Geography in California is expected to play a larger role in the cost of health insurance under the Affordable Care Act. Under the ACA, insurers no longer can deny coverage based on pre-existing conditions or place lifetime limits on medical care. They also cannot charge older policyholders more than three times what younger enrollees pay. Observers say that these restrictions leave geography as one of the only factors that insurers can use to adjust premiums. The federal government has proposed that states avoid creating more than seven geographic rating areas to prevent insurers from charging excessively high rates in certain regions. However, California’s health exchange has proposed using 19 rate-setting regions to accommodate the state’s size and diversity according to a recent report at California Healthline.