"Consumers Union commends HHS for establishing standard rules with respect to fair health insurance premiums, which will apply uniformly to both the individual and small group markets inside and outside Exchanges.... Consumers Union encourages HHS to add ... language that makes explicit that a state may decline using tobacco use as a rating factor altogether, in addition to permitting states to use a ratio narrower than 1.5:1.... Consumers Union believes that relying solely on 'state-specific' thresholds 'based on factors impacting rate increases in a State' will be unlikely to prod issuers or providers to control costs."

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