In an earlier commentary, Virginians for Quality Healthcare (VQH) outlined ways that the Affordable Care Act (ACA, or “Obamacare”) attacks and marginalizes individual liberty, among its numerous oppressive and costly features. Americans have grown increasingly frustrated with Congress, the Obama administration, the Supreme Court, the IRS, the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, and the insurance industry over the implementation of Obamacare.
Fortunately, though, there is some good news for America—alternatives to Obamacare exist. Options for patients and doctors are available now, without waiting for repeal of the ACA. In addition, and of utmost importance, every voter has the opportunity in voting booths across the country on November 8 to permanently reject this government health care tyranny. One major candidate for President has vowed to repeal Obamacare immediately; in stark contrast, the other major candidate promises to uphold and even extend the government’s control of your health.
However, there is no need to wait for government to act to restore your health freedom.
Independent of repeal efforts, a multi-pronged movement to restore health care to a patient-centered model has been quietly gaining momentum across the nation. Many physicians are opting out of Medicare, and many individuals are taking matters into their own hands as they become aware of health care choices outside Obamacare. Within all these alternative models, the quality of health care is improving, patient and doctor satisfaction is high, costs are lower, administrative overhead is reduced, and patient privacy and freedom of choice are replacing government interference. Three alternative models—Self-Pay, Health Care Sharing Ministries, and Direct Primary Care—are briefly introduced below. Patients are encouraged to talk with their doctors and ask them to actively engage on these health care reforms.
“Self-pay:” Patients are saving money by paying cash for health services in this model. “Shock Your Doctor: Ditch Insurance And Pay in Cash” describes the financial benefits to patients using this method. Self-payers weigh the cost of their insurance premiums, deductibles, and any ACA penalty or exemptions before adopting this model.
In fact, patients who don’t max out their deductibles would do far better for themselves and their doctors by paying cash straight up. Providers typically charge 20 to 50 percent less when they can get paid immediately and without funneling payment through a third-party health insurer.
“Health Care Sharing Ministries” (HCSM): These programs have been around for more than 20 years, are increasingly popular, and operate without third-party insurance. “The Obamacare Alternative More Americans Are Turning To” discusses how HCSMs work; these organizations facilitate the sharing of medical costs between members, all of whom have shared benefits. Sometimes members are encouraged to negotiate lower prices with providers and pay cash, as in the self-pay model, before being reimbursed by the ministry.
… [H]ealth care sharing organizations are exempt from the requirements the Affordable Care Act places on insurance policies … and protects [members] from crossing any ethical boundaries.
Membership in these organizations nationwide is above 600,000; among the largest are Medi-share and Samaritan Ministries.
“Direct Primary Care” (DPC): This is one of the most promising and popular reform models. Under DPC agreements, a provider charges a patient a predetermined fee (usually monthly) for primary care services. Physicians across the country are abandoning the traditional third-party, fee-for-service model and converting their practices to direct primary care.
One reason for the mounting interest in direct primary care among physicians is the growing complexity of managing a practice. Many physicians say keeping up with the paperwork involved in [collecting measurement data for health outcomes in] value-based care, meaningful use of electronic health records, and other initiatives tied to the Affordable Care Act leaves little time to actually practice medicine.
Health care professionals are flocking to educational summits to learn the nuts and bolts of setting up and running DPC practices. Guidelines for doing so are readily available from researchers and professional organizations, and should be consulted in order to comply with evolving legal, policy, and regulatory issues related to DPC.
Even employers are turning to DPC to reduce their health care costs, as they respond to the Obamacare mandate requiring companies with 50 to 99 employees to provide health insurance to all employees starting this year. Most employers would augment DPC with a health insurance product. In fact, most patients in a DPC model generally should purchase insurance to cover emergencies and large medical costs; typically a lower-cost, higher-deductible insurance plan pairs well with DPC membership.
