Since the Affordable Care Act (ACA) was enacted, Americans have faced soaring health insurance premiums, which have more than doubled since 2013.
Rising deductibles have compounded the issue, creating a double blow to affordability. Government subsidies, often touted as relief, merely mask this price inflation rather than addressing it, obscuring consumers from the true cost of care.
A lesser-known ACA option, Copper plans, could change this. These bare-bones plans feature high deductibles but significantly lower premiums—20-30% less than Bronze plans and up to 60 percent less than Platinum plans. The premium savings are so profound that, with the premium savings, patients may more easily afford the high deductibles shared by most ACA plans.
While Copper plans were previously little-used because of restrictions (such as for those aged 30 years or younger), the Trump administration’s recent “hardship exemptions” now allow many Americans to purchase them during open enrollment for 2026.
High-Deductible Workaround
Like all ACA plans, Copper plans cover the 10 essential health benefits (e.g., preventive care, hospitalization, prescription drugs, maternity care) with no cost for preventive services and no denials for preexisting conditions.
Critics argue high deductibles may lead patients to delay care, potentially worsening health outcomes. However, pairing Copper plans with health savings accounts (HSAs) and direct primary care (DPC) mitigates this concern.
DPC practices operate on an insurance-free, subscription-based model, offering same- or next-day appointments, extended visits, and after-hours access without copays. Since DPC physicians are prepaid through memberships, patients can access care without worrying about deductible costs.
DPC providers handle about 80 percent of medical issues in-house, addressing most needs at no additional cost. For more complex issues requiring specialists, a DPC physician functions as a trusted advisor, reassuring the patient they have a situation justifying seeking care within the insurance context.
HSAs are tax-free investment accounts that can be used for medical expenses. The One Big Beautiful Bill Act (OBBB) clarified that HSAs can be used to cover DPC memberships. By doing so, OBBB augmented the synergy between Copper plans and DPC by allowing tax-free HSA funds to be used for the already low-cost DPC memberships, which average $80 per month, making them even more affordable.
Fortunate Timing
The timing of these changes could not be better, as an HSA-linked Copper plan with DPC could function as a cost-effective, self-funded option for those affected by Medicaid reductions or unsubsidized Obamacare plans. By making coverage more affordable, these plans may help patients avoid fickle government largesse and gain the confidence of self-sufficiency.
Policymakers could take these plans even further. Since ACA plans must include 10 essential health benefits—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 would let insurers exclude from premiums the benefits already covered by DPC, sparing consumers from paying twice for the same care, thus making coverage truly affordable.
Incentive Reform
Finally, the incentive structure for selling health insurance should change to minimize the incentive for insurance agents to oversell high-cost ACA plans and instead act more in a fiduciary role, ensuring the patient is truly getting the coverage best suited to their situation.
With these changes, a true transformation could occur within health care, with fewer people dependent on the fractious governmental system while gaining the confidence that comes with quality, affordable health care and self-sufficiency.
Chad Savage, M.D., is a Heartland Institute policy advisor, founder of YourChoice Direct Care, Docs 4 Patient Care Foundation policy fellow, and the president of DPC Action. A version of this article appeared in Red State. Reprinted with permission.
Dr. Chad Savage is the founder of YourChoice Direct Care in Brighton, Michigan. YourChoice Direct Care is the first Direct Primary Care practice to open in Brighton. With Direct Primary Care (DPC) Dr.
