Except that the ACA also instututes marketplaces and enforces insurance standards, so that consumers can shop and switch between substitute services if one insurer tries to hike premiums.

Except they're ALL hiking premiums... What it comes down to is adding fiduciary responsibility to act on behalf of their clients' interest in negotiating rates, which they don't do and stopped doing.

Where I am, the 2019 marketplace has two providers, but one of them has a very limited network, so I can't do anything in network without driving at least 30 minutes. So, that's really just one provider and I get to pick which metal I like. What I really wanted to know, but couldn't tell is if I hit the out of pocket max, is there any difference in what's covered by plan.

It may be a better marketplace than before, but it's still a pretty shitty marketplace.

Rural US, right? Keep in mind that the providers in your area are also in areas where they compete with others on premium price. Just because you anecdotally don't see it doesn't mean the competition isn't happening.

Semi-rural, west puget sound, lots of Seattle commuters.

A few months ago, when I looked at buying private health insurance via the exchange in California, I had never heard of any of the insurance companies & none of them would let me see my own doctor. I was not impressed.

> A few months ago, when I looked at buying private health insurance via the exchange in California, I had never heard of any of the insurance companies

Blue Shield of CA has plans available in the full region for each of CA’s 19 pricing regions, and is the third largest insurer in the state.

Exactly right. And if you happen to have some preexisting condition, and who doesn't, individual policy prices are insane.