That the Obama administration and their fellow Democrats thought that they were doing themselves a political service with their glib and incessant iterations of “if you like you doctor, you can keep your doctor” really is quite the quandary; I suppose it was worth repeating whatever attractive falsehoods they had to in order to pass their crowning legislative achievement, but oh, how heavily that crown lies now that the always very obvious eventuality of insurance companies behaving as rational actors in a wildly manipulated healthcare market is coming due.

The market’s mandated changes mean that insurers are trying to hold down costs by creating smaller, more streamlined networks than those typically available in commercial insurance, and those restrictions are going to translate into fewer options for patients — which is going to come as something of a surprise to the Americans that were assiduously assured that they would be able to keep their doctors.

As millions of new ACA health plans begin 2014 coverage on Wednesday, consumers in some parts of the country, including California, will find that the plans offered under Obamacare give them access to fewer providers than their previous plans or those offered to Americans with job-based health insurance. Narrowing networks — promising select providers higher patient volume in exchange for lower reimbursement rates — is nothing new, but as insurers compete on price in Obamacare’s new exchanges, avoiding expensive hospitals and doctors has new appeal, especially since insurers can no longer exclude sick people or charge them more. …

A recent study suggests limited provider networks could become more common in the years ahead as the ACA takes hold. A Dec. 13 McKinsey study of 20 U.S. metropolitan areas found that two-thirds of ACA plans analyzed had “narrow” or “ultra narrow” networks, with at least 30 percent of top 20 hospitals excluded for coverage. The medium premium for plans with narrower networks, according to the study, was 26 percent lower than comparable benefit packages with broad networks.

And in less populated regions than California, the effects of these smaller networks is likely to be even more acute. ObamaCare coverage has been up-and-running for almost a month now, and several Tennesseans have been experiencing the new reality firsthand, via the Free Beacon:

WSMV’s Nancy Amons reported two cases of Obamacare enrollees who have been notified that they will no longer be able to see doctors they were able to visit when they were on their previous plan.

Shawnna Simpson’s fifteen year old daughter was hurt last week in a cheerleading accident. Simpson called her family doctor and learned that they do not accept her current health insurance plan, BlueCross Network E.

“We have health insurance at this point that is worthless,” Simpson said of the plan that she pays $600 a month for. … We can’t use it in the county that we live” she said.

BlueCross Network E is a micro network – a very small network with limited doctors and hospitals. Neither Vanderbilt nor TriStar are in the network.