Recently, five more States strengthened their laws protecting consumers in disputes with their health insurance plans. The District of Columbia, Massachusetts, New Hampshire, Ohio and Wisconsin have bolstered their laws surrounding the part of the appeals process known as “external review.” These five States join 33 others that provide these State-based external review protections that ensure consumers have a voice. The remaining States’ consumers are protected by a Federal process. The strengthened appeals rights are one of several common-sense consumer protections and insurance market reforms established by the Affordable Care Act.