Riley Forces Insurance Companies to put Patients Over Profits

Care Over Profits Act Would Force More Premium Dollars Into Patient Care and Crack Down on Insurance Fraud

WASHINGTON, D.C. - U.S. Representative Josh Riley (NY-19) today announced he is co-leading the bipartisan Care Over Profits Act (H.R. 7861) with Representative Tom Barrett (MI-07), legislation to force health insurance companies to spend more of the money families pay in premiums on actual care. The bill would raise the required Medical Loss Ratio from 80 percent to 85 percent and impose penalties on agents and brokers who fraudulently create or modify Affordable Care Act marketplace plans without a patient's consent.

"Upstate New Yorkers are getting screwed by health insurance companies that pocket premiums as profits, deny patients' claims, and jack up out-of-pocket costs," said Riley "That has to change. My bipartisan Care Over Profits Act says the money Upstate New Yorkers pay in premiums needs to go toward your care, where it belongs, and not to corporate profits."

The Care Over Profits Act would:

1. Require insurance companies to spend at least 85 percent of premium revenue on actual medical care and quality improvement.
2. Crack down on fraudulent ACA marketplace enrollments and plan changes made without a patient's knowledge or consent.
3. Put patients first by limiting how much premium money insurers can divert to overhead and profits.

Riley has been pushing to protect access to care, keep rural hospitals open, and hold insurance companies accountable across Upstate New York. That work includes:

• Taking on insurance companies cutting coverage in rural communities. Riley demanded answers from major insurance companies after they moved to cut Medicare Advantage plans in rural parts of Upstate New York, a decision that threatened to leave seniors with fewer local coverage options.
• Fighting to keep rural hospitals open. Riley backed bipartisan legislation to address unfair Medicare reimbursement rates for rural and small-town hospitals and supported emergency funding to help struggling rural hospitals keep their doors open.
• Bringing health care funding home to Upstate New York. Riley requested federal funding for local health care projects across Upstate New York, including primary care upgrades, hospital equipment, and expanded access to care in underserved communities.

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