Health Insurance Consumer Protection Act
Bill: H.R.1890 | Sponsor: Rep. Schakowsky, Janice D. (D-IL)
Policy area: Health

Summary:
Health Insurance Consumer Protection Act  This bill requires health insurance exchanges to establish network adequacy standards for health insurance plans to meet. It also expands the review process for potentially unreasonable health insurance rates, including premiums.  The review process, which currently covers only premium increases, is expanded to include the annual review of potentially excessive, unjustified, or unfairly discriminatory rates for health care coverage. If a rate is determined to be unreasonable, the Department of Health and Human Services (HHS), or the relevant state agency, must take corrective action before, or as soon as possible after, the rate takes effect. Corrective actions may include denying or modifying a rate or requiring the insurer to issue a rebate to consumers.  HHS may apply civil monetary penalties to health insurers that fail to comply with a corrective action. Additionally, HHS may decertify the plan as a qualified health plan (i.e., a plan that is certified for sale on a health insurance exchange, is eligible for premium subsidies, and meets the requirements for minimum essential coverage).

To amend the Patient Protection and Affordable Care Act to require 
Exchanges to establish network adequacy standards for qualified health 
 plans and amend the Public Health Service Act to provide protections 
       for consumers against excessive, unjustified, or unfairly 
               discriminatory increases in premium rates.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Insurance Consumer Protection 
Act''.

                    TITLE I--NO MORE NARROW NETWORKS

SEC. 101. SHORT TITLE.

    This title may be cited as the ``No More Narrow Networks Act of 
2021''.

SEC. 102. REQUIRING EXCHANGES TO ESTABLISH NETWORK ADEQUACY STANDARDS 
              FOR QUALIFIED HEALTH PLANS.

    (a) In General.--Section 1311(d) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18031(d)) is amended by adding at the 
end the following new paragraph:
            ``(8) Network adequacy standards.--
                    ``(A) Certain exchanges.--In the case of an 
                Exchange operated by the Secretary pursuant section 
                1321(c)(1) or an Exchange described in section 
                155.200(f) of title 42, Code of Federal Regulations (or 
                a successor regulation), the Exchange shall require 
                each qualified health plan offered through such 
                Exchange to meet such quantitative network adequacy 
                standards as the Secretary may prescribe for purposes 
                of this subparagraph.
                    ``(B) State exchanges.--In the case of an Exchange 
                not described in subparagraph (A), the Exchange shall 
                establish quantitative network adequacy standards with 
                respect to qualified health plans offered through such 
                Exchange and require such plans to meet such 
                standards.''.
    (b) Effective Date.--The amendment made by this section shall apply 
with respect to plan years beginning on or after January 1, 2023.

         TITLE II--PROTECTING CONSUMERS FROM UNREASONABLE RATES

SEC. 201. SHORT TITLE.

    This title may be cited as the ``Protecting Consumers from 
Unreasonable Rates Act''.

SEC. 202. PROTECTION OF CONSUMERS FROM EXCESSIVE, UNJUSTIFIED, OR 
              UNFAIRLY DISCRIMINATORY RATES.

    (a) Protection From Excessive, Unjustified, or Unfairly 
Discriminatory Rates.--The first section 2794 of the Public Health 
Service Act (42 U.S.C. 300gg-94), as added by section 1003 of the 
Patient Protection and Affordable Care Act (Public Law 111-148), is 
amended by adding at the end the following new subsection:
    ``(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 relating to rate review standards and 
        procedures and information reporting) on health insurance 
        issuers with respect to rates that are in addition to the 
        requirements of this section and are more protective of 
        consumers than such requirements.
            ``(2) Consultation in rate review process.--In carrying out 
        this section, the Secretary shall consult with the National 
        Association of Insurance Commissioners and consumer groups.
            ``(3) Determination of who conducts reviews for each 
        state.--The Secretary shall determine, 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), 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 determination that the State is not 
                adequately undertaking and utilizing such actions in 
                that market.
            ``(4) Corrective action for excessive, unjustified, 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 excessive, unjustified, 
        or unfairly discriminatory rates 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 under section 
        2723 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 ``Premium'' and 
                inserting ``Rate'';
                    (B) in paragraph (1), by striking ``unreasonable 
                increases in premiums'' and inserting ``potentially 
                excessive, unjustified, or unfairly discriminatory 
                rates, including premiums,''; and
                    (C) in paragraph (2)--
                            (i) by striking ``an unreasonable premium 
                        increase'' and inserting ``a potentially 
                        excessive, unjustified, or unfairly 
                        discriminatory rate'';
                            (ii) by striking ``the increase'' and 
                        inserting ``the rate''; and
                            (iii) by striking ``such increases'' and 
                        inserting ``such rates''; and
            (2) in subsection (b)--
                    (A) by striking ``premium increases'' each place it 
                appears and inserting ``rates''; and
                    (B) in paragraph (2)(B), by striking ``premium'' 
                and inserting ``rate''.
    (c) Conforming Amendments.--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)--
                    (A) in subsection (a)--
                            (i) in paragraph (1), by inserting ``, 
                        section 2794,'' after ``this part''; and
                            (ii) in paragraph (2), by inserting ``, 
                        section 2794,'' after ``this part''; and
                    (B) in subsection (b)--
                            (i) in paragraph (1), by inserting ``, 
                        section 2794,'' after ``this part''; and
                            (ii) in paragraph (2)--
                                    (I) in subparagraph (A), by 
                                inserting ``, section 2794,'' after 
                                ``this part''; and
                                    (II) in subparagraph (C)(ii), by 
                                inserting ``, 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''.
    (d) Applicability to Grandfathered Plans.--Section 1251(a)(4)(A) of 
the Patient Protection and Affordable Care Act (Public Law 111-148), as 
added by section 2301 of the Health Care and Education Reconciliation 
Act of 2010 (Public Law 111-152), is amended by adding at the end the 
following:
                            ``(v) Section 2794 (relating to 
                        reasonableness of rates with respect to health 
                        insurance 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, 2023.
                                 <all>