States move to enable direct primary care as a new approach to health care services

A trip to the doctor, and treatment, without a co-pay?

It’s possible under “direct primary care,” a model whose growing popularity can be traced by the number of states (23) with “enabling” laws to clarify that direct primary care is an acceptable health care model and not to be confused with health insurance coverage or a health plan under federal law.

So far, Indiana, Kansas, Michigan and Nebraska are the only Midwestern states with such laws, all having passed legislation since 2015, when Kansas’ HB 2225 and Michigan’s SB 1033 (passed in the 2014 session, signed in 2015) were signed into law.
In direct primary care practices, patients pay a monthly fee for a set of services, which can include lab work and, in some practices, even house calls. Direct primary care is also typically paired with a high-deductible insurance plan to cover hospitalization and access to specialists.
“You’re sort of repurposing traditional insurance to be what we used to call ‘major medical’, ” says Jay Keese, executive director of the Direct Primary Care Coalition.
“If you take primary care out and pay for it directly … then the whole process becomes much more efficient.”
The coalition is pushing Congress to pass the Primary Care Enhancement Act, which would define direct primary care as a service, not insurance, and allow people with health savings accounts to use them to pay the monthly fee.
A changing health care model was the impetus for Indiana’s enabling law (SB 303, signed into law in April), says Sen. Ed Charbonneau, one of the measure’s main authors.
“When this issue came up, the concern was that this was legal and had nothing to do with insurance — that it was just a business model. We just wanted to make sure that it was OK,” he says.
Nebraska legislators passed LB 817 in March 2016.
Sen. Merv Riepe, who introduced the bill and authored a FirstPerson article about it for the February 2016 edition of Stateline Midwest, says “it’s probably early” to know how the law is affecting primary care delivery.
“I think it’ll play out over two, three years,” he says.
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Stateline Midwest: January 20182.48 MB