Of all the states that will have reduced health insurance offerings in 2017, Virginia doesn’t seem like one of them. When Aetna pulled out of 75 percent of its participation on the public exchange, the company still agreed to sell products in Delaware, Iowa, Nebraska, and Virginia. In 2014, Virginia had only five insurers in the state. Now, in 2017 — they will have nine.

Virginians have also lucked out on price increases, it would seem. Nobody has been harder hit than Arizona, where people living in Phoenix will likely see a stunning 145-percent increase in their prices. Residents in Birmingham, Alabama, will have to shoulder a 71-percent increase. So when compared with these other prices — Virginians and their 19.5-percent increase would seem fairly tame.

“It’s troubling enough that I’m being forced to purchase it — but I’m being forced to purchase a luxury product I don’t want,” said a woman in Arlington, Virginia.

But that’s not telling the whole story.

Karen McPadden, a self-employed physical therapist in Allston, Virginia, said she will have to absorb a 60-percent increase in her health insurance rates if she wants to stay with Blue Cross Blue Shield. Insurance companies in Virginia wanted to increase their rates by as much as 60 percent — but the federal government approved only a 25-percent increase. So many of the companies decided to eliminate their bronze plans, forcing everyone on a cheaper plan to buy a more expensive silver plan.

Before the Affordable Care Act, McPadden paid between $90 and $108 in premiums each month. She said she supported the concept of the ACA because she’s aware of the problems in the health care industry, as a health care provider herself.

“I’m willing to pay more in my health insurance premiums so that everybody can get access to health care. I’m very supportive of that. But it is called ‘affordable’ health care,” she told LifeZette.

The first year the ACA went into effect, McPadden’s insurance plan didn’t qualify under the individual mandate because it didn’t include pediatric dental care or mental health care. McPadden, who is 42, said, “I don’t have children. I’m past the childbearing years, and I haven’t needed mental health [care] up to this point. I felt very angry that I had to pay for services that weren’t at all what I needed.”

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Her premiums with the BCBS bronze plan were around $300 a month last year. Now, because the bronze plan has been eliminated, she will have to purchase a silver plan for $500 a month in premiums. That’s not a price increase she can just “absorb.”

“I just raised my rates [for physical therapy] this year substantially to cover the increase in the health care cost that I incurred last year. I can’t go back to my patients, my customers, with my hand out again,” she said. “So it will affect my business. Either I take a cut in pay to cover this health care cost — or I go back to my customers and say I need more, and potentially lose more customers.”

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Another option would be switching to an HMO plan, which doesn’t cover out-of-network expenses. Since McPadden used to work in a trauma unit, she knows how families can be blindsided by the financial burdens of out-of-network costs incurred during emergency situations. It’s a risk she’d rather not take.

Other small-business owners in Virginia are also feeling squeezed. “Prior to the ACA, we were paying $250 a month for a catastrophic plan, and our deductible was around $10,000 a year. We combined that with a health savings account,” said Jean Card, a self-employed speechwriter and small business owner in Alexandria, Virginia.

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The first year of the ACA, Card and her husband paid $800 a month in premiums. Then they paid $940 a month. Now they’ve received a letter from their insurance company saying they will have to pay $1,500 a month to remain on the same plan — with an $11,000 deductible.

“You used to be able to choose between a high deductible and a low premium. Now, because of the ACA, you have to have a high deductible and a high premium,” Card told LifeZette.

She compares it to being forced by law to pay for a luxury vehicle. “I used to say, ‘I would love a Corolla or a bicycle for health insurance’ — that was fine with me. And now I’m being told that the very minimum that’s available to me is a Lexus. And, in fact, it’s like a Lexus or a Cadillac — ‘Which one do you want?’ I don’t want either. But the law requires me to buy one or the other. I’m completely up against a wall.”

The Cards are working with an insurance broker to figure out their next step. If they switch to a different insurance company, they lose their doctors, with whom they have built relationships over the last 10 years. Keeping one’s own doctor had been a hallmark promise of the health care law, but that has not worked out for most customers. In order to find the most affordable plan, customers on the exchanges have to shop each year and be willing to switch networks.

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Other options include increasing the prices for their small business at a rate that’s higher than inflation — but Jean Card already sees them working seven days a week next year as they try to make ends meet.

“We might squeeze in a week of vacation somewhere there’s WiFi,” she said. And since she had melanoma last summer, she and her husband don’t feel comfortable foregoing insurance and absorbing the penalty instead.

“There’s no other product that the federal government forces me to buy,” Card said. “And it’s troubling enough that I’m being forced to purchase it — but I’m being forced to purchase a luxury product. If you’re going to force me to buy a product, at least let me have a discount option.”