<P> While health insurance premium costs have moderated, some of this is because of insurance policies that have a higher deductible, co-payments and out - of - pocket maximums that shift costs from insurers to patients . In addition, many employees are choosing to combine a health savings account with higher deductible plans, making the impact of the ACA difficult to determine precisely . </P> <P> For those who obtain their insurance through their employer ("group market"), a 2016 survey found that: </P> <Ul> <Li> Deductibles grew by 63% from 2011 to 2016, while premiums increased 19% and worker earnings grew by 11% . </Li> <Li> In 2016, 4 in 5 workers had an insurance deductible, which averaged $1,478 . For firms with less than 200 employees, the deductible averaged $2,069 . </Li> <Li> The percentage of workers with a deductible of at least $1,000 grew from 10% in 2006 to 51% in 2016 . The 2016 figure drops to 38% after taking employer contributions into account . </Li> </Ul> <Li> Deductibles grew by 63% from 2011 to 2016, while premiums increased 19% and worker earnings grew by 11% . </Li>

How many amendments were there to the affordable care act