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The ten states participating in the Robert Wood Johnson Foundations monitoring and tracking project have enhanced their health insurance rate review programs in response to the Affordable Care Act. Although there has been significant variation among the states, all have taken steps to improve their processes to ensure that health insurance rates are justified. They have also increased transparency and expanded efforts to educate consumers about the factors underlying rate increases and involve them in the process. To a large extent, the actions taken by these states reflect the diversity of approaches to rate review that exist among states nationwide.