Americans are still trying to escape the Affordable Care Act, but now that President Trump and Congress have failed to repeal it (as they promised…) the escape hatches are looking more… creative. More Americans – doctors, patients, businesses and states – are taking it upon themselves to find a way out of the ACA’s draconian grip.

All of these actions of course undermine the ACA system, but they aren’t sufficient. Instead, they are all signs that continually point to Americans’ dissatisfaction with the status quo and the need to once again revisit the issue via legislative reform. In the meantime, let’s look at some of the ways Americans are escaping the ACA:

Escape Hatch #1 – Innovative Payment Models

The ACA is an insurance-based system. The goal of the law was to expand insurance coverage via Medicaid and the law’s exchanges as the primary method of financing healthcare services. But instead of using ACA-regulated insurance, some doctors and patients are adopting new models that allow for more transparency and more freedom. One such model is direct primary care. Another is a “health share.” Neither of these is the traditional insurance model. And both are much more affordable.

Escape Hatch #2 – States Leading the Way

The Governor and Lieutenant Governor of Idaho have recently signed an executive order that will allow insurers to offer non-ACA-compliant plans in the state’s exchange. One insurance company has just submitted some plans to the state department of insurance for approval. This could bring broader choices and affordability and demonstrate to the rest of the states in the nation that the federal government’s regulations are counterproductive.

Escape Hatch #3 – Employer/Tech/Industry-led revolution

The employer-centric nature of the U.S. health insurance market is really an accident of history, but a few employers – Amazon, Berkshire Hathaway, and JP Morgan – recently announced a new experiment aimed to disrupt the current health system. The industry giants aim to use technology, innovation scale to develop a new model for the payment, delivery, and customization of health services. But so far, very little is known about how they aim to do it.

All of the above point to a health workforce, a patient population, and an economy that are suffering the consequences of an ill-fitting top-down system under the ACA. It’s sad that it has to be this way, but encouraging to see disrupters and problem-solvers continue to apply their best thoughts and efforts to making health care affordable and accessible.

Necessity is truly the mother of invention, and the ACA has made it necessary for folks to invent new ways to get out.