Riley Leads Bipartisan Bill to Lower Health Costs & Protect Patients | US Rep. Josh Riley

WASHINGTON — Representative Josh Riley (D-NY-19) and Representative Tom Barrett (D-MI-07) announced a bipartisan effort on March 20 to compel health insurance companies to allocate a greater portion of premium revenue to patient care. The lawmakers are co-leading the Care Over Profits Act (H.R. 7861), which aims to increase the Medical Loss Ratio (MLR) requirement and curb fraudulent practices within the Affordable Care Act (ACA) marketplace.

The proposed legislation would raise the MLR – the percentage of premium dollars that insurers must spend on medical care and quality improvement – from 80 percent to 85 percent. It too targets deceptive enrollment tactics, imposing penalties on agents and brokers who fraudulently create or modify ACA plans without a patient’s explicit consent, according to a press release from Riley’s office.

“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,” Riley stated. “That has to change. My bipartisan Care Over Profits Act says the money Upstate New Yorkers pay in premiums needs to proceed toward your care, where it belongs, and not to corporate profits.”

The bill’s introduction follows ongoing scrutiny of insurance company practices and concerns about access to affordable healthcare, particularly in rural communities. Riley has actively challenged insurance providers over decisions to reduce Medicare Advantage plan options in Upstate New York, requesting explanations for cuts that threatened coverage for seniors. He also supports legislation aimed at addressing Medicare reimbursement disparities affecting rural and tiny-town hospitals, and has sought federal funding for healthcare projects across his district, including upgrades to primary care facilities and expanded access to care.

The Care Over Profits Act is not the only legislative effort focused on increasing accountability for health insurers. Senator Jeff Merkley (D-OR) and Representative Val Hoyle (D-OR-04) introduced the Patients Over Profits Act in September 2025, which seeks to address conflicts of interest by requiring insurers to divest ownership of Medicare providers. That bill, co-sponsored by Senators Warren and Representatives Ryan and Jayapal, aims to prevent insurers from both providing and restricting care, a practice critics argue drives up costs and compromises patient well-being.

The American Economic Liberties Project endorsed the Patients Over Profits Act, stating that large healthcare conglomerates “jack up prices and reduce the quality of care seniors receive.”