[Congressional Record Volume 165, Number 116 (Thursday, July 11, 2019)]
[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

                                 ______
                                 

                          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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