Sally Pipes: "Despite Dems' Protests, Affordable Health Plans Are About to Multiply"

A mix of catastrophic coverage, HSAs, and direct primary care can secure better care at a lower cost than a conventional Obamacare plan.

The following is an excerpt from an article by Sally Pipes, Founder & Chair of the Benjamin Rush Institute, published in The Detroit News. Click here to read the full article in your browser.

Obamacare premiums are climbing yet again during open enrollment. But there’s also some good news for cost-conscious shoppers ― a new way to secure affordable coverage without forgoing access to care.

This year, many people can buy low-cost “catastrophic” health plans for the very first time. Combine one of these plans with a tax-advantaged health savings account and a direct primary care subscription, and the result is quicker access to high-quality care for less than the cost of a typical exchange plan.

For most working-age Americans, this three-part combo means keeping more of their money rather than sending it to an insurer. It also means faster appointments, longer visits and a real relationship with your doctor, something no exchange plan can buy.

Let’s start with the Trump administration’s decision to allow more people to buy “catastrophic” plans. They protect against major medical shocks, like an unexpected illness or injury. But enrollees have to pay for routine care themselves.

In 2025, average catastrophic plan premiums for a 40-year-old person were just $361 a month. By comparison, a mid-level silver plan for that same patient ran an average of $621 a month. A top-tier platinum plan was a whopping $913 a month.

Before now, catastrophic plans were only available to individuals under the age of 30, as well as those who qualified for a hardship exemption. The administration has loosened these requirements so anyone who does not receive federal subsidies can buy one.

These plans do include relatively high deductibles ― the amount of money a patient must pay out of pocket before coverage kicks in. Next year’s catastrophic deductible for an individual will be $10,600.

That sounds scary. But most people never come close to spending that much. In 2022, half of American adults spent less than $1,400 on health care all year. In 2021, roughly 14% of the population had no health expenditures at all.

For these folks, a high-deductible plan isn’t a risk. It’s an opportunity to save money. The numbers suggest that roughly half the country would be better off buying a cheap catastrophic plan and plowing the savings into a health savings account.

HSAs are triple tax-advantaged. Money goes in pre-tax, grows tax-free and can be withdrawn tax-free, as long as it goes toward qualified medical expenses. HSAs enable people to deploy their health care dollars as they see fit ― or stack them year by year, until they need them.

Thanks to a budget law enacted by Republicans this summer, people with catastrophic or slightly more comprehensive bronze plans are now automatically eligible to contribute to HSAs.

That’s a big deal. Just 2% of exchange customers enrolled in an HSA-compatible plan this year.

The same law makes HSAs even more powerful by allowing the proceeds to be spent on direct primary care starting next year. Under the direct primary care model, patients pay a monthly fee of around $50 to $100 in return for easy, essentially unlimited access to their primary care doctor; routine lab work; and comprehensive care management.

This arrangement is especially useful for patients who don’t want to wait to see their doctor, as nearly all direct primary care practices offer same-day appointments. It’s also a good option for those who need to make frequent trips to the doctor, would prefer to have longer visits, or would like to be able to get quick answers via email.

The combination of a direct primary care subscription for routine care, an HSA for ancillary services and a catastrophic plan in case of an emergency can deliver better care at lower cost than a conventional Obamacare plan.

For most Americans, it’s a strategy that can make health care affordable again.