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California voters soundly rejected two hotly contested propositions Tuesday night — one that claims it would have halted excessive health care insurance rates and another that would have raised the state’s 39-year-old cap on medical malpractice damage awards.

Proposition 45 would have given the state insurance commissioner the power to reject health insurance rate hikes for about six million Californians who buy their own policies or who work for small businesses. The measure would have required health insurance companies to publicly disclose rate changes and allowed California’s insurance commissioner to control rates. Supporters said the initiative would stem skyrocketing healthcare costs. It failed to pass by a wide margin. Insurance Commissioner Dave Jones won reelection Tuesday, but he’s left with no real power over health insurance rates. Jones had invested significant political capital in campaigning for Proposition 45 and drew the ire of fellow Democrats at times for his criticism of Covered California. The commissioner called Tuesday’s vote a major setback. “Health insurers flooded Californians with $57 million worth of false television commercials, radio ads and slick mailers,” Jones said. “Our consumer coalition simply could not compete with that.” Jones’ backers see the fight returning to Sacramento. “We expect the rate regulation debate to return to the Legislature, possibly with more momentum,” said Anthony Wright, executive director of Health Access. “We will continue to advocate the simple point that patients shouldn’t have to pay premiums deemed unreasonable by regulators.”

“Prop. 45 was an ill-conceived measure that would have been a step backwards against the progress made by the Affordable Care Act and our state’s health exchange, by giving a politician power over health care decisions that should have involved doctors and their patients,” Dr. John Maa of the San Francisco Medical Society, said in a statement. “California voters saw through this deceptive measure motivated by self-interest, and opposed it wholesale.”

The Los Angeles Times laments the loss as a “boon for health insurers.” The Times went to to say that “California’s biggest health plans, led by Anthem Blue Cross and Kaiser Permanente, spent millions of dollars on ads portraying Proposition 45’s rate regulation as a threat to implementation of the health law. In a lopsided result, 60% of voters joined the industry in opposition.” Despite the stinging loss, supporters of rate regulation vowed to keep fighting on behalf of consumers in the courts, state Legislature and possibly again at the ballot box.

“It’s incredible that an industry that’s so unpopular could do so well in this election,” said Robert Laszewski, a healthcare consultant who has closely tracked California’s implementation of the health law. “Pro-Obamacare forces and anti-regulation folks formed a 60% coalition. It was a strange set of bedfellows.”

Proposition 46, which would have raised the state’s 39-year-old cap on medical malpractice damage awards, would have also required doctors to take random drug tests and mandate use of a database designed to reduce prescription drug abuse. It was a wide-ranging initiative that included raising the limit on pain and suffering damages in medical malpractice lawsuits. This proposition was also defeated Tuesday by a wide margin. Supporters had said the proposition would have detected and deterred medical negligence, over-prescribing of prescription drugs and drug and alcohol abuse by doctors and promoted justice for people who don’t have an income — including retirees, children and stay-at-home parents — who are victims of medical malpractice.

“This was a battle worth fighting. But the battle doesn’t stop here,” Bob Pack, author of Proposition 46, said in a statement released late Tuesday night. He and his wife, Carmen, lost their two children Troy and Alana as a result of medical negligence. “Our coalition will continue to press for changes to end that cycle of preventable death, to put a dent in prescription drug abuse, ensure our doctors aren’t operating under the influence and give malpractice victims a better shot at justice,” Pack said.

The defeat of Proposition 46 came after a cascade of negative advertising financed by insurance and physician groups. They warned the change would send medical costs soaring and drive doctors from the state. “In this health care environment, undermining California’s long-standing malpractice cap is a political poison pill,” Dustin Corcoran, chief executive of the California Medical Association and chairman of the No on 46 campaign, said in a statement. “Increasing payouts in medical lawsuits would have increased health care costs.” Insurance companies, hospitals and physician groups depicted the proposal as a sugar-coated pill that’s really about fattening attorneys’ wallets.