(By Robert F. Graboyes, adjunct professor of health economics in the U.Va.. School of Nursing) State insurance commissioners have long seen themselves as protectors of the public's wallets – the officials who say "no" to insurers' requests to increase health insurance premiums. It has not yet sunk in that on this coming New Year's Day, the Affordable Care Act will flip the commissioners' motives upside-down, prompting them to approve and even encourage premium increases.