There is a large element of guesswork estimating the bill's cost.

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TripAdvisor, which collaborates with SmarterTravel (both are owned by Expedia), also instituted a fees estimator, which allows people to figure out what flights will really cost, removing the element of surprise.

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Another important element of the PPACA is the extension of no-cost preventive care and treatment to the insured.

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"The problem is if you isolate, as this report did, one particular element of that contract, it seems to distort the cost to the taxpayer without recognising the changes that have occurred in recent times, " he said.

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"As the cost of education goes up, so parents seem to feel that they need to have an element of control, " says Mr Hallam.

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