The Care Over Profits Act makes two main changes to how health insurance works in America. First, it requires insurance companies to spend more of the money they collect from premiums directly on actual medical care. Currently, insurance companies in the individual and small group markets must spend at least 80% of premium dollars on medical care; this bill raises that requirement to 85%. This means less money can go toward administrative costs and profits, and more must go toward paying for doctor visits, hospital stays, and other healthcare services. Second, the bill cracks down on fraud and dishonesty in the health insurance enrollment process. It creates new penalties for insurance agents and brokers who provide false or misleading information when people sign up for health plans through the government marketplace (Healthcare.gov and similar state exchanges). Agents and brokers who negligently provide wrong information face civil penalties between $10,000 and $50,000 per person affected. Those who knowingly and willfully commit fraud face even steeper penalties—up to $200,000 per person—plus potential criminal charges including fines and up to 10 years in prison. The goal is to ensure that insurance enrollment is honest and that insurance companies prioritize paying for actual healthcare over keeping profits.

To amend title XXVII of the Public Health Service Act and the Patient Protection and Affordable Care Act to provide for certain reforms with respect to medical loss ratios and reducing fraudulent enrollment in qualified health plans.