article_snippet: ACA's push toward offloading risk onto hospitals rather than insurers is encouraging hospital consolidation, with large hospital corporations seeking to build economies of scale to offset future risk  
article_snippet: This trend may drive up costs as hospitals face less competition.
article_snippet: Meanwhile consumers shopping the exchange plans can select from few in-network hospitals and physicians, again making the health care marketplace less competitive.
article_snippet: The United States may be graced with institutions offering stellar care in complex conditions that attract patients across state lines as well as across the world, centers that contribute to medicine generally through as well research and training.
article_snippet: But going out of state to seek such care isn't an option for many patients on exchange plans.  
article_snippet: Some rather fundamental revisions lie ahead, like a forthcoming administrative decision on whether to continue allowing state variability among the prescribed Essential Health Benefits it covers.