“Several major problems have hampered the implementation of the coverage provisions of the ACA. First was the troubled debut of the federally run insurance marketplaces and a number of state-run programs. The federal marketplaces now seem to be functioning adequately, and most states with problems have either fixed them or imported solutions from other states or the federal government. Second, a number of insured Americans were upset and surprised when companies canceled policies that did not meet minimum standards under the ACA. The numbers of canceled policies have declined over time, and cancellations have become less troublesome as better-functioning marketplaces have offered accessible and affordable alternatives.⁹ Third, some new marketplace plans restrict access to providers so as to control costs. Although surveys do not yet show widespread discontent with these restrictions, constrained provider networks could cause a consumer backlash in the future. Fourth, some persons have purchased marketplace plans with substantial deductibles and copayments in order to minimize premiums. These choices could leave them with large out-of-pocket payments and limited access to services.⁴“

Source: Blumenthal D, Abrams M, Nuzum R. The Affordable Care Act at 5 Years. N Engl J Med. 2015 Jun 18;372(25):2451-8. doi: 10.1056/NEJMhpr1503614. Epub 2015 May 6. PubMed PMID: 25946142. https://www.nejm.org/doi/full/10.1056/NEJMhpr1503614