WASHINGTON – A bipartisan group of Representatives led by Congressman Lloyd Smucker (PA-11) are announcing the re-introduction of the Primary Care Enhancement Act, legislation designed to expand access to Direct Primary Care (DPC). Reps. Dan Crenshaw (TX-02), Jimmy Panetta (CA-19), Brad Schneider (IL-10), Kim Schrier, MD (WA-08), and Claudia Tenney (NY-24) are co-leads in introducing the legislation, representing bipartisan support from members of the Committees on Ways and Means, Energy and Commerce, and Education and Workforce.
The legislation would clarify provisions of the Internal Revenue Code to remove barriers for individuals with Health Savings Accounts (HSAs) from using those funds to access DPC, a health care delivery model which provides high-quality care at lower cost for individuals of all ages and incomes across America.
“As a former business owner that provided health insurance for over 150 employees, I know that innovative care delivery models like Direct Primary Care put patients in charge of their health, improve outcomes, and reduce costs for businesses and employees. Unfortunately, the Internal Revenue Service’s interpretation of current tax law prevents individuals with Health Savings Accounts (HSAs) from accessing DPC, even when their colleagues without HSAs can do so. I am thankful for my colleagues’ support of this bipartisan legislation to expand access to DPC,” said Rep. Lloyd Smucker (PA-11).
“Allowing people to use their Health Savings Accounts for direct primary care is just common sense,” said Rep. Crenshaw. “Primary-care providers play a crucial role in managing and reducing the severity of comorbidities—leading to lower emergency room use, improved patient outcomes, and reduced overall healthcare costs. In fact, studies show that when patients maintain a continuous relationship with a primary care physician, hospital admissions drop. It’s time we give Americans the freedom to choose direct primary care with the support of their HSAs.”
“We must continue to modernize our nation’s health care system with new ways to ensure access to affordable, high-quality primary care,” said Rep. Panetta. “The Primary Care Enhancement Act would give individuals and employers more flexibility to use Health Savings Accounts for Direct Primary Care, making it easier to access preventive and routine medical services. This bipartisan legislation is a commonsense step to lower healthcare costs, improve patient outcomes, and ensure hardworking families and businesses have the tools they need to invest in their health.”
“I am proud to support the Primary Care Enhancement Act, which will enable individuals with Health Savings Accounts (HSAs) to access Direct Primary Care (DPC), a subscription-style health care model that improves health outcomes and lowers costs,” said Schneider. “Individuals may already use their HSA to pay for primary care deductibles and copayments, yet they are inexplicably barred from accessing primary care through a DPC model. By making HSAs compatible with DPC, we will ease financial and administrative barriers to primary care and empower more individuals to take command of their health and savings.”
"As a doctor, I know how crucial access to primary care is for the health of families and children. Dependable access to primary care can be the key to catching and addressing medical issues early on and reducing costly trips to the emergency room," said Congresswoman Schrier. "By making it clear that individuals participating in Direct Primary Care arrangements can fund their Health Savings Accounts and use those funds to cover additional medical needs, this legislation will help expand access to primary care and achieve better health outcomes."
“Direct Primary Care is an innovative, patient-centered subscription model that lowers costs, improves access to quality care, and empowers patients to choose their primary care provider,” said Congresswoman Tenney. “DPC has become an increasingly popular option for families and individuals across Western New York because it strengthens doctor-patient relationship and cuts through bureaucratic red tape. The bipartisan Primary Care Enhancement Act removes outdated tax barriers, ensuring that patients with Health Savings Accounts (HSAs) can take full advantage of this innovative approach to care. I am committed to supporting commonsense reforms that promote flexibility, reduce costs, and empower patients to make the best decisions for their health.”
Support for the bipartisan Primary Care Enhancement Act:
“Direct primary care is medicine as it should be: affordable, high-quality care from the doctors you trust, with no insurance-company meddling. We congratulate you and your colleagues on introducing the Primary Care Enhancement Act because it will expand access to a truly innovative, patient-empowering option. By repealing the "DPC Tax" and putting direct primary care on a level playing field with other forms of health care, you give Americans a Personal Option -- hassle-free health care they can afford.” - Dean Clancy, Senior Heath Policy Fellow at Americans for Prosperity
“The Primary Care Enhancement Act is a vital step in improving access to affordable care. By allowing Health Savings Accounts to cover direct primary care arrangements, more Americans will be empowered to access comprehensive primary care services with transparent, predictable costs,” said Joel White, President of the Council for Affordable Health Coverage. “CAHC commends Reps. Smucker, Blumenauer, Tenney, and Schneider for leading this effort and working to make healthcare more accessible and affordable for all working Americans.”
“PBGH applauds Reps. Smucker, Schneider, Tenney, Panetta, Crenshaw and Schrier for their work to accelerate direct primary care. Our organization has a 35-year history of supporting employers in getting the best care for their employees and know that increased access to primary care significantly improves people’s health outcomes, while simultaneously lowering health care costs by as much as 30%. We strongly support this legislation that will allow employers to more easily offer direct primary care to improve the health and well-being of their workforce and avoid wasteful spending.” - Elizabeth Mitchell, CEO Purchasers Business Group on Health
Background:
- DPC is an innovative, subscription-like model in which patients pay a monthly or annual fee for primary care services, providing an alternative to traditional fee-for-service insurance.
- DPC has been proven to reduce costs and improve access to primary care. Employers report up to 20% savings on the total cost of care for their employees as a result of providing better health care up front in the primary care setting, reducing unnecessary hospital and specialty care, and drastically reducing administrative expenses.
- By emphasizing preventive care and chronic disease management with a proactive approach, DPC models have the potential to lower overall health care spending in federal programs like Medicare and Medicaid.
- With increased access to primary care, healthier Americans will be able to boost economic output and reduce their reliance on federal support programs.
- More than twenty states have passed laws defining DPC care as a medical service and not a health insurance plan. Likewise, Department of Health and Human Services (HHS) rules on Essential Health Benefits clearly state that DPC arrangements are medical services, not health insurance.
- Currently, the Internal Revenue Service (IRS) prohibits individuals with HSAs from funding their accounts if they have a DPC arrangement. Furthermore, individuals cannot use their existing HSA dollars to pay for the monthly or annual DPC fees as qualified medical expenses.
Primary Care Enhancement Act:
- The Primary Care Enhancement Act clarifies two provisions in the Internal Revenue Code that currently treat these innovative payment arrangements for employees and individuals as health insurance rather than medical services. The bill would allow patients using DPC to contribute to their HSAs and use HSA funds to pay for direct primary care fees.
- Allowing individuals with HSAs to pay for DPC services before they enroll in Medicare can reduce the incidence of unmanaged chronic conditions, decreasing federal spending on one of the largest drivers of our national debt.
- The Primary Care Enhancement Act has twice been favorably reported out of the Ways & Means Committee with bipartisan support in prior Congresses.