Some states have the power to reject rates before they take effect. HHS has awarded $44 million in grants to help states bolster rate review, though it has not required them to pursue prior-approval authority. Another $200 million in grants will be awarded later.

The insurance industry says the focus on premiums ignores the real reason they’re going up — rising healthcare costs.

“Focusing on health insurance premiums while ignoring underlying medical cost drivers will not make health care coverage more affordable for families and employers,” America’s Health Insurance Plans said in a statement. “The public policy discussion needs to be enlarged to focus on the soaring cost of medical care that threatens our economic competitiveness, our public safety net, and the affordability of health care coverage.”

When the rate review regulation was first proposed, insurers were rankled by the fact that a 10 percent premium increase was the trigger for federal review. They said it seemed arbitrary — that a 10 percent increase might be reasonable in some cases and excessive in others.

That standard will remain in place for the first year of the new rules, after which HHS will transition to state-based benchmarks.

“We’re very comfortable that at this point the 10 percent is a reasonable threshold and the right number,” Larsen said.

HHS delayed the effective date of the federal rate review rules until September. They were previously slated to take effect in July.

This post was updated at 2:07 p.m.