Congress can empower employers with direct primary care

.

There is no shortage of ideas or arguments about how to fix our country’s broken healthcare system. While politicians on both sides of the aisle argue about what to do and how to do it, there is a bipartisan bill moving through Congress that could improve care for millions of Americans while reducing costs.

The Primary Care Enhancement Act makes a simple change to the tax code to allow any employer to offer direct primary care to their workforce.

DPC is, in short, a healthcare delivery model in which the employer or employees pay a flat, monthly subscription fee for access to a dedicated primary care physician whenever needed. The fee covers high-quality, coordinated, and affordable care for individuals of all ages and income levels.

Patients have no copays and deductibles for primary care, and physicians don’t have to rush through their appointments or perform an abundance of services to maximize reimbursement because nobody ever files a claim. Patients get the right care in the right setting from a doctor they know personally — the sort of patient experience that today is much more the exception than the norm.

With DPC, physicians spend as much time with each patient as needed. They can better understand and address patients’ whole health instead of referring them to specialists. There is improved management and prevention of chronic health conditions such as diabetes and hypertension, which in turn improves health outcomes, lowers costs, and elevates the patient experience.

Employers who offer direct primary care as a benefit enjoy reduced costs by keeping primary care services outside of expensive fee-for-service billing. More primary care makes for happier, healthier employees and less healthcare spending for both patient and employer.

Current IRS rules treat DPC as a health plan. The effect is to bar employers who use health savings accounts paired with high-deductible health plans from offering DPC as a benefit. The Primary Care Enhancement Act aims to expand access to high-quality DPC by clarifying that DPC arrangements are excepted from being defined as insurance or “other coverage” that disqualifies an individual from funding an HSA. As of 2019, 26 million Americans have a high-deductible health plan paired with an HSA. This is a growing trend to address high premiums, and now 70% of employers offer at least one HSA option.

In October, the House Committee on Ways and Means unanimously passed the bill on to the full House for a vote. Earlier this month, a bipartisan group of senators introduced the measure in the upper chamber of Congress.

In June, President Trump signed an executive order urging the Treasury to propose regulations that would clarify that DPC expenses are qualified health expenses under the tax code — allowing individuals to use HSA funds to pay for DPC. This is a rare bipartisan moment — both parties, the administration, and Congress working together toward better primary care for all. Now we must finish the job and pass the legislation. We urge congressional leaders to act this year and call on employers and patients to do the same.

Good health starts with excellent primary care. The Primary Care Enhancement Act would clear the way for millions of Americans with HSAs to gain access to affordable healthcare from a DPC physician. Helping individuals achieve better health at lower costs is a goal we can all embrace.

Chris Miller is the CEO of Denver-based Paladina Health, which provides and champions the DPC model through employer-sponsored direct primary care solutions. Jay Keese is the executive director of the Direct Primary Care Coalition in Washington, D.C.

Related Content

Related Content