More people gained health insurance as a result of the health law's requirement that young adults can stay on a parent's plan until age 26. But employers increasingly steered workers and families into high-deductible health plans, which come with lower monthly premiums but require patients to pay a greater share of their bills out of their own pockets. That's a disincentive to go to the doctor.
Although some insurers are currently seeking big premium increases for certain plans, it's not clear that's a widespread trend.
The slowdown in health care spending has been widely debated. Some experts see it as an echo-chamber effect of a weak economy. Others say cost controls by government and employers are starting to have an effect. Many believe costs need to be squeezed more.
"I think it's a big opening," said Ken Thorpe, a professor of health policy at Emory University in Atlanta, who served in the Clinton administration as a senior adviser. "If we have a debate on entitlement reform this year, we need to come up with ideas for pulling costs out of the system."
Cutting payments to hospitals and doctors won't solve the problem, said Thorpe. The challenge is to slow the spread of chronic illnesses such as diabetes while also finding ways to keep patients healthier and out of the hospital.
The numbers back up Thorpe's observation. Health care spending is highly skewed toward the sickest people. Five percent of patients account for nearly half the total spending in any given year.