5 states with strict premium rate review processes:
Illinois passed a law in June that establishes a premium rate review process. Starting in 2026, the state’s insurance department will approve or deny proposed rate increases for the individual and small group markets.
Texas created a rate review program in 2021 that allows the state’s insurance commissioner to establish rules for reviewing and rejecting rate changes, creates a dispute resolution process for payers, and requires that proposed rate increases are open for public comment.
Rhode Island uses “affordability standards” to assess rate increase requests, including a cap on price increases for inpatient and outpatient services in payer-provider contracts to no more than annual inflation plus 1 percent.
Iowa requires payers to notify members when it requests a rate increase that exceeds the average annual health spending growth rate published by CMS. Iowa law also requires a public hearing and approval, disapproval or adjustment of proposed rates by the state’s insurance commission.
Oregon compares payers’ rates to their competitors’ premiums, along with administrative costs.
