During the debate on health care reform, Franken was one of the strongest supporters of a single-payer system. He authored an amendment to the Patient Protection and Affordable Care Act called the Medical Loss Ratio, which required that insurance companies spend at least 80% of premiums on actual health care costs, and 85% for large group plans. On September 30, 2013, Franken voted to remove a provision that would repeal Obamacare's medical device tax from a government funding bill, saying that though he supported the provision, he disagreed with its being used as a condition for preventing the 2013 federal government shutdown.