Regulatory shiftRegulatory constraints
In 2016 people without employer coverage bought health insurance on the exchanges created by the ACA, comparing plans from competing insurers side by side BH43. They moved to the cheapest plans and would switch insurers from one year to the next for a better deal, and because a premium depended heavily on what an insurer's hospitals charged, some insurers had begun building narrow networks around a few health systems BH43. Choice was thinning in some states: in Colorado regulators had shut down the nonprofit co-op Colorado HealthOP in October 2015, and UnitedHealthcare was leaving the state's exchange BH29. Under the ACA's risk-adjustment program, insurers with healthier members paid those with sicker members according to the risk scores each recorded, so an insurer learned its true costs only after claims were paid and scores compared BH23.