Aside from former President Donald Trump's repeal of Obamacare's individual mandate, every Republican attempt to roll back the Affordable Care Act since its inception in 2010 has either failed or been overthrown by President Joe Biden. As a result, healthcare has gotten less affordable and accessible over time.

Nearly half of respondents to a 2022 poll by the Kaiser Family Foundation report delaying healthcare due to cost, and one-third of insured adults worry about the cost of insurance premiums. The majority of black, Hispanic, uninsured, and low-income adults all say it is difficult to afford healthcare.

Congress does not need to and clearly cannot fix the abomination that is the American health insurance industry. But it can finally help us work around it.

Already, some people have a health savings account — a tax-advantaged account for funds that are specifically delegated toward qualified medical expenses, including everything from over-the-counter medications to co-pays and out-of-pocket care. But the majority of the country is legally barred from using HSAs.

Some HSA users have found they can not only reduce out-of-pocket costs, but also increase access to timely care. It takes the average patient more than 20 days to see their primary care physician, but direct primary care models offer patients "concierge" service. One Medical, the DPC practice recently purchased by Amazon, charges patients an annual fee of $199 for access to next-day appointments in major cities and 24-hour virtual care with no additional cost. But whereas One Medical relies on the health insurance of patients to cover lab costs, other DPC startups such as Forward charge a higher upfront rate to forgo dealing with insurance companies entirely.

Of course, paying for a high-quality DPC subscription such as Forward without insurance leaves an obvious risk: Such a patient would be 100% on the hook for emergency care, say in the case of a car crash or cancer.

Congress can do two things to fix this. First, it could help patients act a little more like customers by eliminating the onerous regulations governing who can have an HSA, something Rep. Chip Roy (R-TX) has repeatedly introduced in his Healthcare Freedom Act. Second, it can make some allowance for pre-ACA catastrophic health insurance models. Even after some Trump-era deregulation, the Obamacare exchange only allows high-deductible, low-premium catastrophic coverage for patients older than 30 with a "hardship exemption."

What about medication costs? Thanks to Congress's efforts to make health insurance more comprehensive, the very medications and procedures that insurers must now cover have become more costly. Take oral contraceptives, which the ACA mandated employers fully fund. From January 2014 to 2020 , oral contraceptive prices nearly doubled. Compare this to prescription drug prices, which rose by about 40% in that period, and nonprescription drugs, which only increased by only 10%. Whereas the insurance industry has severed the laws of supply and demand in pharmaceuticals, an HSA model could help restore them, reducing the list price of prescription drugs in the process.

The HSA-to-DPC model would also eliminate the moral hazard of the worst relic of the New Deal: employer-sponsored health insurance.

While health insurers would ideally have a vested interest in reducing the long-term costs through preventive care and short-term spending, the most affordable form of health insurance generally follows us from job to job. Thus, insurers are fine kicking chronic health problems or likely health consequences down the road for another company to cover. For this, thank President Franklin D. Roosevelt, whose wage and price controls impelled insurers to offer health benefits in lieu of pay raises.

The healthcare industry is one-fifth of the U.S. economy. Congress has lost the ability and the will to upend the insurance industry itself. However, with two minor legal tweaks, Congress could help people bypass the effective cartel entirely, making the country happier, healthier, and wealthier in the process.