The U.S. Government Accountability Office (GAO) came to the conclusion that most U.S. health insurers are responding to the new federal medical loss ratio (MLR) rules by cutting, or planning to cut, brokers' commissions.

The MLR provision in the Patient Protection and Affordable Care Act of 2010 (PPACA) has taken effect and requires insurers to spend 85% of large group premiums and 80% of individual and small group premiums on health care and quality improvement. Insurers that miss this mark are supposed to pay customer rebates.

"Almost all of the insurers we interviewed were reducing brokers' commissions and making adjustments to premiums in response to the PPACA MLR requirements," John Dicken, a GAO director, writes in a summary of the GAO's findings. "These insurers said that they have decreased or plan to decrease commissions to brokers in an effort to increase their MLRs."

The first full set of data subject to the MLR requirements will be for this year and will be ready in 2012, but some insurers have helped by preparing preliminary PPACA MLR data for 2010.