For far too many families and small business owners in the United States, the cost of health insurance, driven by health care prices, is already too high — and prices keep rising. Fortunately, states can help rein in health insurance prices by strengthening health insurance rate review laws, including giving consumers a voice in the rate review process. State insurance regulators can also take steps to constrain hospital and health care provider price increases that are built into health insurance rates. Although health care advocates frequently face challenges as they work to strengthen rate review laws, several states are leading the way to overcome these barriers. For example, with advocates’ involvement, Illinois lawmakers enacted legislation to strengthen their state’s health insurance rate review law in 2023.1 Using Illinois as a model, advocates in other states can work to strengthen their state laws and procedures. This paper describes goals and approaches to help address high and rising health insurance prices and the underlying provider prices that are driving unaffordable care. It also describes the political challenges that advocates should be prepared to face and can be used as a road map to creating a robust rate review process that can help lower health care costs and increase the financial security of families.