We are living through the most fractious political times of most Americans’ lives. In these hyper-partisan times, is it possible to agree on something as polarizing as health care?
The answer could easily be a resounding “yes.”
All it would take is one slight modification to a little-used coverage tier of the Affordable Care Act (ACA) combined with a new medical care innovation known as Direct Primary Care (DPC).
As a bonus, all sides of the political aisle would win, including progressives, who generally push for ACA expansion to insure more people, and conservatives, who seek to improve patient control and decrease cost.
DPC is a membership model of medical care. For a fixed monthly membership fee—typically ranging from $40 to $85 per month—patients can access unlimited primary medical care, telemedicine, and medications, labs, and imaging services at markedly lower prices.
Many DPC practices also offer family discounts, accommodate same or next-day visits, and schedule 30-minute to one-hour visits. And it’s time actually spent with your primary care physician, not including the waiting room, front desk, or intake time spent with others.
As 80 percent of medical care can be provided through primary care offices, DPC is able to provide the first dollar medical care, or the “direct” of direct primary care. That is, you don’t hand over your insurance card and pray for the best when you get a bill weeks later. Nor do you pay out-the-nose via a high deductible before you finally reach zero copay medical care, thus minimizing the reason many patients delay or avoid care.
In addition to the less costly and more personal patient experience, the DPC model is proving to be a massive improvement in system-wide health care: 40 percent fewer emergency room visits and 20 percent fewer costly, morbid hospitalizations.
As for health care outside the DPC physician’s office, patients ideally would combine their insurance-free DPC physicians with a less expensive insurance plan that covers everything else.
Enter the ACA’s Copper plan. Despite premiums that are 22 percent cheaper than Bronze plans, Copper plans are restricted to people younger than 30. Simply removing the age restriction would create a much more affordable and accessible coverage option for millions of Americans who are currently disqualified due to their age.
A Michigan family of four, for example, can purchase a 2021 Bronze plan anywhere from $1,200 to $1,800 per month. The Copper plan’s rate would drop that family’s monthly premium by $264 to $396 per month, respectively.
The savings would be more than enough to obtain unlimited primary care via DPC for their family for around $150 per month, leaving another $100 to $250 a month in their pockets—money that would otherwise be sunk into a more expensive ACA plan.
And that’s just the Bronze plan. Compared to the ACA’s Gold plan, the ability for the same family to choose the Copper plan would result in savings of $1,200 and $2,000 per month on unsubsidized health insurance premiums.
One final note about the ACA and its Copper plan: Don’t believe the hype. Copper plans are not “junk” insurance. Copper plans cover pre-existing medical conditions and all 10 ACA essential health benefits.
Much like Bronze plans, Copper plans do have very high deductibles. However, the more money patients keep in their pockets by choosing health coverage plans with lower premiums, the less onerous those deductibles become. Even more so when people get the majority of their care through their DPC physician where insurance is a non-participant.
With the goal of covering more Americans, President Biden has made expanding the ACA the focal point of his health care policy. The little-talked-about truth, however, is that the ACA has fallen 15 million people short of the federal government’s own original coverage estimates.
Opening up the Copper plan to the 30-plus crowd would likely attract a good chunk of those 15 million people, especially if paired with DPC.
Citizens have in their own hands the power to seek out the high-quality, affordable, insurance-free care provided by DPC. The other part is up to Congress, and our elected lawmakers should step up to the task.
The ACA may still be unpopular in some policy circles, but removing the Copper plan’s age restriction would go a long way toward delivering on the affordability promised when the law passed more than a decade ago.
Chad Savage, M.D. (info@d4pcfoundation.org) is a Docs 4 Patient Care Foundation policy fellow and the founder of the DPC practice YourChoice Direct Care in Brighton, Michigan.
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