Regulatory Agencies

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At the federal level, there are a number of important statutes applicable to healthcare insurance. The McCarran-Ferguson Act provides that even though the insuring or provision of healthcare may be national in scope, the regulation of insurance is left to the states. Likewise, the Health Maintenance Organization (HMO) Act provides that HMO’s or health service plans are regulated by the states. As a result of these two federal statutes, much of the task of health insurance regulation is left to the states.

However, in 2010, Congress passed the Dodd–Frank Wall Street Reform and Consumer Protection Act, which created the Federal Insurance Office (FIO) in the Department of the Treasury. The FIO is authorized to monitor all aspects of the insurance industry and identify any gaps in the state-based regulatory system. The Dodd-Frank Act also establishes the Financial Stability Oversight Council (FSOC), which is charged with monitoring the financial services markets, including the insurance industry, to identify potential risks to the financial stability of the United States.

The Affordable Care Act also created an agency charged with overseeing the insurance agency, called the the Center for Consumer Information and Insurance Oversight (CCIIO), which is part of the Centers for Medicare & Medicaid Services.

Below, you’ll find more information about the Center for Consumer Information and Insurance Oversight and the Federal Insurance Office:

Center for Consumer Information and Insurance Oversight: The Center for Consumer Information and Insurance Oversight  is charged with helping implement many provisions of the Affordable Care Act. CCIIO oversees the implementation of the provisions related to private health insurance, including: Ensuring compliance with new insurance market rules, such as the Patient’s Bill of Rights; Helping states review unreasonable rate increases and overseeing new Medical Loss Ratio rules; Providing oversight for the State-Based Health Insurance Exchanges and compiling data for; Administering the Consumer Assistance ProgramPre-Existing Condition Insurance Plan and Early Retiree Reinsurance Program. CCIIO works closely with governors and the state insurance commissioners, consumers, and stakeholders to ensure the new law best serves the American people.

Federal Insurance Office: The Dodd-Frank Wall Street Reform and Consumer Protection Act established Treasury’s Federal Insurance Office (FIO) and vested FIO with the authority to monitor all aspects of the insurance sector, monitor the extent to which traditionally underserved communities and consumers have access to affordable non-health insurance products, and to represent the United States on prudential aspects of international insurance matters, including at the International Association of Insurance Supervisors.