State Update: (in no particular order) - last updated 04/11/18
BTW - the AAFP is surveying DPC practices.
Nebraska - LB 1119 - This is a well drafted bill designed to create a DPC pilot program for state employees. It has passed both the house and senate. It was presented to the governor for signature on 04/11/18.
Maryland - HB0718 and SB0531 - were well written and should receive broad bipartisan support by appropriately defining DPC as outside of insurance. Neither passed the committee level, and HB0718 was formally withdrawn after an unfavorable recommendation on 04/09/18 (Maryland also has a wonderful piece of legislation designed to call out PBMs for their lack of price transparency.)
South Carolina - House Bill 4643 has been introduced in the 2018 session. It has passed the house and is at the committee level in the senate.
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 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.
Iowa - Legislators have drafted helpful legislation in the form of House File 2275 and House File 2356 that describes DPC as outside of insurance. HF 2356 has passed the house and senate and subsequently was signed by the governor on 03/28/18. Iowa is the 25th state to pass "not insurance" legislation!
Missouri - They are also debating a DPC state Medicaid pilot with HB 1588, but this proposal has not made it out of the committee stage.
Georgia - HB 1051 has been introduced to define DPC as outside of insurance. This is the same legislative language that was proposed last year. The bill was quickly tabled and might be bundled with other legislative language in the next session.
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 2410) (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!