Under the Affordable Care Act, small businesses purchasing through an exchange would see CareFirst rates rise on average about 15 percent because of rising health care costs and new taxes, fees and assessments required under health care reform, according to the insurer.

Older individuals could see decreases under the proposed rates, but Burrell has said younger people could see increases of as much as 150 percent, reflecting limits on how much rates can vary based on age.

Kaiser Permanente laid out nine plans for individuals in its proposal to state regulators, and said "the weighted average rate increase" across all is 4.3 percent. The insurer expects to offer 15 plans under the small group market at an average rate increase of 2.8 percent.

"Although some provisions of the Affordable Care Act appear likely to contribute to premium increases, others will likely contribute to reductions in premiums," the insurer said in a statement Tuesday.

State Sen. E.J. Pipkin, the Senate Republican leader, is concerned about how the state will pay to insure more people. State officials estimate that one-third of Maryland's 750,000 uninsured residents will gain coverage under the federal act in its first year.

"The fact of the matter is, no one has been able to show how we're going to nationally cover 30 million people without increasing the supply of doctors and medical providers and at the same time keep costs down," the Eastern Shore lawmaker said. "When you look at other states that have done this, if you give insurance to people who don't have insurance, they will use it."

Pipkin also criticized the plan suggested by the state to link hospital spending to the state's economy. He worried that people wouldn't get care when they need it.

"If the state hits its cap on hospital expenses and the doctors said you need a hip replacement, does that mean you don't get the hip replacement because the cap is exceeded?" Pipkin asked.

Gansler's campaign has said that he will not formally announce his plans for 2014 until the fall, but over the weekend he ruled out seeking a third term as attorney general — an alternative he previously had held open.

In January, Gansler's campaign reported $5.1 million in its account — establishing a fundraising lead over Democratic rivals to succeed Gov. Martin O'Malley. About $3 million of that was carry-over from the 2010 election, in which Gansler ran unopposed.

Lt. Gov. Anthony G. Brown, a Democrat who has declared his candidacy for governor, has made implementing the health care law a top priority.

Brown's office said he would not comment on the insurers' rate requests. His office referred questions to the Governor's Office of Health Care Reform, which is coordinating implementation of the law in the state.

Carolyn A. Quattrocki, executive director of the Governor's Office of Health Care Reform, said it was not right to comment on the hospital proposals while the rate process is under way.

"That is what the rate review process is for," Quattrocki said. "The whole process has been set up to test the assumptions that the insurance companies have put forward as a basis for their rates."

In making his announcement, Gansler showcased the owners of one small business who worry that higher insurance premiums will price them out of providing health coverage to employees.

The owners of Re Fresh Salon & Spa in Baltimore employ nine stylists, technicians and other workers, and say they have found it cost-prohibitive to provide them with insurance.

They are looking for ways to provide supplemental insurance but worry that higher premiums will keep them from doing that and prevent their employees from buying insurance on their own as well.

"When you hear you're going to be outpriced, it's not a good feeling," said JoVonne Day-Miles, co-owner of the salon.

andrea.walker@baltsun.com

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