Politicians argue about subsidies while families face premiums that can top $26,900 and deductibles big enough to delay basic care. We step past the slogans to map how the ACA exchanges actually work today—standardized benefits that reduce real choice, narrow networks that hide access problems, and a pricing spiral that subsidies struggle to catch. Along the way, we unpack ghost networks in mental health, why out-of-network showdowns hit consumers hardest, and how pharmacy benefit manager reb...