What’s sadly missing from the health care debate – a debate that the Affordable Care Act did not end – is the notion of competition. In every other sector of our economy, competition is a good thing. It brings down prices and increases quality, as firms vie against each other for limited consumer dollars.

But in Texas, we’re seeing a kind of competition in health care that is doing just that – and adding the benefit of convenience, as well.

A new report by the Texas Tribune shows how stand-alone emergency rooms are just what the doctor ordered.

Five years after Texas became the first state to permit freestanding emergency rooms, more than 160 of the facilities have set up shop around the state – a presence that suburban commuters and health insurers alike are finding impossible to ignore,” the Tribune reports. “Health care experts say the financial success of the freestanding facilities – and the growing bargaining power that comes with it – is leading health insurers to arrange for more of the emergency rooms to be in a patient’s network.”

There are a number of such emergency rooms in the East Texas area, often owned by doctors themselves who like the flexibility and the freedom they provide.

“Supporters of the business model say that with more of the facilities joining health plans’ networks, and with the growing number of Texans who got insurance under the Affordable Care Act, the businesses are likely to show up in smaller towns and poorer neighborhoods where they can expand needed access to emergency care,” the Tribune added.

So naturally, the federal government just can’t leave success alone.

“Freestanding emergency rooms aren’t recognized by the federal government, which means they cannot accept public insurance like Medicare or Medicaid,” the article explained. “Unlike public hospitals, freestanding facilities are largely spared the flow of uninsured, poor patients who strain traditional emergency rooms – though representatives for the companies say they are bound by law to treat all patients, regardless of their ability to pay. Some critics say the facilities target wealthier neighborhoods where people are more likely to have private insurance and fewer serious medical complications.”

Rice University health economist Vivian Ho is one of those critics. She points to the business model, which she implies is discriminatory.

“They’re sprouting up like Texas wildflowers,” Ms. Ho said of the emergency rooms. “Everywhere you drive in upper-middle-income Houston, you’re seeing emergency rooms on every block.”

Modern Healthcare magazine noted last month that so far, only three states allow them – Texas, as well as Arizona and Colorado. They’re facing a great deal of resistance in other states, particularly from traditional hospitals.

“It’s clear these guys are disruptors, so there are going to be challenges,” Houston attorney Daniel Sternthal told Modern Healthcare.

But these emergency rooms are meeting a real need, and they’re giving Texans more choices. They’re also injecting free market principles into the health care debate.

The Affordable Care Act increased coverage for – but not access to – health care for many. This positive new trend – freestanding, privately owned emergency rooms – is increasing access.