What is direct primary care?
Direct Primary Care (DPC) is an innovative alternative payment model improving access to high functioning healthcare with a simple, flat, affordable membership fee. No fee-for-service payments. No third party billing. The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider. Patients have extraordinary access to a physician of their choice, often for as little as $70 per month, and physicians are accountable first and foremost their patients. DPC is embraced by health policymakers on the left and right and creates happy patients and happy doctors all over the country!
October 20, 2019
U.S. House of Representatives
Washington, DC 20515
Dear Members of Congress:
I'm writing to ask for your support and co-sponsorship of H.R. 3708, The Primary Care Enhancement Act which provides important clarifications about Direct Primary Care (DPC) agreements for the tax code. DPC is one of the most important value-based reforms in healthcare today. As the founder of the first DPC practice almost two decades ago, we had a bold yet simple idea: Give people a personal relationship with a high-functioning primary care doctor and people will be healthier and happier using the less expensive and scary parts of the healthcare system. Along the way, we can save millions of dollars by reducing hospitalization and administrative costs, since nobody ever files a "claim" to get paid for care.
It works. Since 2009, almost 1,200 new DPC practices have emerged and employers, unions, and even health plans now rely on DPC doctors to provide better care for their employees. Employers report their cost of providing healthcare goes down by as much as 20%. Patients love the care they get. Doctors love doing what they were trained to do instead of filling out insurance forms.
We've passed laws in 28 states since 2007 to define DPC as a medical service outside of state insurance regulation. Unfortunately, our current tax laws haven't kept up and look at a DPC agreement between doctor and patient as a form of insurance or health plan—only for people with High Deducible Health Plans (HDHP) paired with Health Savings Accounts (HSAs). Whether you like HSAs or not, a change in this policy is critical for our patients—your constituents. Nearly 1/3 of all employer sponsored plans are HSA qualified HDHPs today; as such, none of the 23 million Americans with these high deductible plans has access to affordable primary care delivered by a DPC practitioner of their choice.
H.R. 3708 definitely corrects that interpretation and says that a DPC arrangement will not be treated as a health plan that would make an individual ineligible to contribute to an HSA. It will allow fees paid for an affordable DPC arrangement to be treated as medical expenses and not the payment of insurance, allowing patients to use their HSAs to pay for much needed primary care services.
The good news is that there is strong bipartisan support for a change. Last week the Ways and Means Committee unanimously passed H.R. 3708 for consideration on the House floor. We appreciate the bipartisan efforts of the bill sponsors, Representatives Earl Blumenauer (D-OR), and Devin Nunes (R-CA), and thank Ways and Means Committee Chairman Richard Neal (D-MA) and Ranking Member Kevin Brady (R-TX) for moving the bill forward. Please urge House leaders to bring this important bill to the House floor for a vote this year.
Please reply if you have any questions or call the Direct Primary Care Coalition at (202) 624-1450 for any further information.
Garrison Bliss, MD
Chairman, Direct Primary Care Coalition
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The Primary Care Enhancement Act of 2019
The Primary Care Enhancement Act, a bipartisan bill by Representatives Earl Blumenauer (D-OR), Devin Nunes (R-CA), Brad Schneider (D-IL), and Jason Smith (R-MO) passed the House Ways & Means Committee unanimously by voice vote on Wednesday, October 23, 2019.
Senators Bill Cassidy, MD (R-LA), Doug Jones (D-AL), Jerry Moran (R-KS), and Jeanne Shaheen (D-NH) introduced S. 2999, The Primary Care Enhancement Act of 2019. This bipartisan bill is the Senate companion to H.R. 3708 , introduced by Representatives Blumeanuer, Nunes, Smith (MO), and Schneider, which passed out of the House Ways & Means Committee in October 2019 with a unanimous vote.
Bipartisan legislation that will definitively make DPC arrangements compatible with HSA has passed the House Ways and Means Committee. Representative Earl Blumenauer (D-OR) has been joined by Devin Nunes, (R-CA), ranking member of the Ways and Means Health Subcommittee, Reps. Brad Schneider (D-IL) and. Jason Smith (R-MO) as original co-sponsors of the Primary Care Enhancement Act of 2019. This bill passed the House of Representatives one year ago with strong bipartisan support. We urge the House of Representatives to pass the bill.
Senators Bill Cassidy, MD (R-LA), Doug Jones (D-AL), Jerry Moran (R-KS) and Jeanne Shaheen (D-NH) also introduced S. 2999, The Primary Care Enhancement Act of 2019. This bipartisan bill is the Senate companion to H.R. 3708, Introduced by Representatives Blumenauer, Nunes, Smith (MO) and Schneider, which passed out of the House Ways and Means Committee in October with a unanimous vote.
Momentum is building in support of DPC. The House bill comes on the heels of a Presidential Executive order urging the Treasury Department to consider guidance or rulemaking that might address one of the two issues that need to be clarified in the Tax Code by potentially defining DPC Arrangements as qualified health expenses under Sec. 213 (d) of the Internal Revenue Code. This bipartisan bill will finish the job by clarifying in statute that DPC arrangements are excepted from definitions under Sec. 223 (c) as insurance or “other coverage” that disqualifies an individual from funding an HSA. A bipartisan Senate companion will be introduced soon. S.2999 contains the same language that recently passed the House Ways and Means Committee, with a one-sentence change.
Act Now! Be a part of the solution: Please contact your Senators and Representatives today and ask them to co-sponsor and pass the Primary Care Enhancement Act (H.R. 3708 and S. 2999). Representatives and Senators need to hear from their constituents about the importance of bringing high-quality affordable primary care to more Americans with DPC. The Primary Care Enhancement Act will ensure that millions of Americans with HSAs are allowed access to the best primary care available with the DPC doc of their choice. Instructions, talking points and staff contact information can be found on our Call to Action page here.
Action Alert: Support S. 2999 and H.R. 3708
The Primary Care Enhancement Act Today!