Obamacare enrollees had trouble affording and accessing health care as well as understanding how to use their plans, according to a report from the Government Accountability Office.

The top factors that Obamacare enrollees considered when selecting a plan in 2015 were the cost of premiums, deductibles, and copayments.

The auditors talked to stakeholders including policy experts, state departments of insurance, and exchange officials, and found that some Obamacare enrollees said the out-of-pocket expenses were too expensive before reaching their deductible.

"Two national surveys of QHP [qualified health plan] enrollees found that over a quarter of them had experienced financial difficulties paying for their out-of-pocket health care expenses in the prior year, with some enrollees reporting unmet health care needs due to cost," the auditors said. "One national survey reported that in 2016, 25 percent of QHP enrollees reported higher-than-expected out-of-pocket costs after using their coverage."

According to the report, some enrollees have been overwhelmed when trying to juggle the need to pay out-of-pocket costs on top of monthly premiums and other life expenses. Many of these enrollees have lower incomes and have been uninsured, so they may have not previously paid for health care expenses, a fact that may contribute to dissatisfaction with their plans’ affordability.

Some Obamacare enrollees said they have faced problems accessing care. The Obamacare exchanges offered 34 percent fewer providers than plans offered outside the exchanges, according to one analysis.

"Concerns have been expressed both by some experts and in literature we reviewed about QHP enrollees’ ability to obtain or continue care given the increased prevalence of QHP with narrow networks," the auditors said. "Issuers have increasingly begun to offer narrow network plans as a mechanism to lower premiums; these plans offer coverage for services through a smaller group of physicians or hospitals than the plan has covered in the past."

The report found that Obamacare enrollees had trouble understanding how their coverage worked. "Some QHP enrollees who obtained their coverage through the exchanges have faced difficulties understanding how to use their plans," the report says. "About half of nationwide QHP enrollees surveyed in 2015 had a good understanding of their plan benefits and total health coverage costs at the time of enrollment."

The Centers for Medicare and Medicaid Services did not respond to requests for comment.