A sneak peek at America 2014 from the Ghost of Christmas Future. It’s not the premiums that are killing these people, although those are higher in some cases too. It’s the out-of-pocket costs. The media coverage of O-Care has paid less attention to those for the simple reason that no one’s actually incurred them yet. That’ll change on Thursday.

Insurance broker Michael Harp said small businesses, part of what’s known in the industry as the “small group market,” are used to seeing health insurance premiums climb about 10 percent a year, but it’s never before been this dramatic. For Extreme Dodge to have kept deductibles and out-of-pocket costs at last year’s levels, he said, would have cost the dealership almost 50 percent more than last year.

Harp says what is happening at this dealership is representative of the other small businesses he deals with. Businesses with 50 or fewer employees currently provide health insurance to about 17 million U.S. workers, according to the National Association of Insurance Commissioners.

He said the biggest surprise to him in how the law impacts small business clients is “how many people are losers versus winners. … There are some people who do come out ahead, but I would say the overwhelming majority, they’re paying much higher rates and they have lower benefits.”

The dealership’s old policy didn’t comply with O-Care requirements so it was canceled. A new policy would have been too expensive for the company to sponsor, so instead they handed their employees $2,400 apiece and wished them luck on the exchanges. Will that pay for the premium hikes and the higher deductibles? Probably not (especially once the new ObamaCare excise tax on premiums takes effect), but that’s all the company says it can afford to give. The employees themselves can, of course, opt for cheaper plans on the exchange to keep their costs down, but that brings us to the other post-New-Year’s ObamaCare landmine — namely, shrinking provider networks. According to the Journal, some doctors have seen a huge crunch in December of patients scheduling tests and treatments before New Year’s because that doctor isn’t in the network for their new O-Care plan in January. I thought that was a problem limited to rural areas where there aren’t many doctors to begin with, but no, evidently this is systemic. And it doesn’t affect just the cheap “bronze” plans either:

Some 70% of new plans under the health law offer relatively narrow networks compared with many current plans, according to a recent McKinsey & Co. report…

The recognition by some consumers that their new plans won’t always cover the facilities or doctors they want is triggering the boomlet in last-minute procedures, say health-care providers.

UT Southwestern Medical Center in Dallas has seen requests for complicated imaging tests and colonoscopies rise in recent weeks, said Bruce Meyer, an executive vice president. Barnes-Jewish Hospital in St. Louis has seen “dozens” of patients push up elective orthopedic surgeries, a spokeswoman said. Cedars-Sinai Health System, a top teaching hospital excluded from most exchange plans in the Los Angeles market, said it has fielded thousands of calls from people concerned about losing access and wanting to schedule elective procedures before Dec. 31.

Per the WSJ, more than two-thirds of “silver” plans “sharply reduce” the number of hospitals available to consumers as compared to their current plans. So there’s the consolation prize for the dealership workers: Sure, they’re paying more than they used to, but they’re getting … less choice than they used to as well. It’s going to be a long year.

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