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First you can only deduct health insurance premiums up to the amount of your business income, not out of pocket or deductibles. Those expenses has to be deducted on Schedule A. HSA is usually the only options for higher income couples if a better plan is not available through the employer. No, you are not missing anything. Because of the restriction AGI cap, only very small percentage of people, 5 or 8%, can actually deduct some of the medical expenses.
Sorry, I know that's not what you wanted to hear. Let me know if you have any questions.
Your best course of action would be to maximize your HSA and/or check with your spouse's employer if he offers better coverage. That's the only way to pay medical premiums pretax if you don't have enough business profit to take above the line self-employment health insurance deduction. ACA offers some high deductible plans where you can contribute to HSA but you will have to take in consideration other aspects. Depending on your health and expected medical expenses, a plan with lower deductible and no HSA might be a better option in the long run.
When it comes to co-pays and deductibles you may not be able to deduct them, just like 95% of others. Unfortunately there's no other way to deduct medical expenses.
Here's what can be a what cannot be deducted when it comes to medical expenses and how to deduct it: