DC Legislation Worth Supporting, Nearby Ignorance Remains in Richmond

The DPC Coalition continues efforts to fix HSA hurdles in DC.  For those interested, check out this video out of House Health Ways and Means Committee hearing.  Testimony on DPC from Rep. Erik Paulsen (R-MN) starts at around the 15:05 mark and continues until around 20:10.  He specifically mentions DPC at section 17:15 (in the context of making it HSA eligible), and then again in more detail from 19:00 - 19:50.  For ongoing updates, follow the Direct Primary Care Coalition.  

From Jay Keese of the DPC Coalition:  "Rep. Paulsen and Senate Finance Committee Chairman Orrin Hatch (R-UT) are the authors of the Health Savings Act, H.R. 4469/S.2499.  Sections 206 and 603 contain language that would clarify to the IRS that HSAs are compatible with DPC.  S. 1989, the bipartisan Primary Care Enhancement Act, contains the same language.  In addition to Rep. Paulsen’s testimony on the DPC HSA fix, Rep. Mike Thompson (D-CA) and Rep. Charles Boustany (R-LA) testified on H.R. 2911, the Small Business Healthcare Relief Act, which would eliminate a $100 per employee per day fine the ACA can impose on small employers under 50 not subject to the ACA mandates who want to offer DPC without insurance."  For more details on these complicated tax hurdles, see my detailed discussion here.  

Virginia Governor Terry McAuliffe "Governor McAuliffe Vetoes Legislation Exempting Direct Primary Care Agreements from Health Insurance Laws and Regulations" Gov McAuliffe, an attorney (an inactive member of the DC bar and not a member of the Virginia bar) joins the ranks of the ignorant opposition along with Montana Governor Bullock.  They have the distinction of being the only governors to veto DPC legislation (I covered Governor Bullock's blunder here.)  

Consider this statement from McAuliffe "A direct primary care agreement is merely a stop-gap measure in a time when bolder steps are needed.  Not only would a product like this deter an individual from purchasing health insurance, it would still not cover any catastrophic care or chronic conditions requiring a specialist."  By it's nature this statement represents an admission that DPC is NOT insurance, yet Gov McAuliffe veto's a law designed to clarify that DPC is not insurance while claiming that the law would create confusion! 

News Flash to Gov McAuliffe - DPC is ALREADY LEGAL in Virginia!  DPC practices are already operating in Virginia!  Your veto makes the model more confusing for patients, and legally more expensive for physicians. The next time you explain your veto, try being honest - I vetoed this legislation because the insurance companies were against it, because it achieves price transparency that could lead to more informed health consumers (my investments were focused on the dead rather than the living), and because as an attorney and non-physician I genuinely do not know the first thing about primary care, especially direct primary care.

Governor McAuliffe should be aware that the out of state union money that financed much of his campaign is actually in favor of DPC, so while this might make his insurance donors happy, the unions might be giving him an earful during the next fundraising cycle when their health plans are failing.  As a democrat, you just vetoed a bipartisan bill on a subject that was supported in the ACA. What were you thinking?

Virginia and Tennessee - At the Governors' Desks

Most states are winding down their legislative sessions.  Fortunately DPC laws passed in Wyoming and Nebraska.  Other proposals lost steam at some point in the legislative process.  Florida and Georgia made it further than most.  Alaska never gained traction at the committee stage.  Things look very promising in Tennessee where Governor Bill Haslam is expected to sign the legislation.  Virginia is a different story where it is anticipated that Governor Terry McAuliffe will not sign the bill.  Hopefully we will not face any additional Montana scenarios.  When it comes to DPC ignorance is not bliss.  We could go 2/7 or 4/7 this session - it's up to the governors now.

Congratulations to Nebraska! Legislative Update

Yesterday Nebraska became the 16th state to pass DPC legislation!  See the Nebraska page for more details.  As of today we do not have any Nebraska practices in the mapper, but this should change soon!

We are still waiting on legislative outcomes in Virginia (where DPC legislation has passed the House and Senate and rests with the governor) and Tennessee (where legislation is cruising through the committee stages).  Florida, Georgia, and Alaska legislative proposals have lost steam and are unlikely to regain attention in this legislative session.  An earlier blog post offers links to each state's proposed legislation.