Washington (AFP) - Just days before the US elections, it is an unwelcome surprise.
As they prepare to choose their next president on November 8, millions of Americans are learning that the health care promised them in landmark legislation driven by President Barack Obama will be even more expensive next year, that they must switch to new health insurance carriers -- or both.
And in electoral battleground states, where polling suggests Democrat Hillary Clinton and Republican Donald Trump are locked in tight races, the pinch consumers are feeling is at least as sharp as elsewhere.
In the crucial state of Florida, as in many other states, insurance companies have pulled out, citing financial losses in the newly created marketplaces. As another result, monthly premiums may rise by an average of 19 percent.
The story is similar in other swing states. In Ohio, a traditional bellwether for the presidency, Republican officials including Lieutenant Governor Mary Taylor have attacked Obamacare, as it is known, claiming that premiums have risen as much as 91 percent since the policy was introduced.
States like Arizona and Georgia -- once unthinkable territory for Democrats but where the Clinton camp now believes it can compete with Trump -- reportedly may see eye-popping annual price hikes of 68 percent and 33 percent, respectively.
Polling has consistently found the public to be narrowly divided over Obamacare. Health care is the fourth most important issue for voters in the current election cycle, according to the Pew Research Center.
"I am going to fix it because I agree with you," Clinton said during a debate with Trump earlier this month. "Premiums have gotten too high."
Though his position has evolved over time, Trump most recently called for the Obamacare law to be scrapped in favor of free-market solutions, deregulation and lump-sum federal assistance to states.
Analysts say however that the general picture for Obamacare is brighter than such developments may suggest and that the number of people likely to experience painful disruptions is comparatively small.
Sixty percent of Americans receive health care insurance through their employers. Only 16 percent purchase their own individual policies, a subset of whom do so on the exchanges created under Obamacare.
"There's a lot of political hullabaloo around a relatively small sliver of the population," said Larry Levitt of the Kaiser Family Foundation, a health policy group.
"It's about 11 million people nationally out of a population of about 300 million."
Furthermore, of those 11 million, about 9.2 million receive public support to defray the costs of care, with many not liable to see any out-of-pocket increase for insurance at all, according to Levitt.
With Trump in open war with his own party and repeatedly buffeted by revelations about his taxes and allegations of sexual misconduct, health care has not emerged as driving issue in the campaign.
But in key places where the vote is balanced on a knife's edge, and with health care such a polarizing issue, unhappiness over Obamacare may be influential, according to Levitt.
"Over the next few weeks, people will be getting renewal notices from their insurers and some may be finding that their insurer is exiting the market or raising premiums substantially," he said.
"Getting a letter in the mail can make it very tangible for someone," said Levitt. "There could be some places where news of plan exits and premium increases could create a talking point."
- Critical voter turnout -
Unlike other developed nations which offer universal health care coverage, the United States has long received health insurance in a complex hodge-podge of ways, with many covered by commercial plans, others eligible for social programs like Medicaid and Medicare -- and millions of others left uninsured.
In Obama's 2010 reforms, the government moved to broaden coverage, requiring individuals to hold health policies and offering subsidies to lower-income consumers to help them pay.
The law has faced relentless opposition from Republicans.
Its proponents insist it is working: About 20 million people gained health insurance, reducing the share of those uncovered to 9.1 percent, the lowest level ever, and people may no longer be denied coverage merely because they are sick or pregnant.
But as insurers have dropped out of the Obamacare marketplaces and premiums have risen, Clinton and Obama have both conceded the difficulties and called for more reforms -- including the so-called "public option" in which state-supported insurers could offer care where for-profit carriers have withdrawn.
Julia Clark, a pollster at Ipsos, said health care frustrations could help drive voter turnout in the election, with even unaffected voters motivated by the cost of care.
"Turnout could be critical," she said. "I don't think that the rising price issue is something that will be isolated to those directly impacted."