“The most terrifying words in the English language are ‘I’m from the government and I’m here to help.’” Ronald Reagan uttered these words more than three decades ago, but they still ring true today. Like Reagan, 1,500 physicians are concerned about the perils of government intervention that means well but fares poorly. That’s why they have signed a petition imploring the American Academy of Family Physicians (AAFP) to oppose the bill HR 3708, which is purportedly designed to help them.
Despite the House resolution’s upbeat title and good intent, the Primary Care Enhancement Act of 2019 would hamstring the most innovative category of primary care physicians in the country — harming doctors and their patients.
Most of the doctors who have signed in opposition to HR 3708 practice under a patient-friendly model called direct primary care (DPC). These doctors practice outside of the insurance-based payment model. Instead, DPC physicians offer comprehensive primary care for an extremely low monthly fee — and offer huge discounts on more specialized care.
Liberated from the time-consuming and costly insurance industry, DPC physicians can devote more time to their patients — providing better care and cheaper prices on services, labs, imaging and medications. And if the IRS clarifies the ability to use Health Savings Accounts (HSAs) for DPC, everything could become even more affordable. HSAs use pre-tax dollars to pay for qualified medical expenses. Counting DPC monthly fees as HSA-eligible expenses would result in huge savings for patients.
HR 3708 claims to ensure the IRS classifies DPC correctly — i.e., to write into law that HSAs can pay for DPC. So, why do more than 1,000 doctors who would seem to benefit from this bill oppose it?
Because it would shut out specialists, cripple innovation, and limit patients’ treatment options.
As written, HR 3708 would restrict specialists, such as cardiologists, from engaging in DPC’s innovative and streamlined monthly contribution model. It would take years for specialists to fight back and push for new legislation to correct this mistake, all while patients pay more for treatments they desperately need.
HR 3708 would also prevent physicians from including such services as joint injections, steroid shots or B12 injections in their monthly membership offerings.
The bill would restrict variations of the fixed monthly membership model and inhibit the development of additional patient-friendly DPC models. HR 3708 would also place the first cap on how much of their HSA patients can use for medical expenses.
Finally, by modifying the wrong part of the IRS code, HR 3708 could cause DPC to be categorized as a form of health “plan.” If categorized as a second health plan, it could open DPC to regulation by overzealous State Insurance Commissioners. Even worse, it could mean patients paying for DPC with their HSA would no longer be able to contribute to the HSA they are using to pay for it.
These are just objections to the bill as written. On its journey to becoming a law, a bill passes through a maze of agencies that add layer upon layer of new regulations based on their interpretation of the text. No one knows what kinds of problems these agencies, and their subjective interpretations of the language of this bill, would cause.
Simply put, while trying to improve DPC, HR 3708 would reverse the progress DPC providers are achieving outside the country’s insurance-based health care system. This bill would limit physicians’ ability to innovate, restrict services, and trigger bureaucratic nightmares.
Those wanting to ensure that patients can use HSA funds to pay for DPC don’t need to compromise on a flawed HR 3708. President Trump signed an executive order in June 2019 that should resolve this issue. For those wanting a more durable legislative fix, a more robust and appropriate bill is rumored to be on the way. Until it arrives, Congress should resist prescribing a drug worse than the sickness.
Chad Savage, M.D. (firstname.lastname@example.org), is a policy fellow at the Docs 4 Patient Care Foundation and the founder of the DPC practice YourChoice Direct Care in Brighton, Michigan.