Sen. Mary L. Landrieu reminds feds, many health insurance agents are small business owners, too, and a new health reform provision threatens to put them out of business at a time when their clients need them most.

Landrieu, chair of the Senate Committee on Small Business and Entrepreneurship, sent a letter to Health and Human Services Secretary Kathleen Sebelius expressing concern over the medical loss ratio provision of the Affordable Care Act.

The MLR provisions require health insurance companies to spend 80 to 85 percent of premium dollars on patient care and quality improvement, leaving the remainder for marketing, administrative costs, profits, and other expenses. The goal of the provision was to ensure that insurance companies were providing the highest standard of care, but agents have taken a hit in the form of lost commissions.