West Virginia's Clueless DPC Resolution

Below I have copied and pasted a new resolution related to DPC in its entirety:

HOUSE CONCURRENT RESOLUTION 106
(By Delegates Waxman, Ellington, Summers, B. White, Stansbury, Atkinson and Campbell)[Originating in the Committee on Health and Human Resources; Reported March 8, 2016]
 Requesting the Joint Committee on Government and Finance to study direct primary care.

WHEREAS, Direct primary care is primary care offered directly to the consumer without insurance administration, incorporating various health care delivery systems that involve direct financial relationships between patients and health care providers; and
WHEREAS, Direct primary care is intended to remove many of the financial barriers of healthcare, often, there are no insurance co-pays, deductibles or co-insurance fees thus avoiding the overhead and complexity of maintaining relationships with insurers; and
WHEREAS, A provision of the Patient Protection Affordable Care Act (PPACA) in Section 1301 (and amendment Section 10104) allows for direct primary care to compete with traditional health insurance options in the mandated health insurance exchange when combined with a low cost high deductible plan; and
WHEREAS, Direct primary care practices do not typically accept insurance payments, thus avoiding the overhead and complexity of maintaining relationships with insurers; and
WHEREAS, Because direct primary care payments are typically paid over time, rather than in return for specific services, the economic incentives are such that the long-term health of the patient can be a profitable option for providers while also being an  affordable option to patients; and
WHEREAS, West Virginia currently does not authorize direct primary care; therefore be it
Resolved by the Legislature of West Virginia: (Pay attention to your own laws!  West Virginia was the first state to carve out a legal path for DPC -albeit an awful one with so many restrictions I would not recommend anyone pursue DPC in West Virginia.)
That the Joint Committee on Government and Finance is hereby requested to study the potential benefits of authorizing direct primary care in West Virginia as an alternative for those citizens who do not qualify for Medicaid and are unable to afford health insurance; and, be it
Resolved by the Legislature of West Virginia:
That the Joint Committee on Government and Finance shall consult with the State Medical Board, the Insurance Commission, the Health Care Authority, medical providers, health insurers and any other relevant groups or entities in gathering and reviewing information regarding direct primary care; and, be it
Further Resolved, That Joint Committee on Government and Finance report to the regular session of the Legislature, 2017, on its findings, conclusions and recommendations, together with drafts of any legislation necessary to effectuate its recommendations; and, be it
Further Resolved, That the expenses necessary to conduct this study, to prepare a report and to draft necessary legislation be paid from legislative appropriations to the Joint Committee on Government and Finance.

To this proposal I have the following response:  Dear Joint Committee on Government and Finance.  Please save your limited time and resources.  Other than the handful of (Vic Wood, DO's) practices listed in the mapper, there really are not any West Virginia DPC practices to study.  Your bad DPC law has prevented further growth.  There are plenty of academic resources (and nonacademic white papers - if you prefer) that demonstrate the need for DPC and evidence in favor of DPC.  Replace your terrible and restrictive law with something real - I've detailed all the problems on the West Virginia page.  

Phil Eskew

Hawaii Dabbling (Ignorantly) With DPC

Hawaii has a sad piece of legislation that contemplates DPC using the statements below.   SCR 157, SCR 159, and SCR 108 all contain the same quoted language.

"WHEREAS, the development of direct primary care or "concierge medicine," which is the practice of financing direct primary care through direct payments by consumers, usually in the form of monthly fees, and the billing of patient health insurance plans, has also grown nationally and in this State;" (Notice the statements in bold - they have confused DPC and concierge straight out of the gate.)

"BE IT RESOLVED by the Senate of the Twenty-eighth Legislature of the State of Hawaii, Regular Session of 2016, the House of Representatives concurring, that the Insurance Division of the Department of Commerce and Consumer Affairs is requested to conduct a survey of the medical professional community that identifies the extent to which:"

"Direct primary care, or "concierge medicine," has penetrated the Hawaii healthcare marketplace;" (According to our mapper this is easy - there are no DPC practices in Hawaii)

"Health care providers, in terms of their numbers and types, are participating in direct primary care, or "concierge medicine," arrangements;"

"Patients, in terms of their numbers and the type of insurance plan covering them (i.e., private insurance, Medicare, or Medicaid), are being served and provided primary care through direct primary care, or "concierge medicine," practices; and"

"Accountable care organizations and direct primary care, or "concierge medicine," have either increased or decreased the access of Medicare or Medicaid patients to primary care services in the State; and" (This is an attempt to marginalize DPC by claiming that this would worsen access problems for Medicare patients.  As we know, this is a false assumption.  DPC physicians routinely opt out specifically so that they CAN continue to see Medicare patients. Recall that Hawaii also had proposed legislation in this session that would make it illegal to not have your practice open to Medicare patients.) 

"BE IT FURTHER RESOLVED that the Insurance Division is further requested to submit a report of its findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days before the convening of the Regular Session of 2017."

For those that do not follow this issue closely.  Hawaii appears interested in DPC, but not interested enough to proffer simple "not insurance" legislation.  Instead, they are attempting to have the Department of Insurance "study" DPC and Concierge, which they inappropriately lump together.  The Department of Insurance is the LAST group that should be tasked with studying this model!  Just ask the Washington state insurance commissioner.  Their office has to reluctantly track data about DPC practices and present an annual report to the legislature.

Updates from WY, MA, and WA

Three updates worth sharing - one from each side of the country.  If you have thoughts or questions, please click the story above to comment on the story, or place a question/comment in the forums (we use Muut - which is spam free).  Phil Eskew

• Wyoming's Governor Mead signed SF0049 Direct Primary Care Insurance Exemption into law on leap day (Feb 29th).  Check it out when you get a chance.  It is now one of the best examples of DPC law (of the 15 states with active laws)
• In Massachusetts, where discussions are under way that could lead to DPC legislation next year, Jeff Gold has obtained a helpful letter (which was uploaded to the Massachusetts page)  from Daniel Judson (the Massachusetts Commissioner of Insurance).  
• In Washington state Qliance recently restructured and has changed ownership.  Jeff Bezos (of Amazon), Nick Hanauer, Rich Barton (of Zillow), Drew Carey (comedian), Michael Dell, and others had their stakes purchased as part of the management buyout by co-founder and CEO Erika Bliss, MD and president Cheryl Kilodavis.  Going from 40,000 to 25,000 patients and changing ownership in this way is concerning, but we wish Qliance well.