Those who believe health care is a right, along with those who believe having access to health insurance equals access to health care itself, are in for a nasty surprise. A survey conducted by the American Action Forum (AAF) reveals that as many as 214,524 American doctors “will not be participating in any ACA exchange products.” According to the Kaiser Family Foundation, there are 425,032 primary care physicians and 468,819 specialist physicians, totaling 893,851 physicians in the entire country. Thus a whopping 23.9%, or nearly one-in-four doctors, are opting out of participating in ObamaCare. If you like your doctor…

The number of non-participants will exacerbate an already precarious doctor shortage expected to reach 45,000 in six short years. And despite all the happy talk about how ObamaCare is working, courtesy of leftist cheerleaders like The New York Times, this is where the proverbial rubber meets the road.

And it’s a road that may get bumpier still. The AAF survey was conducted last May, and it appears the list of disgruntled doctors is growing. California, a.k.a. the epicenter of leftist pipe dreams, is already hard-hit: As of January, a staggering 70% of CA’s 104,000 physicians were not participating in Covered California, the state’s insurance exchange. The LA Times disputes that total, insisting that 80,000 CA physicians will be participating in 2015. But even they are forced to admit that health insurers “are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more,” even as those insurers “prepare to enroll hundreds of thousands of new patients.”

The real killer in California? Many consumers have been hit with huge medical bills because insurers won’t cover the costs of doctors deemed “out of network” – even as they continue to narrow those networks to make insurance more affordable. Thus many Californians will be faced with the same “choice” as millions of other Americans: having access to a doctor who may be unaffordable, or no access to a doctor at all.

Why are doctors opting out of ObamaCare? The AAF cites three big reasons. First, they note ObamaCare’s big selling point was the idea that insurers would have to compete with each other for enrollees purchasing subsidized insurance. Insurers made their premium prices competitive by lowering reimbursement rates to providers. Providers were supposed to make up the difference with an increased patient load that resulted from narrowing the networks.

Yet those pay cuts are too dramatic. “It is estimated that where private plans pay $1.00 for a service, Medicare pays $0.80, and ACA exchange plans are now paying about $0.60,” the AAF explains. What about increasing the patient load to make up the difference? “Primary care providers … are already overburdened and have too many patients as it is, so the increase in volume will do nothing to offset their losses.” Just as troubling, physicians believe patients signing up for ObamaCare will be sicker than average, requiring more of a primary doctor’s time at much lower rates.

Second, high-deductible insurance plans are equally problematic for physicians because enrollees – many of whom have no understanding of what a deductible is – may accumulate thousands of dollars in charges that have to be paid in order to meet that deductible. Physicians fear that low-income patents racking up unaffordable costs will fail to pay their bills, even as insurance companies continue to collect premiums.

Yet the third reason physicians are opting out, and the one they cite as the most onerous reality, is a virtual paean to leftist pie-in-the-sky sensibilities. ObamaCare gives enrollees a 90-day grace period to pay their insurance premiums. Thus a patient can continue to claim he or she is insured, even without paying the premium for three months. After a 30-day delinquency, insurers change the patient’s status to “pending,” and any charges accumulated by the patient will be paid by the insurance company – if the overdue premium is paid within the 90-day grace period.

If not? The insurer is required only to pick up the first 30 days of charges. The remaining 60 days of charges must be chased down by the health care provider, who will remain uncompensated if patients can’t or won’t pay their bills. The AAF notes that nearly one million Americans “enrolled” in exchange plans had failed to pay their premiums as of May.

Doctors are also dealing with the issue of chaotic bureaucracy that has been ObamaCare’s hallmark from the beginning. For example, doctors rightly want to know if the insurance card being presented by a patient is connected to an ObamaCare plan so they can verify benefits eligibility. A 2014 Medical Group Management Association (MGMA) survey of 40,000 physicians reveals that 62% considered it “moderately to extremely difficult” to identify a patient that has ObamaCare coverage, rather than traditional commercial coverage.

So doctors have it bad – but the public may have it worse. The latest study by Health Pocket, a health plan comparison and research site, compared premium price data from 2013 pre-ObamaCare polices with 2014 ObamaCare policies from exchanges in metro areas of all 50 states. Three age groups – 23, 30 and 63 year-olds – were used to collate the comparisons. The calculations were made minus the subsidies that make insurance cheaper, but only because the taxpayer is picking up the difference.

Every group got hammered with substantial increases. Costs for 23-year-old women and men increased 44.9% and 78.2% respectively. For 30-year-olds, increases came in at 73.4% for men and 35.1% for women. For 63-year-olds the increase was 37.5% for women and 22.7% for men.

Incredibly, there’s even more bad news on the horizon. All of the non-compliant insurance plans that were supposed to be canceled last year are now ending. They were extended for a year unilaterally (and illegally) by Barack Obama due to the enormous political fallout engendered by his infamous promise – or more accurately Politifact’s 2013 “Lie of the Year” – that if Americans liked their health insurance, they could keep their health insurance. That year is up.

Most of those policies are in the individual market, and hundreds of thousands of Americans have been, and will be, receiving cancellation notices.

They won’t be lonely. As many as 40 million Americans whose insurance is in small-group plans provided by their small business employer will be required to have ObamaCare-compliant insurance beginning in 2015 – precipitating another tidal wave of cancellations. Thus the president’s “promise” will be broken yet again.

One more thing: For insurance policies going into effect in 2014, the open enrollment period began on Oct. 1, 2013. New year, same set-up, right? Wrong. This year the open enrollment period for a 2015 insurance policy begins on Nov. 15 – 11 days after the mid-term election.

The Obama administration would like Americans to believe one has nothing to do with the other. It’s exactly that kind of contempt for the public, coupled with the overall chaos of ObamaCare, that has seen many Democrats up for election running away from the health care law. The very same law their party passed without a single Republican vote. On Election Day, Americans should make it clear to those Democrats that an old cliché still applies: You can run, but you can’t hide.