Updated on 05/30/17 - Twenty one states across the country have DPC "not insurance" laws on the books. Maine and Alabama remain promising in the current session.
Moving West to East I have been assisting the following states with legislation:
Montana - SB 100 "Authorize Direct Primary Care Provider Plans" was first discussed and passed out of the Committee on Public Health, Welfare, and Safety (the discussion was recorded here - for the first thirty minutes) it then passed the Senate (the discussion can be heard here at 32 minutes into the recording to around 64 minutes into the recording) and was discussed in the House and was passed on its third reading on 03/15/17. He vetoed DPC legislation previously based on erroneous conclusions about the model, and it appears that he has made the same mistake again this year.
Colorado - HB17-1115 "Direct Primary Health Care Services" was introduced on 01/20/17 and the governor signed the bill on 04/24/17 making Colorado the 20th state to pass DPC legislation. The bill no longer contains a new prohibition regarding Medicaid private contracting, and instead merely references the old problem already in place in CSR 25.5 (discussed and linked here).
Arkansas - Rep Justin Gonzales introduced HB 2240 on 03/06/17 to exempt DPC agreements from insurance regulation. This legislation corrects some aspects of a bill passed in an earlier session (covered on the Arkansas state page). HB 2240 has been passed out of the House and Senate and was signed by the governor on 04/07/2017!
Kentucky - SB 79 Defining "Direct Primary Care Membership Agreements" was introduced on 01/03/17 and signed by Governor Bevin on 03/17/17. Kentucky is the first state in the 2017 session and the 18th state overall to pass DPC "not insurance" legislation!
Indiana - SB 303 Direct Primary Care Agreements has passed the senate by a wide majority. It was assigned to the House committee on insurance where it was passed and received additional cosponsors. The governor signed the measure on 04/21/17 making Indiana the 19th state to pass DPC legislation.
Florida - SB 240 Direct Primary Care and HB 161 Direct Primary Care Agreements were introduced on 01/12/17 and 01/11/17 respectively and a committee hearing took place on Feb 8th from 3:30 - 6:00 PM EST. Respective Senate and House Committees have both passed the bills unanimously. Drs. Lee Gross, Josh Umbehr, and Phil Eskew spoke along with policy analysts Bill Hurley and Katherine Restrepo. A video recording of the event can be viewed here. HB 161 has passed the House with a 107-6 vote and but alleged proponents in the Senate had secret meetings with large backers and then killed the bill by combining the DPC language with other unpopular legislation to provide cover for their true LACK of support. This political behavior is shameful.
Alabama - Signed SB 94 into law on May 26, 2017 (HB 309 was the companion bill). The law has a good DPC definition, and it would have been helpful (for clarity and consistency) if they included the commonly accepted phrase direct primary care. They have borrowed from Georgia with most of their language. This is the first time I have seen a group add dentistry to "not insurance" legislation. While not necessary, it also is not a problem. Listing the 6,000 and 3,000 yearly fee caps seems misguided. GA made the same mistake in their proposal, but no other proposed or enacted law had this provision. The debate has always been about whether risk transfer was happening (at all). The exact amount 6,000 or otherwise is not helpful. The bill has passed the senate and was sent to the house on 03/07/17.
Georgia - Introduced SB 50 on Jan 24th and it has passed the Senate and is now being considered in the House after receiving a positive vote in the Insurance Subcommittee on 03/20/17. It contains helpful definitions and the earlier fee caps have been removed. The revised version of the legislation looks wonderful and deserves our full support!
Virginia - Senate Bill 800 has been passed by both the House and Senate and is awaiting the Governor's signature as of 03/08/17. Governor McAuliffe decided not to sign the bill, but rather than vetoing it he recommended these four amendments. In a surprise move Governor McAuliffe later signed the bill into law on 04/26/17.
West Virginia (repeal and replace) - House Bill 2301 was signed by Gov Justice on 03/24/17 and it repealed the restrictive and largely unhelpful pilot program discussed in detail here. Congratulations West Virginia! This is a big step in the right direction!
South Carolina -House Bill 3546 and Senate Bill 276 were introduced on 01/24/17 and referred to the committee on labor, commerce, and industry. A series of hearings were held. For now it appears that these bills will be blocked at the committee level.
Pennsylvania - The Pennsylvania Academy of Family Physicians has been leading the charge to get DPC legislation introduced. As of May 26, 2017 the conversation is picking up.
Maine - SP 472 was signed into law by the governor on June 1, 2017. It received a favorable reception in the Committee on Insurance and Financial Services. It was well written and passed in one of the most rapid processes this year!
Texas - This state already has great DPC law on the books, but they are one of a handful of states that currently prohibit any physicians from dispensing medications to patients. This ability to bypass the pharmacy, PBMs, etc and dispense medications at wholesale cost is a major value add for many DPC practices. HB 1482 was introduced on 03/07/17 to allow physicians to dispense medications. Please call your representative to indicate your support if you live in Texas!
New York - Assembly Bill A03966 has been proposed. We are unsure what prompted this bill. It offers a broad definition of "retainer" medicine and establishes a requirement that any kind of retainer practice have an escrow account. It does not actually mention direct primary care, nor does it offer any "not insurance" protections in spite of implementing an escrow requirement. It has not made it out of the committee stage and is not expected to gain much attention.
Michigan's Patrick Colbeck continues to be one of the best DPC supporters. After previously introducing and passing "not insurance" legislation the Senator has now introduced a resolution designed to encourage the federal government to correct confusion around health savings accounts and DPC.
If you are from one of the states listed above and have additional updates for other readers (such as the date of an upcoming committee meeting or vote) please comment below. If you reside in any of the above states, please read the proposed legislation (these are typically quick reads) and if you support it contact your state senators and representatives. 2017 is shaping up to be a great year for Direct Primary Care! Please do your part!
Recent Writing - Dr. John Bender wrote an excellent article about DPC earlier this month that was published on the AAFP website. Dr. Ryan Neuhofel has been defending DPC as well. The editorial Medical Economics has been very interested in DPC lately and we are grateful they regularly write about the model.
Recent CME style videos - more and more are available all the time. I have provided links to over 50 free CME videos here. Check them out when you have the time.