Electronic Health Reporter

By Adam Habig, co-founder and president, Freedom Healthworks.

Obtaining healthcare today is daunting. For those unhappy with our current system and seeking greater choice, HR 6199 is a step in the right direction.

Recently passed in the U.S. House of Representatives and awaiting action in the Senate, HR 6199 leverages the proliferation of Health Savings Accounts (HSAs) to expand Americans’ freedom to spend their health savings on the type of healthcare that best suits their needs.

What’s wrong with healthcare? Pricing is murky and expensive. Networks are confusing and restrict choices, while locking out the uninsured. Even with insurance, patients who need care must wait weeks or even months for an appointment, during which they waste hours in the waiting room.  Millions are simply avoiding the doctor altogether — 44 percent of Americans who were sick or injured last year chose (yes, chose!) not to see a doctor.

If they finally see a doctor, visits are often so rushed that burning questions barely get answers and physicians can never really dig into issues. Today’s typical 12-minute visit is not only unfulfilling, but research indicates that seeing a physician who is rushed, distracted and only half-listening is more likely to lead to serious health problems (beyond an inconvenience, the British Medical Journal recently reported that building a foundational, personal relationship with one physician can actually save lives).

Given these headaches, many surely wonder: Why, even with insurance, is it so difficult to obtain care when needed from a skilled doctor whom the patient trusts and who has the time to listen and provide that care?

HR 6199 modernizes the list of medical goods and services eligible for purchase with HSAs. The bill specifically authorizes direct care, where the patient can choose to purchase their care directly from a physician, without third party interference. In the popularized direct primary care model, a flat monthly fee buys an accessible, personal physician, similar to “concierge medicine” but affordable for the average American ($50 to $150 per month). As a result, the patient’s health insurance is then reserved for unforeseen, catastrophic expenses. This model further eliminates barriers like co-pays, deductibles and narrow networks, which all impede access to routine medical care and ultimately degrade the quality of care received.

Clarifying the tax code to explicitly enable greater healthcare choice is critical to fostering much-needed innovation like direct care. While an overall improvement, there are a few glaring issues with the legislation as-written. The DPC Alliance cited three specific improvements to correct flaws that emerged during revision of the original draft legislation:

1. State that DPC fees are a “qualified medical expense” under IRC 213(d), and not under a more vague categorization of “service arrangement” under IRC 223(d).
2. Make it clear that a patient may use an HSA to purchase prescription medications on a fee basis (outside of DPC bundled fees) from a DPC practice.
3. The bill places a $150 cap of DPC fees under IRC 223(d). We do not believe that price should be a defining feature or legal definition of a DPC practice and suggest removing a price cap altogether. But, if such a cap is required for budgetary reasons, this limit should be an expense cap (maximum deduction) under 213(d).

These suggestions are not simply preferences, but in fact stem from real-world experiences of those of us in the industry who are familiar with the preferences of customers in direct care practices.

For instance, many direct primary care practices sell low-cost generic medications during visits at cost, rather than forcing their patients to make a second stop at a pharmacy. Such a small convenience has been found to dramatically boost patients’ likelihood to actually comply with taking their recommended medications, which then prevents hospitalizations and even premature death. The current version of HR 6199 would interfere with this common practice.

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