Primary Care Enhancement Act of 2019 (HR 3708)

The Primary Care Enhancement Act HR 3708 (which passed the House last year) was re-introduced on 07/11/2019 and it was referred to the House Ways and Means Committee. The bipartisan bill already has three cosponsors:

Rep. Nunes, Devin [R-CA-22]
Rep. Schneider, Bradley Scott [D-IL-10]
Rep. Smith, Jason [R-MO-8]

The bill begins by stating that DPC shall not be treated as a health plan under 223(c) - and is thus off to a good start. There are three scope restriction sections that deserve attention. The “primary care only” restriction is unfortunate, the $150 per month restriction is clearly misguided and should be removed, and the third restriction is understandable (medications, labs, and any procedures requiring general anesthesia are not routinely bundled into monthly fees). I’ve included a brief summary of each section below, and for those that would like a more detailed analysis here is my post regarding the same language when it was first announced in the summer of 2018.

Scope Restriction #1: Primary Care Only

The term ‘direct primary care service arrangement’ means… an arrangement under which a patient is “provided medical care (as defined in section 213(d)) consisting solely of primary care services provided by primary care practitioners (as defined in section 1833(x)(2)(A) of the Social Security Act, determined without regard to clause (ii) thereof), if the sole compensation for such care is a fixed periodic fee.” This definition of DPC restricts certain specialists from participating in DPC - a move made in a minority of states and a scope restriction that really is not necessary.

Scope Restriction #2: $150 per month limitation

“With respect to any individual for any month, such term shall not include any arrangement if the aggregate fees for all direct primary care service arrangements (determined without regard to this subclause) with respect to such individual for such month exceed $150 (twice such dollar amount in the case of an individual with any direct primary care service arrangement (as so determined) that covers more than one individual).”

Scope Restriction #3: Anesthesia, Rx, Labs

For purposes of this paragraph, the term ‘primary care services’ shall not include—
(I) procedures that require the use of general anesthesia,
(II) prescription drugs (other than vaccines), and
(III) laboratory services not typically administered in an ambulatory primary care setting.

Please support the executive order efforts, support the Primary Care Enhancement Act (promoting modifications - especially to the $150 cap, support the DPC Coalition (don’t forget the Fly-In on Sept 16-17), and support DPC Action.