Legislative Voices Advancing Access to Direct Primary Care
Discover how key legislative efforts, such as the Primary Care Enhancement Act and the Medicaid Primary Care Improvement Act, aim to expand access to Direct Primary Care.
The growing momentum around Direct Primary Care has gained critical support in Congress, with key legislative voices championing reforms aimed at expanding access to this innovative healthcare model.
Direct Care physicians are at the heart of this movement, offering affordable, personalized care to patients without the need for traditional insurance. These reforms promise to make DPC a viable option for even more Americans.
On September 10-11, the DPC Coalition organized a meeting that brought together DPC physicians, healthcare associations, companies, and other supporters of advancing state, federal, and private sector policies to promote better primary care. Following this, RosettaFest, hosted by Health Rosetta, dedicated a session to this important topic, featuring special guests such as Dr. Maryal Concepcion, a Family Medicine Physician and CEO at Big Trees MD, Rep. Kim Schrier, M.D. (WA-08), Jay Keese, CEO of Capitol Advocates, and Dr. Garrison Bliss, known as the father of DPC.
“It was interesting being with many of you on Capitol Hill this week, as well as with CMMI, and others, where we were frankly met by a lot of people with wide eyes, saying, 'Hey, we know you're doing something right. What can we learn from you? And how can we do this better?'"Jay KeeseCEO of Capitol Advocates
In this post, we’ll explore the legislative efforts that are shaping the future of DPC, providing a deeper understanding of how these voices are advancing access to Direct Care.
The Primary Care Enhancement Act: Expanding DPC to HDHP and HSA Holders
The Primary Care Enhancement Act is a landmark piece of bipartisan legislation that addresses a significant barrier to DPC adoption. Under current IRS rules, individuals with HDHPs linked to Health Savings Accounts (HSAs) are prohibited from entering DPC arrangements while maintaining HSA eligibility. The Primary Care Enhancement Act, co-sponsored by Rep. Earl Blumenauer (D-OR) and Sen. Bill Cassidy, MD (R-LA), seeks to update these outdated regulations.
About 53.6% of private-sector workers in the U.S. are enrolled in High Deductible Health Plans (HDHPs), and the current rules disqualify these individuals from accessing DPC arrangements, which limits their ability to receive comprehensive, accessible care. The Act, if passed, will allow HDHP enrollees to participate in DPC while still contributing to their HSAs, a move that could transform healthcare for millions.
The Medicaid Primary Care Improvement Act: Bringing DPC to Medicaid Beneficiaries
Another groundbreaking piece of legislation, the Medicaid Primary Care Improvement Act (H.R. 3836), co-sponsored by Rep. Dan Crenshaw (R-TX) and Rep. Kim Schreyer (D-WA), offers the promise of extending DPC services to Medicaid patients. This bill has already passed the House of Representatives with unanimous support and is now pending in the Senate.
“This is true bipartisanship, and I’m thrilled to see the Medicaid Primary Care Improvement Act making its way through Congress. DPC can provide Medicaid patients with the long-term, relationship-based care they deserve, without the complexities of fee-for-service billing."Rep. Kim SchreyerM.D. (WA-08)
The bill clarifies that states can use DPC arrangements to serve Medicaid beneficiaries without needing a federal waiver, unlocking new opportunities for both doctors and patients.
Why These Changes Matter: Real Benefits for Physicians and Patients
For Direct Care physicians, these legislative changes represent more than just policy tweaks. They provide the legal and financial clarity needed to expand DPC practices and serve a broader population.
“First, we work for our patients, period – no fee-for-service incentives, maximum flexibility. The natural results of this design are as follows: real service is rewarded, grafting services disappear, and doctor-patient trust relationships grow massively. Panel sizes are reduced, and time with each patient is multiplied by 5 to 10 times. Hectic activity is replaced with calm, waiting rooms become no-waiting rooms, and the price becomes affordable to 80% of Americans out of pocket. Our practice income becomes adequate and stable. Trust drives better patient compliance, which in turn drives better outcomes. Innovation and exploration thrive. Being on call becomes an honor and a pleasure, not a crushing burden. Documentation drops from 6 to 10 pages of irrelevant justification for payment to a paragraph or two of meaningful prose. Malpractice suits essentially disappear. We even take on the challenge of making referrals to doctors and systems that provide the most humane, effective, and least expensive services. In multiple studies, we’ve reduced the overall cost of healthcare by 15 to 25%, after accounting for the extra money going to the physician, while delivering spectacular service and patient satisfaction."Dr. Garrison BlissThe Father of DPC
The Path Forward: From House to Senate and Beyond
The future of DPC access hinges on the successful passage of these two key legislative pieces. With the Primary Care Enhancement Act now awaiting full House consideration and the Medicaid Primary Care Improvement Act pending in the Senate, the path forward is promising.
“These bills are steps toward a healthcare system that prioritizes relationships, wellness, and patient autonomy,” Rep. Schreyer asserts. "DPC is a model that works, and we’re working hard to clear the way for more Americans to benefit from it."
As these legislative efforts gain traction, Direct Care physicians can look forward to a landscape where their ability to practice medicine is aligned with patient-centered, preventive medical care. And for patients, the message is clear: better access to the doctors they know and trust is on the horizon.
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