Legislative Update

State Update: (in no particular order)

Nebraska - LB 1119 - This is a well drafted bill designed to create a DPC pilot program for state employees. 

Maryland - HB0718 and SB0531 - Are very well written and should receive broad bipartisan support by appropriately defining DPC as outside of insurance.  (Maryland also has a wonderful piece of legislation designed to call out PBMs for their lack of price transparency.)

Florida - SB 80 (no vote yet) and HB 37 (passed  97-10) are active again in the current session - maybe the committees will provide a clean vote this time around (things are looking good so far based on this summary) to define DPC as outside of insurance.

South Carolina - House Bill 4643 has been introduced in the 2018 session. 

Pennsylvania - HB 1739 has already passed and SB 926 had a formal hearing on Dec 12, 2017.

Wisconsin - Senate Bill 670 and Assembly (House) Bill 798 have been proposed to clarify and DPC is not insurance while simultaneously initiating a Medicaid direct primary care pilot program.  Most of the bill is well written and helpful.  If this passes Wisconsin would be the first state to pass DPC defining "not insurance" language in the same piece of legislation as a more controversial Medicaid pilot.  Typically "not insurance" efforts pass with bipartisan support, but pilot programs are a tougher sell. I have a few detailed thoughts:

Section 1(3)(a) comes dangerously close to the old HMO gatekeeper provision and I am not convinced that the language in Section 1(3)(b) will be easily enforced.  

Section 2(2)(h) is missing important language.  As written this section prohibits employers, Medicaid (the pilot proposed in Section 1) or theoretically the patient's Grandma from paying the monthly DPC fee.  I would propose the following language addition.  "The health care provider and the patient are prohibited from billing an insurer or any other third party on a fee for service basis for the routine health care services provided under the Agreement.  

Section 2(3) is not the ideal scenario.  If this language was what it took to get the insurance commissioner's office to withdraw their objection, then okay.  Ideally this entire section should not be needed.  DPC physicians should be policed by the medical board, not the department of insurance.

Federal Update:

At the federal level there are many different vehicles that could pass to solve some or all of our HSA "plan" (section 223(c) and "medical expense" (section 213(d)) problems:

The Primary Care Enhancement Act (HR 365) and (SB 1358)
Health Savings Account Act (HR 1280)
The Health Savings Act of 2017 (SB 403) (only addresses 223c problem)
The Chronic Disease Management Act of 2018 (SB # not assigned yet) (only addresses 223c problem)
The American Health Care Reform Act of 2017 (HR 277)

All of these bills would be helpful for DPC patients and physicians to have more HSA flexibility.  Expect action during omnibus discussions in March of this year.

That's all for now!  I will attempt to post more often, but the start of 2018 has been especially busy.  Did I miss something in your state?  Are you aware of other promising legislation at the federal level?  If so please feel free to comment below or send an email my direction!