Maine Considers Exempting Health Care Model from Insurance Regulations

Published May 18, 2017

Maine lawmakers are considering a bill to protect the right of patients to obtain health care without insurance and to exempt direct primary care (DPC) practices from insurance regulations.

Legislative Document 1385, The Health Care Empowerment Act, introduced by state Sen. Rodney Whittemore (R-Skowhegan), would forbid regulators from interpreting state law as prohibiting patients from obtaining health care unrelated to an insurance plan, Medicaid, or Medicare.

Also known as An Act Governing Direct Primary Care Membership Agreements, the bill specifies DPC agreements between doctors and patients are not a form of insurance and shall not be regulated as such.

In exchange for an average monthly fee of $80, DPC providers offer preventive care, labs, tests, telemedicine services, and a number of office appointments agreed on in advance.

The Committee on Insurance and Financial Services received testimony on the bill on May 4.

Savings for Patients, Doctors

Dr. Michael A. Ciampi, a DPC provider in South Portland, says his patients enjoy knowing their health care costs and getting steep discounts on medication and labs.

“Patients appreciate this model because the costs are transparent and predictable,” Ciampi said. “They also have access through our office to generic medications at prices that are almost always lower than the $4 lists at pharmacy chains, as well as cash pricing on labs that save patients as much as 90 percent.”

The model enables Ciampi to treat his patients personally and repeatedly, Ciampi says.

“[My patients] also appreciate the fact that in our practice they always see me, their personal physician, unlike their experience at bigger practices, where they rarely, if ever, see their assigned primary care physician,” Ciampi said.

Contracting directly with patients instead of through insurers saves providers time and money, Ciampi says.

“I chose to adopt the direct primary care model because as a solo family physician, the administrative burden and high overhead of a traditional insurance-based practice, combined with diminishing reimbursements from insurance companies, was creating great financial hardship,” Ciampi said. “DPC eliminates much of these problems by eliminating the insurance middleman.”

Potential Savings

Liam Sigaud, a policy analyst at the Maine Heritage Policy Center, says patients and physicians should be free to give DPC a chance.

“It really depends on who you are,” Sigaud said. “DPC isn’t a good option for everyone, but it certainly has its place for millions of Americans.”

Routine preventive care could increase savings for relatively unhealthy patients, Sigaud says.

“Some healthy patients with few primary care needs may pay more under DPC than they would if they were uninsured and paying out of pocket,” Sigaud said. “However, for many patients, particularly the chronically ill, research indicates that DPC consistently delivers large savings, by reducing downstream medical expenses and better managing comorbidities.”

Compatible with Insurance

LD 1385 does not preclude DPC patients from having health insurance.

Insured patients receiving preventive care at DPC practices are less likely to file insurance claims, Ciampi says.

“This bill should not be seen as a threat to the insurance companies,” Ciampi said. “In fact, it would be logical for them to support it, because it would improve their bottom line, since DPC physicians do not submit claims for their services.”

Passage of LD 1385 would help people understand the DPC model, Ciampi says.

“Because direct primary care is a relatively new model of health care delivery in Maine, my fellow DPC physicians and I feel it is important to establish in state law that a DPC membership is a type of personal service contract rather than an insurance product,” Ciampi said.

Lawmakers should view the bill as a cost-effective protection of patient choice, Ciampi says.

“We are optimistic that the bill should pass with little or no opposition,” Ciampi says. “It is a nonpartisan issue. It simply establishes the definition of direct primary care. This is a revenue-neutral bill that does not affect the state budget.”

Hayley Sledge ([email protected]) writes from Centerville, Ohio.

Internet Info:

Michael T. Hamilton, “States Should Protect Direct-Pay Health Care Models,” Consumer Power Report, The Heartland Institute, January 26, 2017:

Jordan Finney, “Maine May Consider Protecting Direct Primary Care Practices from Overregulation,” Health Care News, The Heartland Institute, January 17, 2017: