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 pre-
mium 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. HAR-
MAN, 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 re-
ferred 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-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Insurance Rate 
Review Act’’. 
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SEC. 2. PROTECTION OF CONSUMERS FROM EXCESSIVE, 
UNJUSTIFIED, OR UNFAIRLY DISCRIMINA-
TORY RATES. 
(a) PROTECTION FROM EXCESSIVE, UNJUSTIFIED, 
OR UNFAIRLY DISCRIMINATORY RATES.—The first sec-
tion 2794 of the Public Health Service Act (42 U.S.C. 
300gg–94), as added by section 1003 of the Patient Pro-
tection and Affordable Care Act (Public Law 111–148), 
is amended by adding at the end the following new sub-
section: 
‘‘(e) PROTECTION FROM EXCESSIVE, UNJUSTIFIED, 
OR UNFAIRLY DISCRIMINATORY RATES.— 
‘‘(1) AUTHORITY OF STATES.—Nothing in this 
section shall be construed to prohibit a State from 
imposing requirements (including requirements re-
lating to rate review standards and procedures and 
information reporting) on health insurance issuers 
with respect to rates that are in addition to the re-
quirements of this section and are more protective of 
consumers than such requirements. 
‘‘(2) CONSULTATION
IN
RATE
REVIEW
PROC-
ESS.—In carrying out this section, the Secretary 
shall consult with the National Association of Insur-
ance Commissioners and consumer groups. 
‘‘(3) DETERMINATION OF WHO CONDUCTS RE-
VIEWS FOR EACH STATE.—The Secretary shall de-
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are corrected prior to implementation, or as soon as 
possible thereafter, including through mechanisms 
such as— 
‘‘(A) denying rates; 
‘‘(B) modifying rates; or 
‘‘(C) requiring rebates to consumers.’’. 
(b) CLARIFICATION OF REGULATORY AUTHORITY.— 
Such section is further amended— 
(1) in subsection (a)— 
(A) in the heading, by striking ‘‘PRE-
MIUM’’ and inserting ‘‘RATE’’; 
(B) in paragraph (1), by striking ‘‘unrea-
sonable increases in premiums’’ and inserting 
‘‘potentially excessive, unjustified, or unfairly 
discriminatory rates, including premiums,’’; and 
(C) in paragraph (2)— 
(i) by striking ‘‘an unreasonable pre-
mium increase’’ and inserting ‘‘a poten-
tially excessive, unjustified, or unfairly dis-
criminatory rate’’; 
(ii) by striking ‘‘the increase’’ and in-
serting ‘‘the rate’’; and 
(iii) by striking ‘‘such increases’’ and 
inserting ‘‘such rates’’; 
(2) in subsection (b)— 
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(A) by striking ‘‘premium increases’’ each 
place it appears and inserting ‘‘rates’’; and 
(B) in paragraph (2)(B), by striking ‘‘pre-
mium’’ and inserting ‘‘rate’’; and 
(3) in subsection (c)(1)— 
(A) in the heading, by striking ‘‘PRE-
MIUM’’ and inserting ‘‘RATE’’; 
(B) by inserting ‘‘that satisfy the condition 
under subsection (e)(3)(A)’’ after ‘‘award 
grants to States’’; and 
(C) in subparagraph (A), by striking ‘‘pre-
mium increases’’ and inserting ‘‘rates’’. 
(c) CONFORMING AMENDMENT.—Title XXVII of the 
Public Health Service Act (42 U.S.C. 300gg et seq.) is 
amended— 
(1) in section 2723 (42 U.S.C. 300gg–22), as 
redesignated by the Patient Protection and Afford-
able Care Act— 
(A) in subsection (a)— 
(i) in paragraph (1), by inserting 
‘‘and section 2794’’ after ‘‘this part’’; and 
(ii) in paragraph (2), by inserting ‘‘or 
section 2794’’ after ‘‘this part’’; and 
(B) in subsection (b)— 
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(i) in paragraph (1), by inserting 
‘‘and section 2794’’ after ‘‘this part’’; and 
(ii) in paragraph (2)— 
(I) in subparagraph (A), by in-
serting ‘‘or section 2794 that is’’ after 
‘‘this part’’; and 
(II) in subparagraph (C)(ii), by 
inserting ‘‘or section 2794’’ after 
‘‘this part’’; and 
(2) in section 2761 (42 U.S.C. 300gg–61)— 
(A) in subsection (a)— 
(i) in paragraph (1), by inserting 
‘‘and section 2794’’ after ‘‘this part’’; and 
(ii) in paragraph (2)— 
(I) by inserting ‘‘or section 
2794’’ after ‘‘set forth in this part’’; 
and 
(II) by inserting ‘‘and section 
2794’’ after ‘‘the requirements of this 
part’’; and 
(B) in subsection (b)— 
(i) by inserting ‘‘and section 2794’’ 
after ‘‘this part’’; and 
(ii) by inserting ‘‘and section 2794’’ 
after ‘‘part A’’. 
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(d) APPLICABILITY TO GRANDFATHERED PLANS.— 
Section 1251(a)(4)(A) of the Patient Protection and Af-
fordable Care Act (Public Law 111–148), as added by sec-
tion 2301 of the Health Care and Education Reconcili-
ation Act of 2010 (Public Law 111–152), is amended by 
adding at the end the following: 
‘‘(v) Section 2794 (relating to reason-
ableness of rates with respect to health in-
surance coverage).’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of enactment of 
this Act. 
Æ 
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