As I've mentioned before, the health reform law explicitly empowers and encourages states to review premium rate increases by insurers to ensure that they're reasonable, given the current financial situation facing the insurer. At the very least, unreasonable rate increases prior to the opening of the exchanges in 2014 may get an insurer barred from operating in the exchanges. In addition, many states are already authorized to review and approve rate hikes (or are about to authorize themselves to do so). Here's the relevant chunk of the law: As I mentioned, in some states this builds on existing rate review structures in place in the state (for example, in 26 states and D.C. rate hikes can be rejected by state officials; other states require insurers to report rate hikes but have no authority to modify or reject them). Yesterday, the first of those premium review grants went out to 45 states and Washington, D.C. Here's how various states indicated in their grant proposals that they'll be using the award: If you want to go state-by-state to see what individual states can do right now and what they intend to use their grant money to do, you can do that here.