The Center for American Progress (CAP), a leading Democratic think tank, has outlined a plan to lower health care costs and ban insurers from requiring pre-treatment approvals. The plan includes setting up a federal rate review process that presumes any premium increases above general medical cost trends are excessive. It also proposes limiting hospital prices in "concentrated markets" to no more than three times what Medicare pays. The proposal also includes overhauling the Affordable Care Act's "medical loss ratio" so insurer profits won't rise when costs are higher, limited by a cap per enrollee or percentage of premiums collected for a market. The report also recommends a short-term guardrail around insurers paying pharmacies and providers they own, and suggests breaking up these health care conglomerates in the long run. This shift in Democratic policy reflects a shift from their decades-long quest to expand coverage.