U.S. Representative Josh Riley (NY-19) is taking a stand for healthcare transparency by co-leading the bipartisan Care Over Profits Act with Rep. Tom Barrett (MI-07). This new legislation aims to ensure that more of the money families pay in premiums goes toward their actual medical care, not corporate profits.
Currently, insurance companies are required to spend 80% of their premium revenue on medical care. The proposed bill seeks to raise this figure to 85%. It also aims to penalize agents and brokers who modify Affordable Care Act marketplace plans without informing patients.
Riley expressed his frustration over the behavior of health insurance companies. “For too long, Upstate New Yorkers have been taken advantage of. Premiums are rising, claims are denied, and out-of-pocket costs are climbing. This has to change,” he said.
The Care Over Profits Act includes these key measures:
- Increased Medical Loss Ratio: Insurance companies must allocate at least 85% of premiums to actual care and quality improvements.
- Protection Against Fraud: It addresses fraudulent enrollments and changes to ACA plans without patient consent.
- Patient-Centric Focus: The bill restricts how much premium money can be used for overhead and corporate profits.
Riley is dedicated to protecting healthcare access in rural areas. He has taken action against insurance companies that limit coverage in these communities. Recently, he demanded accountability from major insurers after they cut Medicare Advantage plans, which could leave seniors with fewer options.
He is also advocating for rural hospitals, pushing for fairer Medicare reimbursement rates and supporting emergency funding to keep these institutions open. Additionally, Riley is working to secure federal funding for local health care projects, including upgrades to primary care facilities and expanded services in underserved areas.
Recent surveys indicate that nearly 70% of Americans believe healthcare costs are a major concern. This growing anxiety reflects a nationwide issue where many feel financially burdened by health insurance.
In a world where healthcare can often feel like a maze, initiatives like the Care Over Profits Act aim to simplify the process and enhance patient care.
For more details on health insurance regulations, you can visit the Centers for Medicare & Medicaid Services.
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