For over a decade, American health care has operated under the Affordable Care Act (ACA). While it expanded coverage, it also increased federal control, raised costs and reduced flexibility.
A better option, which I call the Health Care Freedom and Choice Act (HFCA), proposes a fundamentally different approach — shifting authority away from federal mandates and toward individuals, states and competitive markets. Rather than modifying the current system, it represents a structural reset.
The ACA relies on federal mandates, subsidies, standardized benefits and Medicaid expansion. While these increased coverage, they also inflated premiums, reduced competition, tied insurance to employment or government programs and obscured the true cost of care.
The result is a highly regulated system that is expensive and often misaligned with individual needs.
The HFCA introduces a consumer-centered model built on four principles:
• Individual choice over employer control — individuals choose their own plans based on personal needs.
• Competition over regulation — removing federal mandates and allowing interstate sales increases competition.
• Targeted aid over broad entitlements — assistance is focused on those who truly need it.
• State innovation over federal uniformity — states regain authority to design flexible insurance markets.
Together, these principles aim to create a more responsive, transparent and sustainable system.
The HFCA would:
• Fully repeal the ACA, including mandates and subsidies
• Eliminate federally defined benefit requirements
• Allow catastrophic and customizable insurance plans
• Permit interstate insurance sales
• Shift employers to fixed financial contributions
• Establish state-based safety nets
This moves health care from a federally designed system to a market-driven, state-led framework. Patients would experience greater flexibility and control. Insurance becomes portable, following individuals rather than employers. Consumers gain price transparency and more options, including lower-cost plans.
Importantly, when insurance stays with the individual, insurers are more likely to invest in prevention and approve necessary care earlier. Today, frequent plan changes allow insurers to defer costs; this model aligns incentives toward long-term health outcomes.
The HFCA redefines the employer role. Instead of managing health plans, employers become predictable financial contributors. They would:
• Provide fixed, tax-deductible contributions
• Eliminate administrative and compliance burdens
• Remove liability from health care decisions
• Improve workforce mobility by eliminating “job lock”
• Increase compensation transparency
Employers can still offer competitive benefits but without managing complex insurance systems. This simplifies operations while maintaining support for employees.
The HFCA replaces large federal programs with state-based indigent health funds, funded by modest premium surcharges. Unlike past high-risk pools, vulnerable individuals remain in the same insurance markets as others, supported by targeted financial assistance.
This maintains integration while addressing affordability, thus:
• Coverage: Access to insurance remains, but shifts from government-driven programs to individual choice with targeted support.
• Pre-existing conditions: Enrollment protections remain, with risk distributed across broader pools and supported by state aid.
• Premiums: Removing mandates and increasing competition is expected to lower baseline costs.
• Employer Support: Employers still contribute financially but no longer control plan design.
The HFCA reduces federal spending by eliminating subsidies, Medicaid expansion funding and administrative overhead. Responsibility shifts to states, individuals and market forces. Transitional funding would help stabilize the system during implementation, with long-term cost reductions anticipated.
This proposal represents more than policy reform — it is a shift in control:
• From government-driven to consumer-driven
• From employer-centered to individual-centered
• From subsidy-dependent to market-based
• From federal control to state flexibility
At its core, the debate is about who should control health care. The Health Care Freedom and Choice Act challenges the assumption that greater federal involvement is the only path to access and affordability.
It raises fundamental questions:
• Should healthcare be directed by government or individuals?
• Can competition lower costs and improve care?
• Can targeted aid replace broad entitlement systems?
Dan Eichenberger is an Indiana native with 30 years experience as a primary care physician, physician executive and health care consultant.