Hospitals are increasingly asking patients to fork over payment— at least some of it — before they are treated.

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That’s according to a Huffington Post report, which says in spite of increasedinsurance coverage under the Affordable CareAct, hospitals see the move as a necessity. Even patients withinsurance are increasingly unable to pay their medical bills,leaving hospitals holding the bag.

Why is this the case, if more people are able to get insurance?They’re increasingly opting for policies that come with low monthlypremium costs but also big deductibles — beyond their ability topay — when they actually need care. Even those with employer-basedhealth care plans are taking those easy monthly payments, gamblingthat they won’t end up saddled with big bills if and when they needcare.

But the gamble is not paying off, and as a result, manyhospitals are trying to collect before the bills are due, providingpatients with care cost estimates before the fact and offeringno-interest loans or perhaps discounts for prepayment.

The strategy isn’t foolproof, of course, with some patientsdeciding not to have whatever treatment is under discussion or atleast to postpone it. And that can lead to worse, and moreexpensive, care needs down the road.

And it looks as if this trend is likely to continue. Even if theTrump administration succeeds in dismantling the ACA, as it intendsto do, high-deductible plans, the report says, aren’t goinganywhere — which means people will continue to be saddled withhefty bills even if they’re covered by a policy. And they may nothave much choice in the matter.

The report says, “Republicans also believe high-deductible planscurb spending, and Americans faced with medical costs that risefaster than inflation and wages will look for premiums they canafford.”

And that means high deductibles.

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Hospitals are fighting back against the resulting unpaid billsby trying to collect up front, since lack of payment is loadingthem up with non-collectable debt. According to the report, theup-front billing trend is expected to accelerate this year, pushedalong by those “unpaid bills [that] are creating massive bad debtfor even the most prestigious medical centers.” It adds, “U.S.hospitals had nearly $36 billion in uncompensated care costs in2015, according to the industry’s largest trade group, a figurethat is largely made up of unpaid patient bills.”

Government data indicate that the average deductible this yearfor the cheapest, widely used health plans available through theACA is $6,000 for an individual — a jump of 18 percent since2014—and more than twice that for a family.