But the gamble is not paying off, and as a result, many hospitals are trying to collect before the bills are due, providing patients with care cost estimates before the fact and offering no-interest loans or perhaps discounts for prepayment.

The strategy isn’t foolproof, of course, with some patients deciding not to have whatever treatment is under discussion or at least to postpone it. And that can lead to worse, and more expensive, care needs down the road.

And it looks as if this trend is likely to continue. Even if the Trump administration succeeds in dismantling the ACA, as it intends to do, high-deductible plans, the report says, aren’t going anywhere — which means people will continue to be saddled with hefty bills even if they’re covered by a policy. And they may not have much choice in the matter.

The report says, “Republicans also believe high-deductible plans curb spending, and Americans faced with medical costs that rise faster than inflation and wages will look for premiums they can afford.”

And that means high deductibles.

Related: Uninsured rate on its way back up

Hospitals are fighting back against the resulting unpaid bills by trying to collect up front, since lack of payment is loading them up with non-collectable debt. According to the report, the up-front billing trend is expected to accelerate this year, pushed along by those “unpaid bills [that] are creating massive bad debt for even the most prestigious medical centers.” It adds, “U.S. hospitals had nearly $36 billion in uncompensated care costs in 2015, according to the industry’s largest trade group, a figure that is largely made up of unpaid patient bills.”

Government data indicate that the average deductible this year for the cheapest, widely used health plans available through the ACA is $6,000 for an individual — a jump of 18 percent since 2014—and more than twice that for a family.