Consumers have suffered sticker shock when they try to enroll in Obamacare's health insurance exchanges, but soon those same consumers may be faced with far fewer choices of doctors and hospitals.

Insurance companies that participate in the exchanges say they have to narrow consumers' choice of health care providers to keep medical costs and premiums from soaring even higher than they already have.

"What we are trying to do is create better price points," an official with the insurer WellPoint told the Washington Examiner. "Something that will be very attractive to consumers across the board. So, we are narrowing and focusing" the choices.

The narrowing of choices is likely to mean that some consumers who already had their existing health plans canceled could now be forced by their new plans to change doctors, dashing a second promise President Obama made while selling the public on Obamacare three years ago.

Obama already apologized to millions of Americans whose existing plans were canceled despite the president's pledge that "if you like the plan you have, you can keep it." But the president also repeatedly promised consumers that “if you like your doctor, you will be able to keep your doctor. Period."

Cigna Health Insurance executives have acknowledged that they would be limiting the choices offered to consumers. That kind of shift in the industry means that a policy bought on Obamacare's insurance exchanges likely would provide far fewer choices than employer-sponsored plans do now.

The limiting of choices also could require consumers in less populous states to drive further for in-network medical attention than they do now.

"In New Hampshire, the health care law cuts out 10 of the 26 hospitals in the state," said Betsy McCaughey, the former lieutenant governor of New York and an Obamacare critic.

In California, many top hospitals, including Cedars-Sinai Medical Center, will not participate in most exchange plans.

"Only a select few plans will provide full coverage for care from Cedars-Sinai Medical Center and our physicians," the hospital announced to patients on its website.

The exchanges will mostly steer clear of many of the nation's top academic hospitals because those providers tend to provide more extensive and expensive care, industry officials said. Insurers also are likely to include in their networks the doctors they deem the most cost effective.

The Medical Group Management Association in September surveyed nearly 48,000 physicians about the health care exchanges and found that less than 30 percent of those doctors planned to participate in the exchanges. Another 40 percent said they would consider joining an exchange, the survey showed.

Nearly 60 percent of the doctors who decided not to participate in the exchanges said they ruled it out because they feared that low reimbursement rates from exchange-purchased insurance plans would threaten their practices.

"Cost is a huge factor," Anders M. Gilberg, a lobbyist with MGMA. "The plans have made no secret of the fact that the way they are offering lower premiums to patients and benefit options on the exchanges is either by reducing reimbursement rates to physicians or narrowing the networks or controlling the number of physicians. They are contracting with fewer physicians and the reimbursement rates are lower relative to plans outside the exchanges."

The reimbursement rates on exchange-purchased plans will vary, but they are expected to parallel rates now paid to doctors under Medicaid (86 cents per $1) and Medicare (91 cents per $1).

McCaughey said Obamacare will operate much like Health Maintenance Organizations, or HMOs, operate now. Under that model, consumers often must choose between lower premiums or greater choice of providers. To keep costs — and premiums — low, insurers impose restrictions like shorter hospital stays and fewer choices of doctors.

The new health care law, McCaughey said, "was designed to ensure continuity of care for lower income people."