The bill, titled the "McCarran-Ferguson Restoration Act," eliminates the Federal Insurance Office (FIO) and its Director within the Department of the Treasury, replacing it with a new United States Insurance Representative (USIR). This USIR is tasked with coordinating federal efforts on prudential aspects of international insurance matters and representing the U.S. Treasury in international forums like the International Association of Insurance Supervisors.

The USIR's duties also include assisting the Secretary in negotiating "covered agreements" and administering the Terrorism Insurance Program. The Representative is mandated to consult with states, including state insurance regulators, on national and international insurance issues, with authority extending to prudential aspects of all lines of insurance, excluding health, most long-term care, and crop insurance.

A key provision grants the USIR limited authority to preempt state insurance measures, but only if a state measure treats a non-United States insurer less favorably than a U.S. insurer and is inconsistent with a covered agreement. The bill outlines a detailed process for preemption determinations, including notification, consultation with states and the U.S. Trade Representative, public comment, and a waiting period before effectiveness.

Crucially, the bill includes several rules of construction to limit the USIR's power, explicitly stating that it does not grant general supervisory or regulatory authority over the business of insurance. It also clarifies that the USIR cannot preempt state measures related to rates, premiums, underwriting, sales practices, coverage requirements, state antitrust laws, or most capital and solvency regulations, thus preserving the primary role of state insurance regulation.

Finally, the legislation amends the Dodd-Frank Act to remove the FIO Director from the Financial Stability Oversight Council (FSOC), replacing this position with the new United States Insurance Representative as a voting member. Significantly, the bill also adds a Presidentially-appointed State insurance commissioner to the FSOC, providing a direct voice for state-level insurance regulation in federal financial stability discussions.