Despite widespread news about changes in health care premiums brought on by the Patient Protection and Affordable Care Act, most of us are in the dark as to what is driving some of the wild variations in premium rates across the country. 

According to a report by the American Academy of Actuaries, the major drivers of premium hikes are linked to insurers' uncertainty in the future of their plans. 

As always, premium growth is related directly to growth in overall health care spending, including medical services and prescription drugs. However, the report notes, the recent economic downturn and recent initiatives to move away from the prevailing fee-for-service system of medical care might be gradually slowing the rate of premium increases.