With the implementation of the Affordable Care Act, many Americans saw their out-of-pocket insurance costs rise dramatically. Insurance companies adjusted premiums and deductibles to compensate for their coverage of a larger and more expensive patient population. With these changes came another: the rise of the direct pay or cash-based business model for medical services.

This article from TIME Health explains the direct pay model and how it may only continue to gain popularity. As Republicans work to repeal and replace parts of the Affordable Care Act while supporting provisions for coverage of people with pre-existing conditions, the direct pay model is viewed by many as a way for them to avoid high deductibles and receive the most value for their money. This model stands to gain further support from self-insured companies, but also could further marginalize the poorest and sickest who could not afford care without assistance from an insurer or employer. The changes made to the Affordable Care Act may have significant effect on the viability and popularity of the direct pay model moving forward.

TIME Health (TIME Magazine): What Happens When Doctors Only Take Cash