The Great Recession followed the collapse on Wall Street in the fall of 2008. People lost their jobs, homes, and life savings. People were reluctant to take off from work to see their doctor. Banks stopped lending and business came to a stand-still. Restaurants and stores were empty. Hospitals closed services and in some cases closed completely or merged with larger corporations. Many small doctor practices closed or merged with large medical enterprises. The closure of small medical practices was not only due to the recession. This is because insurance companies steered incentive bonus reimbursement for quality care to the larger medical corporate entities, according to a Wall Street Journal article, written by an advisor to President Obama.

The Affordable Care Act (Obama Care) was signed into law on March 22, 2010. It regulated insurance contracts to include preexisting conditions, pregnancy care and preventive health care. It was supposed to lower health insurance premiums, but for eighty-five percent of the country, premiums rose sharply in order to pay for mandatory covered benefits. Many found that their doctor and hospital network were no longer covered by their insurance plan. Often their deductibles set at five to ten thousand dollars per year, precluded having any insurance coverage. For those with chronic illness, whose insurance no longer covered needed medicines, they were stuck paying the high list prices. However, insurance companies that covered these medicines seem to pay a much lower price, negotiated through national drug benefit managers.

Government statistics and private research groups like the Kaiser foundation did show a leveling off of premiums and a reduction in the number of uninsured Americans. The latter signed onto expanded Medicaid enrollments, such as in New Jersey, or onto federally subsidized exchanges where government funds paid most of the premium cost. The working poor qualified for these subsidies. Obamacare did cap out of pocket spending. But that did little to relieve those in the middle class who could no longer afford premiums, had high deductibles, or whose needed medicine lost coverage. Charity care paid to hospitals by state funds was also cut, as uninsured patients would now be covered by expanded Medicaid enrollment or by healthcare exchanges. For proponents of Obamacare, their biggest regret was in not getting a government run health exchange option to compete with private insurance companies on exchanges. Those who opposed the law foresaw the destabilization of the health insurance market leading to rising premiums for the middle and higher classes.