The Affordable Care Act requires “rate review” — state officials must review health insurance companies’ proposed rate hikes. But not all state officials have power to regulate the hikes. In California, state regulators can only challenge rate reviews on technical grounds. They do not have the authority to deny or limit rate hikes deemed excessive.

Particularly vulnerable to the high rates are small businesses and people who do not have employer-provided insurance and must buy it on their own. In California, Aetna is proposing rate increases of as much as 22 percent, Anthem Blue Cross 26 percent and Blue Shield of California 20 percent for some of those policy holders, according to the insurers’ filings with the state for 2013.

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