Insurers are no longer treading lightly with premium increases.

Saying that they are paying out more in medical costs than they are receiving in premiums from their members, insurers are dramatically hiking rates for the plans they offer through the federal and state Affordable Care Act marketplaces.

Some of the biggest proposed increases were recently highlighted in The New York Times:

• Blue Cross Blue Shield of Tennessee: 63 percent.

• Blue Cross Blue Shield of Texas: 60 percent.

• Blue Cross Blue Shield of Oklahoma: 49 percent.

• Humana in Michigan: 39 percent.

• Humana in Missouri: 34 percent.

For now, those are merely requests that have to be approved by government regulators. In 46 states, that task is left to the state insurance commissioner, but in Oklahoma, Texas, Wyoming and Missouri, the Obama administration has determined that there is not sufficient state oversight of rate hikes, and so it will be federal regulators who will have the final say on premiums.