by Katherine Restrepo
Director of Health Care Policy, John Locke Foundation
Direct primary care (DPC) could end up playing a more prominent role on the national stage of conservative health reform. The Wall Street Journal considers this patient-centered delivery model the “fourth leg” to any plan that would replace Obamacare. Lawmakers in Congress and others in the consumer-driven health care scene strongly endorse DPC because it drives patients to pull more price transparency out of the very opaque U.S. health care system. And price transparency frequently comes with falling prices.
For a quick explanation of DPC, it works like a health care gym membership. In exchange for a membership fee (the industry average monthly payment ranges from $25 to $85), patients have access to around-the-clock primary health care. They can schedule same-day appointments and longer office visits with their doctors as needed. A major reason why monthly fees are affordable for the masses is because DPC practices have low overhead expenses since they do not accept insurance.
Health and Human Services (HHS) Secretary-appointee Tom Price’s health care plan calls for expanding the presence of DPC by expanding the use of health savings accounts (HSAs) – accounts that can pay for medical expenses with pre-tax dollars. In his proposal, he specifies that patients can pay their DPC membership fees out of their HSA. For this to happen, the tax code needs to be amended so that the IRS considers DPC fees to be a “qualified medical expense.” This policy change, combined with the fact that Price encourages patients on Medicare, Medicaid, and other government programs to become HSA holders, gives DPC a broader appeal for providers and patients alike.
It’s not just Price’s “Empowering Patients First Act” that acknowledges DPC. The Primary Care Enhancement Act of 2017 along with the Health Savings Account Expansion Act also advocate for periodic DPC fees to be paid for with an HSA. Even if a tax code tweak doesn’t make it into a final health reform package, it can still happen if either of these stand-alone bills can are signed into law.
It’s nice to see that the health care playwrights in Washington are eager to use HSAs as a vehicle to expand a concept that has already proven to work in many “laboratories of democracy” across the United States while being tested in other ways.