Much has been said about the formularies, cost-sharing, and patient burden required of enrollees on the ACA health insurance exchanges. Deductibles averaged nearly $3,000 for silver plans on the exchanges, and cost-sharing for specialty drugs can often reach 40 percent or higher. None of this is new, and this is a trend going on outside of the exchanges, in the employer-sponsored market as well. According to the Kaiser Family Foundation, employer plans now have deductibles averaging over $1,000 and a small, but growing share of plans use coinsurance rather than copays even for physician visits. Fundamentally, this means that patients are more involved in their health care decision-making.