August 28, 2015
Contact: Dan Weber
Edwards and Clyburn Lead Letter to HHS on Enforcing Reviews of Insurance Premium Increases
Washington. D.C. – Reps. Donna F. Edwards (MD-4) and James E. Clyburn (SC-6) today sent a letter with sixteen fellow Members of Congress to Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell.  In 2010, Rep. Edwards worked with Rep. Clyburn and others to include Section 104 in the Affordable Care Act “to prevent price gouging by enabling state insurance commissioners to review private insurers’ premium increase.”  The letter asks HHS to clarify how the Department is implementing this provision with state insurance commissioners and within the federal exchange.  The text of the letter is below.
“I was so proud that a provision I championed to address price gouging, Section 104, was included in the Affordable Care Act back in 2010,” Edwards said.  “Consumers in Maryland and across the country have saved millions of dollars in health care premiums because of the protections and oversight this provision provides.  Today’s letter to the Department of Health and Human Services (HHS) seeks to ensure that HHS and state insurance commissioners are using this authority to prevent excessive premium increases to its fullest extent.  I thank Rep. Clyburn and my Congressional colleagues for their leadership on this issue, and look forward to continuing to work with them to protect millions of American consumers.”
“I have called the Affordable Care Act the Civil Rights Act of the 21st Century because it ends discrimination in health care,”Clyburn said.  “All civil rights laws must be implemented vigorously by the Executive Branch for them to have their intended impact.  HHS must use all tools at its disposal to ensure that the ACA continues to provide access to affordable health insurance to millions of Americans.”
The letter is signed by Representatives Ted Deutch (FL-21), Eleanor Holmes Norton (DC), Sheila Jackson Lee (TX-18), Brenda L. Lawrence (MI-14), Betty McCollum (MN-4), Luis V. Gutierrez (IL-4), Michelle Lujan Grisham (NM-1), Raúl M. Grijalva (AZ-3), Cedric Richmond (LA-2), Mark Pocan (WI-2), Dina Titus (NV-1), Chris Van Hollen (MD-8), Lucille Roybal-Allard (CA-40), Paul Tonko (NY-20), Sanford D. Bishop (GA-2), and Jan Schakowsky (IL-9).
August 28, 2015
The Honorable Sylvia M. Burwell
Secretary U.S. Department of Health & Human Services
200 Independence Ave, SW
Washington, DC 20201
Dear Secretary Burwell:
            Congratulations on the continued success of the Affordable Care Act (ACA) and the recent Supreme Court decision to ensure that millions of Americans receive affordable health care through the federal exchange. Today, we write with concern reflected in recent news reports that health insurance companies are seeking substantial rate increases for the 2016 health enrollment season. Reported rate increases of as much as 40 percent could undermine the success of the ACA. We want to make certain that the Department of Health and Human Services (HHS) is doing everything in its power to ensure that health insurance companies are justifying any such rate increases.
Back in 2010, we championed the effort to include Section 104 of the Affordable Care Act to prevent price gouging by enabling state insurance commissioners to review private insurers’ premium increases beginning in 2010. This provision, better known as the Sunshine on Price Gouging by Health Insurance Issuers provision, guarantees transparency on rates and also enables state insurance commissioners to recommend to the National Insurance Commissioner whether a particular insurer should participate in the Health Insurance Exchange, taking into account excessive or unjustified premium increases in making that determination. Section 104 seeks to hold private insurers (both inside and outside of the Exchange) accountable, and ensure affordability for working American families. Under the ACA, millions of Americans have saved more than $9 billion on health care premiums and we look forward to that continuing. 
In practice, health insurance companies must justify to the state in which they operate premium hikes of over 10 percent and then disclose this information on both state websites and The ACA requires “issuers to submit a justification for any premium increases prior to implementation of the increase.” Several states have effective rate review programs that have already prevented unjustified rate hikes. However, other states have not used this authority effectively and, in those cases, the federal government is supposed to step in.
As you are aware, at the federal level the provision requires HHS to conduct an annual review of increases in premiums for health insurance coverage. This annual review requires insurers to submit a justification for any premium increases prior to implementation. As health insurance companies seek rate increases for the 2016 enrollment season, we hope you are requiring them to meet this requirement by justifying their proposed increases. 
It would be helpful to clarify the guidance given by HHS to state insurance commissioners as well as the guidelines for determining and how HHS is implementing this authority within the federal exchange. We look forward to hearing from you and working with you and HHS to ensure that Section 104 continues to be the consumer tool it was intended to be. Thank you for your attention to this matter.