As a former insurance commissioner I can assure you that every state and territory regulates insurance. The state/territory may not set rates, as in MA, but actuaries and financial experts on the insurance department's roster do examine rates and claims to insure companies are charging "appropriately". That leaves lots of room for rate setting at different levels but the goal is to make sure insurance companies are treating consumers fairly, using consistent underwriting standards, and that they are financially sound and able to pay claims even in adverse circumstances.