Its interesting that you mention that. The data I linked seemed to show a steady increasing trend in healthcare costs paid but no spike (see exhibit B ) but the increased access is a factor I hadn't considered. Like you said a large part of the cost should be because of the uncompensated care rate Effectively middle class Americans are still paying the same huge costs as they were with lots of uncompensated cost but they are also paying for the expansion of medicaid that they weren't paying for before. As for prevention I agree that more people are using their free annual checkup but I'm not sure how much more likely they are to use primary care considering 40-60 percent of workers have a deductible over 1k [(see graph on exhibit G) ](http://files.kff.org/attachment/summary-of-findings-2015-employer-health-benefits-survey) and less than half of Americans have $1,000 in savings. The current structure still makes many of those services inaccessible to those who would benefit most.
best chart I could find (old from 2014). But if uncompensated care has gone down, drastically but patient costs have have continued to climb at previous rates that is the the huge spike. Its just hidden by the medicaid expansion. So i'm not off the rails like tacocat might imply (BTW exhibit G shows % of plans with over 1k deductible).