended definition of 
unreasonable rate increase, which shall 
consider a lack of actuarial justification for 
such increase; and 
‘‘(II) other recommended definitions 
for the purposes of carrying out this sub-
section. 
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‘‘(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 this section and 
periodically thereafter— 
‘‘(i) for which States the State insur-
ance commissioner shall undertake the ac-
tions described in subparagraph (A)— 
‘‘(I) based on the Secretary’s de-
termination that the State has suffi-
cient 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), in consultation with the 
relevant State insurance commissioner, 
based on the Secretary’s determination 
that such States lack the authority and ca-
pability described in clause (i). 
‘‘(D) TRANSITION PERIOD.—Until the Sec-
retary makes the determinations described in 
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subparagraph (C), the relevant State insurance 
commissioner shall, as a condition of receiving 
a grant under subsection (c)(1), carry out the 
actions described in subparagraph (A) to the 
extent permissible under State law. 
‘‘(5) PRIORITIZING
POTENTIALLY
UNREASON-
ABLE
RATE
INCREASES
FOR
REVIEW.—The Sec-
retary or the relevant State insurance commissioner 
may prioritize— 
‘‘(A) rate increases that will impact large 
numbers of consumers; 
‘‘(B) rate reviews requested from States, if 
applicable; and 
‘‘(C) rate reviews in the individual and 
small group markets. 
‘‘(6) ANNUAL REPORT.— 
‘‘(A) UNIFORM
DATA
COLLECTION
SYS-
TEM.—The Secretary, in consultation with the 
Association and the Authority, shall develop, 
and may contract with the Association to oper-
ate, a uniform data collection system for new 
and increased rate information, which shall in-
clude information on rates, medical loss ratios, 
consumer complaints, solvency, reserves, and 
any other relevant factors of market conduct. 
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‘‘(B) 
PREPARATION
OF
ANNUAL
RE-
PORT.—Using the data obtained in accordance 
with subparagraph (A), the Authority shall an-
nually produce a single, aggregate report on in-
surance market behavior, which includes at 
least State-by-State information on rate in-
creases from one year to the next, including by 
health insurance issuer and by market and in-
cluding medical trends, benefit changes, and 
relevant demographic changes. 
‘‘(C) DISTRIBUTION.—The Authority shall 
share the annual report described in subpara-
graph (B) with States, and include such report 
in the information disclosed to the public. 
‘‘(b) CONTINUING RATE REVIEW PROCESS.—As a 
condition of receiving a grant under subsection (c)(1), a 
State, through the applicable State insurance commis-
sioner, shall provide the Secretary with information about 
trends in rate increases in health insurance coverage in 
premium rating areas in the State, in accordance with the 
uniform data collection system established under sub-
section (a)(6)(A). 
‘‘(c) GRANTS IN SUPPORT OF PROCESS.— 
‘‘(1) RATE
REVIEW
GRANTS.—The Secretary 
shall carry out a program to award grants to States 
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beginning with fiscal year 2010 to assist such States 
in carrying out subsection (a), including— 
‘‘(A) in reviewing and, if appropriate under 
State law, approving or taking corrective action 
with respect to rate increases for health insur-
ance coverage; and 
‘‘(B) in providing information to the Sec-
retary under subsection (b). 
‘‘(2) FUNDING.— 
‘‘(A) IN GENERAL.—There is authorized to 
be appropriated to the Secretary $250,000,000, 
to be available for expenditure for grants under 
paragraph (1). 
‘‘(B) ALLOCATION.—The Secretary shall 
establish a formula for determining the amount 
of any grant to a State under this subsection. 
Under such formula— 
‘‘(i) the Secretary shall consider the 
number of plans of health insurance cov-
erage offered in each State and the popu-
lation of the State; and 
‘‘(ii) no State qualifying for a grant 
under paragraph (1) shall receive more 
than $5,000,000 for a grant year. 
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‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—In ad-
dition to the amount authorized under subsection (c)(2), 
there are authorized to be appropriated to carry out this 
section $5,000,000 for fiscal year 2010 and such sums 
as may be necessary for each subsequent fiscal year.’’. 
(b) ENFORCEMENT.—Title XXVII of the Public 
Health Service Act (42 U.S.C. 300gg et seq.) is amend-
ed— 
(1) in section 2722— 
(A) in subsection (a)— 
(i) in paragraph (1), by inserting 
‘‘and section 2793’’ after ‘‘this part’’; and 
(ii) in paragraph (2), by inserting ‘‘or 
section 2793’’ after ‘‘this part’’; and 
(B) in subsection (b)— 
(i) in paragraph (1), by inserting 
‘‘and section 2793’’ after ‘‘this part’’; and 
(ii) in paragraph (2), by inserting ‘‘or 
section 2793’’ after ‘‘this part’’ each place 
such term appears; and 
(2) in section 2761— 
(A) in subsection (a)— 
(i) in paragraph (1), by inserting 
‘‘and section 2793’’ after ‘‘this part’’; and 
(ii) in paragraph (2)— 
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(I) by inserting ‘‘or section 
2793’’ after ‘‘set forth in this part’’; 
and 
(II) by inserting ‘‘and section 
2793’’ after ‘‘the requirements of this 
part’’; and 
(B) in subsection (b)— 
(i) by inserting ‘‘and section 2793’’ 
after ‘‘this part’’; and 
(ii) by inserting ‘‘and section 2793’’ 
after ‘‘part A’’. 
(c) EFFECTIVE DATE.—The amendment made by 
this section shall take effect on the date of enactment of 
this Act. 
Æ 
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