DPC benefits patients by providing ongoing continuity of care for all member patients. Analysis of internal data from a corporate multisite DPC model has shown that participating patients had a >50% reduction in emergency department visits, specialist visits, and surgical procedures compared to traditional practices. The only increase was the number of primary care visits per year (from 2 to 4 on average.) These data strongly support the long-held inference:
As the utilization of low-cost comprehensive primary care increases, the need for high-cost emergency and specialty services decreases.
The DPC model is expanding to include specialists and hospitals. For example, in July the Citizens’ Council for Health Freedom launched The Wedge of Health Freedom, a nationwide initiative to “revolutionize health care and restore the mission of medicine: to care for patients:”
[The Wedge is] the answer for Americans who believe it’s time for outside management and control of the patient-doctor relationship to end.
Their resource-rich website offers roadmaps for physicians interested in joining The Wedge, as well as information for patients looking for participating doctors.
Join hundreds of thousands of fellow Americans—patients, doctors, employers—who are privately taking the initiative to learn about, adopt, and promote these alternative solutions to the ACA. Virginians for Quality Healthcare will engage with lawmakers in Richmond to pass legislation in 2017 that encourages the growth of DPC practices in Virginia. Meanwhile, individuals are already empowered to restore health care freedom in the ways described above: one patient, one doctor, one employer at a time. The most crucial step toward health care freedom, for every American, can be taken on November 8, when a new course in America’s health care future can be demanded, one voter at a time.
Note: This article from Virginians for Quality Healthcare is the eleventh in a monthly series on Obamacare, leading up to Election Day, November 8, 2016.
Readers, stay informed and receive alerts from Virginians for Quality Healthcare by joining the mailing list here.
 Nancy Piotter, “Obamacare’s Impact on Individual Americans”, Fairfax Free Citizen, Nov 8, 2015. http://fairfaxfreecitizen.com/2015/11/08/obamacares-impact-on-individual-americans/
 Michael Hamilton,The Federalist, Aug 2, 2016. http://thefederalist.com/2016/08/02/shock-your-doctor-ditch-insurance-and-pay-in-cash/
 Melissa Quinn, The Daily Signal, Sep 12, 2016. http://dailysignal.com/2016/09/12/the-obamacare-alternative-more-americans-are-turning-to/?utm_source=TDS_Email&utm_medium=email&utm_campaign=MorningBell&mkt_tok=eyJpIjoiTldZeU5tSXlNVEkwTm1NMCIsInQiOiI5MWF0R3ltY1REU1wvbGc0ZlpxQlVPOGJxXC9DNHVnYTE1WEhjWTZZUTY0Q2ZLOVJ0ejg0Y3Z5RWFZdWlcL1FzUkxPaFFXZXlZaURpdHl2QjQyS0pSRG9DQVhvUjlDelBOcUNqdVwvUlVRQjVnQWM9In0%3D
 Quinn, ibid.
 Elaine Pofeldt, “The Rise of Direct Primary Care”, Medical Economics, Apr 10, 2016. http://medicaleconomics.modernmedicine.com/medical-economics/news/rise-direct-primary-care. For more on challenges to moving to value-based care, see Bobbi Brown and Jared Crapo, “The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement” Health Catalyst, Aug 2014. https://www.healthcatalyst.com/wp-content/uploads/2014/08/The-Key-to-Transitioning-from-Fee-for-Service.pdf
 P. Eskew and K. Klink present an excellent discussion in “Direct primary care legal and regulatory review of an emerging practice model…” http://c.ymcdn.com/sites/www.aclm.org/resource/collection/398353CC-E8B1-42EB-B6E7-0E725F1C4C42/10_Eskew_Phillip-nocover.pdf?. Accessed Sep 28, 2016. Elsewhere, Docs for Patient Care Foundation is sponsoring the “Direct Patient Care Continuing Medical Education Conference” in Dallas, Texas, Oct 14-15, 2016 dc4pacfoundation.org . Thirdly, the Direct Primary Care Coalition website includes legislative updates and a sample DPC bill for state legislatures http://www.dpcare.org.