Since the Affordable Care Act (ACA) became law, Americans have faced increase in health insurance premiumswho have more doubled since 2013.
Growing franchises have exacerbated the problem, dealing a double blow to affordability. Government subsidies, which are often touted as help, simply mask skyrocketing prices rather than addressing the root causes, thereby hiding the true cost of health care from consumers.
A lesser-known ACA option, Copper planshave high deductibles but significantly lower premiums, typically 20 to 30 percent less than Bronze plans and up to 60 percent less than Platinum plans.
For many years, Copper plans were rarely used due to significant restrictions at the federal level. However, the situation has changed since the Trump administration'last “hardship benefits“, which now allows many more Americans to purchase them during the 2026 open enrollment period.
Like all ACA plans, Copper plans cover 10 essential health care services with no cost for preventive services and no waivers for pre-existing conditions.
Critics argue that high deductibles can lead patients to delay care, potentially worsening health outcomes. But combining Copper plans with Health Savings Accounts (HSA) and Direct Primary Care (Data center) agreements mitigate this problem.
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The DPC practice operates under an insurance-free, subscription-based model, offering same-day and next-day appointments, extended visits, and after-hours access at no co-pay. Because DPC physicians are paid upfront through membership, patients can access care without worrying about deductibles.
Data center providers handle about 80 percent of healthcare problems in-house, meeting most needs at no extra cost. For more complex issues that require specialists, DPC physicians act as trusted advisors, assuring the patient that they have a situation that warrants seeking help in the insurance context.
HSAs are tax-free investment accounts that can be used to cover medical expenses. One big beautiful bill (OBBB) explained that HSAs can be used to cover DPC membership. As such, OBBB has enhanced the synergy between Copper and DPC plans by allowing the use of tax-free HSA funds for an already inexpensive DPC membership that averages $80 per month, making them even more affordable.
The timing of these changes couldn't be better, as Copper's HSA-linked plans with DPC can function as a cost-effective self-funding option for those impacted by Medicaid cuts or unsubsidized Obamacare plans. By making coverage more affordable, these plans can help patients avoid inconsistent government largesse and gain confidence in self-sufficiency.
Politicians could take these plans even further. Because ACA plans must include 10 essential health care services, and direct primary care (DPC) practices already provide many of them, ACA guidelines should be revised to allow Copper plans to integrate with DPC. This reform will allow insurers to exclude benefits already covered by DPC from premiums, eliminating the need for consumers to pay twice for the same service and making coverage more affordable.
Finally, the incentive structure for selling health insurance must change to minimize stimulus insurance agents to resell expensive ACA plans and instead act more in a fiduciary role, ensuring that the patient actually receives the coverage that is most appropriate for their situation.
With these changes, the healthcare industry could experience a true transformation, with fewer people dependent on an unstable government system and gaining the confidence that comes with quality, affordable healthcare and self-sufficiency.
Chad Savage, MD, is a policy advisor to the Heartland Institute, founder of YourChoice Direct Care, policy fellow at the Docs 4 Patient Care Foundation, and president of DPC Action.
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