One of the many ongoing battles over the Patient Protection and Affordable Care Act (PPACA) involves the federal minimum medical loss ratio (MLR) standards for private insurers. Under this provision, health insurance plans in the small group market are required to spend at least 80 percent of premiums on medical costs and no more than 20 percent on administrative costs (15 percent for the large group market). If a plan fails to meet the minimum MLR standard, the insurer is required to pay rebates to enrollees and policyholders.