While ACA advocates point out the law’s stabilizing effects on health care inflation, a closer look shows that many workers continue to languish under burdensome out-of-pocket expenses.

Rising costs have caused considerable financial duress for large portions of the workforce. More than one-quarter of workers say health care expenses have forced them to reduce contributions to their retirement plans; half say the costs eat into overall savings; and 27 percent say they’ve exhausted their savings in order to cover health care costs.

For others, the consequences are direr: One-quarter say out-of-pocket costs made it difficult to cover such basics as food, heat and housing. Workers have done everything from leveraging credit card debt and borrowing money to delaying retirement and taking early withdrawals or loans from their retirement plans. Often, they drop other insurance benefits to curtail costs; just about one in 10 said they have purchased additional insurance to reduce expenses.

Most workers dissatisfied with system

Most workers appear to think little of the country’s health care system — almost two in three rate it as fair or poor, while a small minority say it is very good or excellent.

“Here we are, six years after passage of the ACA, and most people think the system is lacking,” says Paul Fronstin, director of health, research and education at EBRI and the economist who leads the annual study.

Fronstin says the nation’s general dissatisfaction with the health care system explains, at least in some part, President-elect Donald Trump’s surprise victory.

“When is enough enough?” asks Fronstin. “When half of workers say they’ve had to decrease savings to cover medical expenses, that would go some way toward explaining the election’s outcome.”

EBRI’s study reveals some contradictions. While most workers are dissatisfied with the system as a whole, most actually like their workplace benefits: Half say they are extremely or very satisfied with their current plans, and another 39 percent said they are somewhat satisfied.

To explain the contradiction, Fronstin uses a political metaphor.

“People say they don’t like the health care system, but they are generally happy with what they have,” he says. “It’s kind of like when people say Washington is broken but they like their congressman.”

Evidence of disengagement

While out-of-pocket expenses have stabilized for half the workforce, says Fronton, overall frustration with the system remains.

Beyond gauging workers’ affinity — or lack thereof -- for the general market, EBRI’s survey also analyzes how people are addressing their dissatisfaction, and rising costs in particular.

Some of EBRI’s data suggest workers are actually less engaged in their health care than in recent years.

In 2009, for instance, 85 percent of respondents said they would control costs by taking better care of themselves. This year, that number dropped to 73 percent.

In 2006, 80 percent said they would opt for generic drugs more often; in 2016, only 55 percent said they would do the same.

And the number of people who say they would search for cheaper insurance to control costs has been relatively stable over the past decade; this year, 26 percent said they intended to price-shop their plan.

“We’re not seeing a lot of behavior change, and it’s hard to say why that is,” says Fronstin. “For instance, obesity levels are at all-time highs. It raises the questions of what’s actually being done – why aren’t habits changing?”

One possible explanation is human nature.

“For a lot of people, engaging in your health is difficult,” Fronstin says. “Maybe it’s easier to be frustrated and put the blame somewhere else.”

Without question, he says, some portion of the electorate brought their frustration to the polling booths on Election Day.

“Maybe we got to the point where electing someone else was more convenient than actually engaging with the current health care system,” says Fronstin.

“Most people seem to think that something needs to be done,” he adds. “And now they’re likely to see change happen.”