Hawaii's employer-paid health insurance rates are going up again, which is bad for businesses and workers, but the increases ended up smaller than first proposed.

• HMSA, the state's biggest insurer, had asked for a nearly 20% rate hike but regulators pushed that down to about 15%, saying HMSA had overestimated its future losses.
• Small businesses with fewer than 50 workers got the best news: their HMSA rate increase was cut dramatically, from around 15% down to about 6%.
• Rival insurers didn't fare as well — Kaiser Permanente got a 6% increase, HMAA got about 16%, and UHA got the largest hike at nearly 20%.
• Consumer advocates remain worried, especially since HMSA covers most of the market, so its price hikes ripple across nearly every employer in the state.
• One state lawmaker is floating the idea of dropping premium taxes to let more mainland insurers compete in Hawaii, though the top state legislator opposes it over fears of bad actors entering the market.

Outlook: With an aging population and fewer young workers paying into the system, experts warn health costs will keep climbing, and some predict today's insurance system may eventually give way to bigger government programs.