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[Extensions of Remarks]
[Pages E902-E903]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
INTRODUCTION OF THE PRIMARY CARE ENHANCEMENT ACT OF 2019
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HON. EARL BLUMENAUER
of oregon
in the house of representatives
Thursday, July 11, 2019
Mr. BLUMENAUER. Madam Speaker, today I am pleased to introduce the
Primary Care Enhancement Act of 2019, which would open up more access
to affordable primary care.
Direct Primary Care (DPC) is a membership-based alternative payment
model for primary care in which patients, employers, or health plans
pay a DPC physician practice monthly or periodic fees directly for
unlimited access to primary care and prevention services. DPC affords
the patient more time with
[[Page E903]]
the doctor--sometimes an hour per visit--giving the doctor the time to
build a true relationship with their patients, so they can better
understand and address their health needs.
Today, DPC is providing high-quality care at lower cost for
individuals of all ages and incomes across America. By partnering with
wrap-around insurance plans that cover non-primary care services, DPC
practices now serve patients with private insurance, Medicare
Advantage, and Medicaid managed care. As opposed to ``concierge''
physician practices, DPC practices typically charge a low monthly fee
of $50-$100 per month and serve low and moderate-income patients.
However, IRS interpretation of the tax code prevents Americans with
Health Savings Accounts (HSAs) from using this promising alternative
payment model.
The Primary Care Enhancement Act clarifies two small provisions in
the Internal Revenue Code that treat these innovative primary care
arrangements for employees and individuals as health plans rather than
medical services. More than twenty states have passed laws defining DPC
as a medical service and not a health plan regulated by state insurance
law. Likewise, Department of Health and Human Services (HHS) rules on
Essential Health Benefits clearly state that DPC arrangements are
medical services, not health insurance. However, the current IRS
interpretation of the statute 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, even though
the fees are giving them access to their primary care doctor and
primary care services that would otherwise be HSA-eligible.
As more individuals and employers seek to utilize the DPC delivery
model, it is important that an outdated tax barrier not get in the way
of patients accessing this successful model of care.
While many of us have philosophical differences about HSAs and their
role in health care, my legislation is not an expansion of HSAs
themselves; rather, it is a narrow clarification providing tax equity
for individuals who want to use DPC arrangements. I urge my colleagues
support this bipartisan effort to expand access and continue the
movement towards better primary care at lower costs.
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