Though Obamacare was designed to force the American health insurance system into a single payer model, the free market has found a workaround.

A growing number of practices are working directly with uninsured patients or with patients forgoing insurance benefits for a better price tag. Health insurance premium hikes, ridiculously high deductibles, and scant coverage make for-profit specialist shops all the more attractive.

Business Insider reports:

Smith said the Surgery Center has had people fly in from as far away as Turkey and Ethiopia for procedures.

“We are unapologetically for-profit,” Smith said. “I’m not in this business to lose money.”

Because the Surgery Center’s price for a hysterectomy was so much lower than what Millican had been quoted at a Dallas hospital, she asked her doctor why he chose to do the procedure at a lower price. He told her frankly that it was profitable for him. When he performs the procedure using insurance, he is paid $500, she recalled him telling her. For her procedure, he told her, he got paid five times that.

When she thought about how little $500 was in the grand scheme of how much she might have paid for her surgery, she found it frustrating.

“The doctor was the cheapest part,” she said.

To be sure, the prices for certain surgical procedures are still out of reach for many. And in an emergency situation, taking the time to shop around for the lowest price might not be an option.

But cash-pay providers are gaining traction with self-insured employers, who see it as more cost-effective than paying through traditional insurance. Freedman recalled an instance where a woman with breast cancer flew to Oklahoma for a mastectomy, chemotherapy, and reconstructive surgery, all paid for by her employer using cash prices because it was the cheapest option.

In general, healthcare providers that don’t take insurance are still in the minority in the US. Still, the movement appears to be growing. At the Surgery Center, Smith said he’s observed it lately getting busier by the week, though he didn’t give a reason why. The center now performs 7-8,000 surgeries in a year.

A similar movement is happening in the primary care industry. Hospitals and clinics are offering their own version of basic care insurance where consumers pay monthly fees in exchange for basic medical care services.

It’s called direct primary care, and it works like this: Instead of accepting insurance for routine visits and drugs, these practices charge a monthly membership fee that covers most of what the average patient needs, including visits and drugs at much lower prices.

It’s happening at a time when high-deductible health plans are on the rise — a survey in September found that 51% of workers had a plan that required them to pay up to $1,000 out of pocket for healthcare until insurance picks up most of the rest.

While President Trump and Congress continue negotions on the best Obamacare repeal course, the free market is doing what it always does best — filling a basic need.

Follow Kemberlee on Twitter @kemberleekaye