by Jordan Roberts
Director of Government Affairs, John Locke Foundation
In an op-ed posted over the weekend, David Balat of the Texas Public Policy Foundation details the promise of direct primary care and how Congress could make a simple fix to increase the freedom of patients to choose a more affordable primary care solution.
David begins by discussing the problems that some may face with a high-deductible health insurance plan:
Often, the most effective way to make a point is to tell a story. And that’s what NPR does in its new report on high-deductible health policies (HDHPs) that are keeping too many Americans out of their doctors’ offices.
Susan, who carries a gene that makes her predisposed to breast cancer, has one of those policies. The deductible of $6,000 meant that when she got her first MRI and a mammogram to screen for breast cancer, she paid $3,800 out of her own pocket. It cost so much in 2017 that she was forced to delay her screening in 2018.
One solution to this problem? Direct primary care:
But there’s a better solution — Direct primary care. Direct primary care is an affordable primary healthcare model based on a monthly membership with a particular doctor or group. Once that membership is paid, the family sees that doctor for their primary care. Direct care doctors accept no insurance and opt out of all third-party relationships.
These are allowed under the ACA as what it refers to as a “medical home.” A provision of the ACA, Section 1301 (a) (3), would allow direct primary care medical homes to be offered in state marketplaces in combination with qualified health plans.
Federal law hinders the flexibility for families to access these alternative health arrangements by limiting the use of health savings accounts (HSA). David explains his current experience using direct primary care and what Congress can do to increase the use of these affordable plans:
How does it work? I’m an example. I have a high-deductible health plan, but I also utilize a membership with my direct primary care physician in my area for my family’s primary care needs. I have a relationship with my doctor that I value for the very real health benefits it incurs — the kind of relationship President Obama promised all of us when he (falsely) said, “if you like your doctor, you can keep your doctor.”
I also have an HSA funded by my employer, and I’d like to use those dollars to pay my membership. The IRS, however, does not recognize my relationship with the doctor as a qualified medical expense but rather as a second plan.
Congress can fix this. To do so, it would have to instruct the IRS that direct primary care is not a second health care plan. Under ACA rules, only individuals with a HDHP are eligible to have an HSA; the presence of a second plan (in this case membership in a direct primary care system) would invalidate a family’s eligibility.
Direct primary care eliminates unnecessary bureaucratic roadblocks and allows physicians to focus on caring for the patient. The benefits of direct primary care have been documented in the private sector. Federal lawmakers can increase access to these arrangements by removing restrictions on HSAs. At the state level, codifying direct primary care’s existence into law by clearly stating monthly membership fees are not insurance premiums will eliminate all possibility of insurance regulations imposing unnecessary burdens on direct primary care physicians.
The public sector has benefited as well. Here in North Carolina, Union County has implemented a direct primary care option for its county employees. The results speak for themselves. Lawmakers can continue to build on this by offering direct primary care as an option in North Carolina’s State Health Plan as it struggles with solvency issues. With a waiver from the federal government, North Carolina could create a direct primary care option for the state’s Medicaid population to increase access to quality care and improve on cost savings.
Regardless of the healthcare reform, increasing patient choice and removing barriers that impede physicians ability to focus on patient care should always be the goal.