I 
113TH CONGRESS 
1ST SESSION H. R. 1019 
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 6, 2013 
Ms. SCHAKOWSKY (for herself, Mr. ELLISON, Mr. CONYERS, Mr. GRIJALVA, 
Ms. MOORE, Mr. RANGEL, Mr. GEORGE MILLER of California, Mr. PAL-
LONE, Ms. SLAUGHTER, Mr. GARAMENDI, Mr. COURTNEY, Mr. 
MCDERMOTT, Ms. NORTON, Mr. WAXMAN, Mr. FARR, Ms. DELAURO, 
Ms. CHU, Mr. LEVIN, Mrs. CAPPS, and Mr. DOGGETT) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce 
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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termine, after the date of enactment of this section 
and periodically thereafter, the following: 
‘‘(A) In which markets in each State the 
State insurance commissioner or relevant State 
regulator shall undertake the corrective actions 
under paragraph (4), as a condition of the 
State receiving the grant in subsection (c), 
based on the Secretary’s determination that the 
State regulator is adequately undertaking and 
utilizing such actions in that market. 
‘‘(B) In which markets in each State the 
Secretary shall undertake the corrective actions 
under paragraph (4), in cooperation with the 
relevant State insurance commissioner or State 
regulator, based on the Secretary’s determina-
tion that the State is not adequately under-
taking and utilizing such actions in that mar-
ket. 
‘‘(4) CORRECTIVE ACTION FOR EXCESSIVE, UN-
JUSTIFIED, 
OR
UNFAIRLY
DISCRIMINATORY 
RATES.—In accordance with the process established 
under this section, the Secretary or the relevant 
State insurance commissioner or State regulator 
shall take corrective actions to ensure that any ex-
cessive, unjustified, or unfairly discriminatory rates 
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are corrected prior to implementation, or as soon as 
possible thereafter, through mechanisms such as— 
‘‘(A) denying rates; 
‘‘(B) modifying rates; or 
‘‘(C) requiring rebates to consumers. 
‘‘(5) NONCOMPLIANCE.—Failure to comply with 
any corrective action taken by the Secretary under 
this subsection may result in the application of civil 
monetary penalties and, if the Secretary determines 
appropriate, make the plan involved ineligible for 
classification as a Qualified Health Plan.’’. 
(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’’; 
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(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)— 
(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 
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(B) in subsection (b)— 
(i) by inserting ‘‘and section 2794’’ 
after ‘‘this part’’; and 
(ii) by inserting ‘‘and section 2794’’ 
after ‘‘part A’’. 
(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) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this Act, 
such sums as may be necessary. 
(f) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of enactment of 
this Act and shall be implemented with respect to health 
plans beginning not later than January 1, 2014. 
Æ 
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