11/17/2025
After Obamacare (aka Affordable Care Act): Making Healthcare Great Again for Patients and Their Doctors
Despite assurances that the “Affordable” Care Act would reduce healthcare costs, increase access, and improve access for the uninsured, the facts prove it did the exact opposite. Americans spend more for health coverage, more out of pocket for medical needs, and experience rising rates of personal bankruptcy due to medical bills. The existence of Obamacare subsidies made things even worse by padding the pockets of insurance companies who still raised premiums every year by double digits. Insurance companies got richer while their “covered lives” got poorer – and sicker.
What can be done to make healthcare work for patients and their doctors? Here are a few ideas, bearing in mind that each bullet point requires additional explanation about how it would work.
What Government Can Do:
- Change ERISA rules to permit anyone over 18 to have their own health savings account using pre-tax money (i.e., not taxable when contributed or used for medical expenses.)
- Repeal the ACA’s Minimum Essential Coverage requirement that adds services to health plans many patients don't need, e.g., a 65-year-old male having maternity care in his health plan.
- Allow patients to purchase catastrophic-only health plans, or at least, major medical plans and pair that with Direct Primary care membership.
- To address the doctor shortage and promote more primary care access, provide faster medical school loan forgiveness for doctors who choose to practice primary care.
- Eliminate or more tightly regulate pharmacy benefit managers because they increase the cost of prescription medications by 40%
- Impose a luxury tax on insurance company net profits over 10%
- Use luxury tax revenue to fund medical school loan forgiveness
- Allow all taxpayers to deduct 100% of medical expenses over $3,000, up to 50% of the adjusted gross income.
- Repeal Certificate of Need laws that stifle healthcare innovation, discourage competition, and drive up healthcare costs
- Amend state insurance laws to permit health plan purchasing across state lines
What Employers Can Do:
- Replace their expensive group plans with Individual Coverage Health Reimbursement Arrangement (ICHRA) plans which allow employees to have more control of their own healthcare and employers more control over their health plan spending
- Provide a pre-tax stipend to employees to offset the cost of enrolling in a direct primary care or concierge practice
- Arrange for worksite primary care to address common medical needs that often end up in urgent care or the ER
- Fund paid time off for employee doctor visits
What Patients/Employees Can Do:
- Contribute to and USE a health savings account.
- Take more personal responsibility for their own wellness
- Stop expecting 100% pre-paid medical coverage through an employer
- Be your own healthcare advocate by learning how to navigate and negotiate within the healthcare system
