For the past two years, the Affordable Care Act has required health insurers to pay out a minimum percentage of premiums in the form of medical claims or quality improvement expenses—known as a medical loss ratio (MLR). Insurers with MLRs below the minimum must rebate the difference to consumers. This issue brief finds that total rebates for 2012 were 513million,halftheamountpaidoutin2011,indicatinggreatercompliancewiththeMLRrule.Spendingonqualityimprovementremainedlow,atlessthan1percentofpremiums.Insurerscontinuedtoreducetheiradministrativeandsalescosts,suchasbrokers′fees,withoutincreasingprofitmargins,foratotalreductioninoverheadof1.4 billion. In the first two years under this regulation, total consumer benefits related to the medical loss ratio—both rebates and reduced overhead—amounted to more than $3 billion