As exchanges created under the Affordable Care Act enter their third year of operation, Professor Robert Field discussed trends that are emerging under the complex law as a guest on WHYY’s Radio Times on Nov. 24.

While an estimated 17 million previously uninsured Americans now have health care coverage, Field said, “this is really a brave new world for insurance companies.”

Accustomed to selling insurance to employers who in turn provide coverage to hundreds or thousands of employees, carriers now find themselves selling to individuals, Field said.

“Traditionally, they’ve tried to avoid the individual market,” Field said, noting that the companies are still figuring out how to price their plans and some are threatening to withdraw from the exchanges.  

Many consumers are confronted with higher deductibles and narrowing networks of physicians, specialists and hospitals, Field said, noting that premiums are increasing as much as 30 percent in some states, while Pennsylvania rates have risen by a more modest 4 percent for popular plans.

“Competition works,” he said. “Where there’s less competition, you see less pressure on prices.”

Wall Street Journal reporter Louise Radnofsky, who also took part in the discussion, noted that high deductibles for some plans create a disincentive for many consumers.

While insurers seek to reduce costs by covering young and healthy customers, Field said, significant numbers of young adults are opting to skip the premiums, pay less costly fines and then take advantage of exceptions permitted for “life changes” such as marriage, divorce or moving to a different state to sign up outside of open enrollment periods.  

“There are always possibilities to game the system,” he said. “That’s one of the dangers when you use the private sector instead of a single payer system.”

Field is an internationally recognized authority on health policy and health care law who writes about related topics at the Philadelphia Inquirer’s Health Cents blog.