ObamaCare’s impact on health costs.

Three of the nation’s largest insurance companies – Aetna, Humana and UnitedHealth – have let researchers have a look at the negotiated prices they pay for services and procedures like C-sections, MRIs and hospital stays. This includes claims data for 88 million customers and $682 billion of healthcare bills. For a long time, economists like Martin Gaynor have believed the more hospitals merge, the more their monopoly power helps them drive prices up. Until now though, the evidence has been limited to single states or hospitals that have merged and it often relied on the sticker price listed by hospitals. This analysis is different because it comes from hospitals coast to coast and uses the actual amount insurers paid.

A Plain Dealer analysis of plans offered through healthcare.gov, the exchange website, shows that deductibles, co-pays, and co-insurance expenses are putting up significant barriers to accessing medical care, particularly for middle-income earners. The average deductible for a silver-level plan – among the most affordable options for someone with medical needs – is $3,561 in Cuyahoga County for a 40-year-old male earning $30,000, according to the analysis. The maximum annual out-of-pocket expense for that individual averages $6,277.

Under ObamaCare, most health insurance plans must cover a set of preventive services without any cost to patients. Patients are soon discovering, however, that anything else discussed during a visit with their health care providers could cost them. “There are times when a person might be charged cost-sharing for a service that is unrelated to the screening or preventive service, while they are not charged cost-sharing for the screening or preventive service itself,” says Jesse Bushman, director of advocacy and government affairs at the American College of Nurse-Midwives. But doctors don’t always tell patients about the possibility of fees up front.

The 2015 United Auto Workers union contracts with General Motors Co., Ford Motor Co. and Fiat Chrysler Automobiles NV allow the companies to alter hourly-worker health plans if they are likely to trigger a 40% federal tax on some high-cost health-care plans. The most likely change: adding yearly deductibles for affected workers.

ObamaCare plans have substantially raised the amount of cost sharing they require for drugs. Often they don’t cover any specialty drug costs until a patient has hit their deductible. There is also the issue of the dwindling number of specialty drugs that health plans include in their formularies, and provide any coverage for. Almost all of the “Silver” plans offered under ObamaCare sport closed drug formularies, where there’s no coverage for drugs not listed on the narrow formulary lists. This means when a drug doesn’t make a health plans list, consumers are completely uncovered.

Individuals who do not obtain health coverage, through any source, are subject to a tax penalty unless they meet certain exemptions. The penalties under the so-called individual mandate were phased in over a three-year period starting in 2014 and are scheduled to increase substantially in 2016. This analysis from the Kaiser Family Foundation provides estimates of the share of uninsured people eligible to enroll in the marketplaces who will be subject to the penalty, and how those penalties are increasing for 2016.

Those without health in­sur­ance have a lot to con­sider. On one hand, the fine for re­main­ing un­in­sured steeply in­creases for next year. On the oth­er, the cost of the in­di­vidu­al man­date pen­alty is cheap­er than buy­ing the least ex­pens­ive in­sur­ance plan for 7.1 mil­lion of the nearly 11 mil­lion un­in­sured eli­gible to en­roll in health ex­changes, ac­cord­ing to a Kais­er Fam­ily Found­a­tion ana­lys­is re­leased Wed­nes­day.

The penalty for failing to have health insurance is going up next year, perhaps even higher than expected. Among uninsured individuals who are not exempt from the ObamaCare penalty, the average household fine for not having insurance in 2015 will be $661, rising to $969 per household in 2016, according to a Kaiser Family Foundation analysis.

An increasing number of preferred provider plans (PPOs) offered under the health care law have no ceiling for out-of-network costs, leaving policyholders facing unlimited financial exposure. Forty-five percent of the silver level PPO plans coming to the market for the first time in 2016 provide no annual cap for policyholders’ out-of-network costs, an analysis by the Robert Wood Johnson Foundation finds.

Democrats like to talk a lot about being the party of choice, but under Obamacare, individuals are finding their choices increasingly limited. At its core, Obamacare forces individuals to purchase government-approved insurance policies and precludes them from buying plans that might be more in line with their healthcare needs. Though Obamacare’s defenders argue that the requirements imposed on health insurance plans only serve to guarantee that individuals have better coverage, in reality, what’s happening is that the law is driving insurers to limit choices.