abstract
The U.S. health care system faces rising costs, disparities in access, and significant physician burnout. Direct primary care (DPC) offers an innovative approach by emphasizing patient-centered care, price transparency, and reduced administrative burden. However, federal policy reform is needed to expand this model nationwide. This article outlines practical federal policy recommendations and identifies how mechanisms such as agency rulemaking and budget reconciliation can be used to accelerate adoption, expand access, and empower physicians. Masu.
introduction
Health care reform is one of America’s most pressing challenges. Rising costs and decreasing access have brought the system to a critical inflection point. Direct primary care (DPC), a subscription-based healthcare model, offers a viable alternative by reducing administrative complexity and focusing on the patient-physician relationship. Despite the potential of DPCs, systemic barriers such as restrictive tax policies, insurance regulations, and limited funding for physician training limit their scalability.
To foster innovation in health care, federal policymakers must take decisive action. By leveraging legislative processes such as budget reconciliation and agency rulemaking, we can facilitate important reforms, avoid partisan gridlock, and create a more just and efficient health care system.
Policy recommendations and implementation pathways
1. Tax reform supporting DPC
- Clarification of DPC participation as eligible medical expenses
The Internal Revenue Service (IRS) must update its definition of qualified medical expenses (QME) to explicitly include DPC membership. This adjustment allows patients to use Health Savings Accounts (HSAs) and Medical Savings Accounts (MSAs) to cover DPC costs, reflecting modern healthcare preferences. - Universal HSA eligibility
Removing the high-deductible health plan (HDHP) requirement for HSAs would allow uninsured people and people with alternative insurance to save for medical expenses tax-free. These changes are enacted through the budget reconciliation process and may impact federal revenues.
2. Make all medical insurance payments tax deductible
One of the most glaring inequities in the current health care system is the tax incentives that corporations receive for providing health insurance. Employers can deduct health insurance premiums as a business expense, but individuals often do not receive similar benefits if they pay for their own insurance or alternative health plans, such as health sharing programs. To promote equity and innovation, all health insurance payments should be tax deductible.
- Allow personal deductions for medical insurance payments
It would extend the same “above-the-line” tax credit currently enjoyed by employer-paid premiums to individuals who pay health insurance, health-sharing plans, or DPC membership fees. This will end the disparities that disadvantage freelancers, gig workers, and the unemployed.
Impact of the reform:
- Equalize tax benefits between businesses and individuals.
- Encourage wider adoption of alternative care models such as DPCs and health sharing plans.
- Empowering individuals to allocate more resources towards innovative, patient-centered care.
3. Improving physician autonomy through regulatory reform
Physicians who seek to practice medicine outside of traditional insurance frameworks face significant regulatory hurdles. Key reforms include:
- Simplify the Medicare opt-out process
Streamline Medicare enrollment rules through CMS rulemaking to give physicians more flexibility and lower-cost care directly to patients. - Authorizes states to oversee Association Health Plans (AHPs)
Delegating regulatory authority for AHPs to states would encourage innovative group insurance models and reduce reliance on employer-sponsored plans.
4. Promoting transparency and consumer choice
Lack of price transparency is a major barrier for patients and independent healthcare providers.
- Require insurance companies to publish negotiated rates
HHS could implement transparency regulations that would require insurers to disclose negotiated prices, potentially leveling the playing field for DPC practices. - Eliminate minimum essential coverage (MEC) obligations
Allowing consumers to choose alternative insurance products, such as disaster plans or health-sharing arrangements, could help tailor insurance policies to their preferences. This could be accomplished through adjustments to adjust the ACA provisions.
5. Addressing the shortage of doctors
Expanding the physician pipeline is critical to sustaining innovative models like DPC.
- Increase your stay funds
Congress could increase funding for housing quotas or encourage private sector funding through grants passed through settlements. - Supporting loan forgiveness for independent physicians
Expanding loan forgiveness programs for physicians in rural and underserved areas would encourage more providers to adopt independent practice models like DPC.
6. Innovative Medicaid Delivery through DPC
Allows Medicaid recipients to access DPC through a voucher program. HHS could do this through a Section 1115 waiver that would allow states to allocate Medicaid funds to DPC members. For this to work, Medicaid recipients must be distinguishable from private salaried patients, similar to EBT or SNAP benefit programs for food.
Utilize budget adjustment and rule creation
budget adjustment
The budget reconciliation process allows Congress to pass changes that affect federal revenue or spending with a simple majority. Reforms such as tax credits for personal medical expenses, universal HSA eligibility, and increased residency funding fall squarely within this framework and are achievable even in a divided political climate.
Formulation of rules for government agencies
Regulatory agencies such as HHS, CMS, and the Treasury Department have broad authority to enact health care reform. By revising definitions, simplifying the registration process, and increasing transparency, these agencies can implement significant changes without requiring Congressional approval.
conclusion
Direct primary care offers a path forward in transforming health care delivery, but reaching its full potential depends on coordinated federal policy. Equalizing tax benefits for individuals, empowering states to innovate, and removing regulatory hurdles are important steps toward fostering a fairer and more efficient system. By leveraging reconciliation and agency rulemaking, these reforms are not only possible, but essential.
Federal policy must reflect the diverse needs of patients and health care providers and allow innovation to flourish. By leveling the playing field in health insurance payments and supporting models like DPC, America can lead the way in building a health care system that is affordable, transparent, and centered on the patient-physician relationship. can stand.
Christopher Habig Co-founder and CEO Freedom Health Worksis a company dedicated to expanding the Direct Primary Care (DPC) practice model and giving physicians back control of their patient care. Christopher was inspired to pursue healthcare innovation after seeing his family struggle in an industry dominated by insurance and hospitals. He envisioned a system where health care was available at high quality and affordability. This vision led to the creation of Freedom Healthworks, which provides tools, technology, and support for physicians to successfully run their DPC practices. Christopher spends his time educating both consumers and healthcare providers about the benefits of the DPC model through his podcast. healthcare americanaleads the Indiana Free Market Physicians Association and is a contributing member of the Indiana Physicians Health Alliance. His goal is to create a future for Americans in which health care is synonymous with the compassionate, individualized attention that is its hallmark.
You can contact him at facebook,X @FreedomDPC, linkedinInstagram @freedomdoccare.
