Obamacare established the Medical Loss Ratio – the 80/20 Rule – which forced health insurance companies to devote more premium dollars to medical care for policyholders, as opposed to administrative costs. When insurers don't meet these requirements, they have to issue refunds to policyholders. In 2021, more than $2 billion in rebate checks were sent to American consumers.
The ACA also requires Medicare Advantage plans to spend at least 85% of revenue on medical costs and quality improvements, although rebates in the case of non-compliance are issued to the federal government instead of enrollees.