The article quotes a study in Health Affairs:
Low health literacy could reduce the gains for consumers, particularly…if the consumers who do enroll face unexpected out-of-pocket expenses.
I do not have low health literacy and I find it difficult to understand health insurance plans. In a class recently, we were given various Medicare patient scenarios and then challenged to use online Medicare calculators to figure out which coverage would be best. Everyone—about 25 fourth year med students—found this to be challenging at best.
I think we are moving towards a tipping point where more direct financial relationships between physicians and patients will be necessary.