Health reform has spiked consumer interest in the individual insurance market California, but policyholders are finding shrinking benefits in the sector; in particular, plans with maternity coverage are hard to come by. The sticker shock of rising insurance premiums is creating a backlash against insurers as regulators intensify scrutiny of rate proposals. Meanwhile, small employer groups are buying down benefits to keep premiums down, and many are turning to lower-cost plans with restricted provider networks. Carriers saw little growth in their commercial books for 2009 as the economy continued to put pressure on job growth. As more people turn to Medicaid for coverage, the state is moving closer to its goal of expanding managed Medicaid to more beneficiaries in the aged, blind and disabled population, which represents 380,000 covered lives in California. In the senior market, Medicare Advantage plans are bracing for reimbursement to remain flat in 2011 and start declining in 2012, plotting a strategy that's likely to involve pullouts from high-cost counties and elimination of some optional benefits. In both the commercial and Medicare sectors, provider groups of all stripes are taking steps to become accountable care organizations when Medicare adopts this new care-coordination and payment model in 2012 for the fee-for-service population.