Health Plan

 Those buying insurance on the exchanges were shocked and angered when they realized that not only could they not keep their health plan but they also could not keep their physician. To control higher-than- expected medical costs, insurers narrowed their provider networks, requiring enrollees to use network physicians and hospitals. Further, the benchmark Silver plan kept changing as insurers entered and exited the market. To avoid higher premiums, enrollees had to keep switching insurers, which also included changing their provider networks, including their physicians.

The Obama administration claimed that it would “bend the cost curve.” Instead, the ACA increased the rate of growth of medical expenditures. In the years before the ACA, there was a slowdown in the annual percentage increase in health expenditures. The slowdown was generally attributed to the recession and the growth of high- deductible health plans. The ACA’s expanded coverage resulted in an increase in use of services and higher prices, both of which increased per capita and total healthcare spending. Health expenditures increased from 17.2 percent of the gross domestic product in 2013 to 17.9 percent in 2016. On a per capita basis, health expenditures, adjusted for inflation, increased from 1.7 percent annually in the six-year period before the ACA was enacted to 3.2 percent annually for the three-year period from 2014 to 2016. Premiums in the highly volatile nongroup market increased, on average, 8 percent in 2016 and 21 percent in 2017. Some cities experienced very high premium increases; in Phoenix, they rose 145 percent.