Sherri Stoddard is a registered nurse who works in San Luis Obispo County, and serves on the board of directors of the 86,000-member California Nurses Association, which supports Proposition 45.

As a registered nurse, I've seen patients pay the price for immorally high costs that health insurance companies charge for needed medical care. I've seen patients who own small businesses cry over whether they should leave the hospital against their doctor's advice because they can't afford to miss a day of work. They worry their insurer will hike premiums so much that they can't afford to insure their families, let alone any employees.  

Health insurance premiums in California have risen 185 percent since 2002 — five times faster than the rate of inflation. Price gouging is rampant in California because health insurance companies charge whatever they like.

Proposition 45 would change that, and that's why health insurance companies are spending $37.5 million campaigning against it. They know Proposition 45 will stop thievery and save tens of billions of dollars.

Federal law now requires all of us to buy health insurance. But California is one of the few states that does not guarantee that it must be affordable. Propositioin 45 creates that guarantee for the individuals and small businesses that must buy their own health insurance, and often suffer the most.

Proposition 45 gives California the authority to reject excessive rate hikes and ensure that patients don't have to make choices between doctor-recommended treatments and basic necessities like food, clothing or utilities. It extends the same protections to Californians that already exist in 35 other states that have the power to stop this price gouging.

Recently, regulators deemed $250 million in proposed rate hikes for individuals and small businesses "unreasonable," but they had no power under state or federal law to stop them.

Proposition 45 requires health insurance companies to justify rate hikes and get permission before raising rates on 6 million individuals and small businesses. It enhances the ability of our new health benefit exchange, Covered California, to negotiate rates. In states that have these regulations, like Oregon, Maryland and New York, policyholders recently saw big rate cuts in their exchanges because insurance regulators ordered lower rates than what was negotiated.

Proposition 45 makes the elected insurance commissioner the umpire over whether rate hikes are excessive. It creates transparency and accountability, including requiring health insurance company CEOs to request permission for rate hikes under penalty of perjury.

Health insurance companies are falsely claiming that voluntary government negotiation is enough to keep rates as low as possible on our new health benefits exchange. Yet, their track record shows that they plan to keep, and grow, billions of dollars in excess reserves by charging individuals and small businesses more, while including fewer doctors in network, and charging higher co-pays and deductibles.

Proposition 45 creates rate regulation that will complement government purchasing and lower rates for all individuals and small businesses anyplace they buy insurance, without affecting benefits or quality of care. The free market has proved to be incapable of constraining health insurance company greed, particularly when four huge companies control the market.

Proposition 45 simply extends to health insurance rates the successful regulation for auto and home insurance that voters enacted in 1988. California drivers now pay less in real dollars for insurance than they did 25 years ago — the only state with such success. And California has one of the most competitive auto insurance markets in America.

Key to auto insurance reform's success was not only creation of the office of elected insurance commissioner, directly accountable to the voters for lower rates, but also the same consumer participation system that applies to electricity rates. Consumers can challenge unreasonable auto, home and business insurance rate hikes. Since 2012, more than $3 billion in proposed rate hikes have been stopped by consumer group challenges.

The rate relief provided by voter-enacted insurance reform has proved an undeniable consumer triumph for drivers, homeowners and businesses. It has saved them more than $100 billion.

Californians now required to buy health insurance under federal law deserve no less.