Voters have soundly defeated an attempt to raise California's cap on medical malpractice damage awards, after physician and insurance groups poured tens of millions of dollars into the opposition campaign.

California voters on Tuesday shot down a ballot initiative that sought to expand the state insurance commissioner's authority after health insurance companies poured millions of dollars into advertising to fight it.

Opponents of Proposition 45 say the measure, which would give the state insurance commissioner authority over proposed health insurance rates, could interfere with Covered California.

The outcomes of Tuesday's midterm elections could have a significant effect on health care policy, Modern Healthcare reports.

Health insurance premiums for Covered California's Small Business Health Options Program (SHOP) have been proposed and submitted to state regulators.

Moving to close what many see as a major loophole in Affordable Care Act rules, the Obama administration will ban large-employer medical plans from qualifying under the law if they don't offer hospitalization coverage.