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GAO Report: Early Effects of the ACA Medical Loss Ratio Requirements and Rebates on Insurers and Enrollees
U.S. Government Accountability Office [GAO] 
July 10, 2014
47 pages. "Three of the eight insurers stated that the MLR requirements were one among several factors that influenced their decisions about premium rates. Four of the eight insurers stated they had recently made changes to their payments to agents and brokers, and one reported the MLR requirements were a primary driver behind its business decision. All eight insurers GAO interviewed stated that the MLR requirements did not affect their decisions to stop offering health plans in certain markets and have had no effect or a very limited effect on their spending on quality improvement activities." [GAO-14-580, Jul. 10, 2014]
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