The Affordable Care Act status quo has been affirmed by the Supreme Court, but this doesn't mean that it has been rescued. While subsidies will continue flowing to federal exchanges, significant challenges remain: A lack of patient-friendly information on the exchanges along with the growing threat of hospital monopolies that can drive up costs will cause new headaches for people enrolling on exchanges. Addressing these problems will require conservative reformers to take a step back and work with local policymakers to help enable constructive but powerful changes to the law.

Of the 11.7 million people enrolled in exchange plans, a growing number will be facing high deductibles. The most commonly purchased plans on the exchange, for instance, had average deductibles of nearly $3,000 in 2015. While this is something that conservatives have wanted to see for many years, high-deductibles demand transparency on price, quality and safety. We're still a long way away from that.

Imagine yourself trying to decide between an iPhone 6 and a Galaxy S6, but neither Apple, nor Samsung, nor any store like Best Buy is willing to tell you what it will cost. Instead, they tell you that the price will depend on what other services are bundled with the phone and whether you qualify for "income-based cell phone insurance." Later, they'll send you a bill for things you never knew you had to pay for and that intuitively seem overpriced.

Shopping for a doctor's visit, MRI, or any other non-emergency service is even worse. And since for many years most Americans had insurance plans with low or zero-dollar deductibles, (and with relatively low copayments) the demand for transparency wasn't there. That is changing, but lack of consumer-friendly information on plans, doctors and hospitals makes true choice difficult.

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