President Obama used the disbursement of $500 million in "medical loss ratio" (MLR) refunds to show that the Affordable Care Act "is working the way it was supposed to for middle-class Americans" at a public event at the White House July 18. The ACA's MLR provision requires health insurers that do not spend at least 80 percent of premiums on medical claims or quality improvements to refund the difference to consumers.

Senate Minority Leader Mitch McConnell (R-Ky.) fired back that the MLR rebates will be dwarfed by a new $8 billion health insurance fee imposed by ACA beginning in 2014, in addition to higher premiums for many people.

Also July 18, the Department of Health and Human Services issued its own report finding that preliminary 2014 rates released by 10 states and the District of Columbia are 18 percent lower than earlier estimates based on Congressional Budget Office forecasts.