Tennessee Lawmakers Offer Direct Primary Care as Alternative to Medicaid Expansion

Published April 2, 2016

A year after rejecting Gov. Bill Haslam’s (R) plan to expand Medicaid under the Affordable Care Act (ACA), Tennessee lawmakers are adopting free-market reforms to increase patient access to affordable health care, lower costs, and improve quality.

The Health Care Empowerment Act would protect the rights of patients and physicians to enter into direct primary care agreements, in which patients pay membership fees to doctors in exchange for a suite of medical services defined by private contracts.

Senate Bill 2443, sponsored by state Sen. Kerry Roberts (R-Springfield), passed the chamber 32–0 on March 17 with an amendment requiring such agreements state direct primary care “[do] not constitute health insurance” or exempt patients from potential tax penalties under ACA.

The House counterpart bill, House Bill 2323, sponsored by state Rep. Sabi Kumar (R-Springfield), a surgeon, passed the Health Subcommittee on March 8 and was referred to the Calendar and Rules Committee on March 29. If the House and Senate approve identical versions before adjourning on April 20 and Haslam signs the bill, it will take effect on July 1.

Lemonade from ACA Lemons

Roberts says direct primary care offers Tennesseeans free-market health care solutions national lawmakers failed to produce in the ACA.

“I haven’t positioned [SB 2443] as a bill to nullify the ACA, although some have suggested it does so in practice,” Roberts said. “I viewed the bill more—and forgive the analogy—as taking lemons and making lemonade. Despite all the Washington, DC rhetoric, there is no effective effort to repeal Obamacare and empower the free market. So we looked at the situation and pondered what we could do that would bring affordable health care to Tennesseans using free-market principles.”

Roberts says he discovered the direct primary care model while looking for an alternative to ACA Medicaid expansion, which he opposes.

“The timing of this was on the heels of Gov. Haslam’s failed effort to expand Medicaid via Insure Tennessee, which the governor touted as a plan with free-market principles,” Roberts said. “Because of the governor’s popularity, many Republicans supported his effort and, upon its failure, asked the simple question: If not Insure Tennessee, what?”

Access to Care vs. Coverage

Roberts says the Beacon Center of Tennessee think tank had been asking the same question and pointed him to the direct primary care movement.

Beacon Director of Policy Lindsay Boyd says state lawmakers’ 2015 rejection of Medicaid expansion turned the tide in favor of free-market health care solutions, such as direct primary care.

“[Haslam] himself has admitted that the legislative climate would have to change significantly for him to revisit Insure Tennessee, which has fortunately allowed members to shift focus from defending against bad legislation toward supporting positive reforms like direct primary care that truly address the need for access to care, not just coverage,” Boyd said.

Boyd says she expects the Health Care Empowerment Act to “pass smoothly through [the] remaining House committee” because the Health Subcommittee passed it “nearly unanimously” and the bill has the support of House Speaker Beth Harwell (R-Nashville) and Lt. Gov. Ron Ramsey (R).

Empowering Communities, Employers, and Providers

The bill would increase opportunities for communities and employers, instead of governments, to subsidize health care for low-income individuals, Roberts says.

“An added benefit to empowering direct primary care in Tennessee is that charitable organizations can subsidize clinics to serve impoverished areas,” Roberts said. “Further, an employer can subsidize DPC to lower insurance premiums on employee health plans.”

The Health Care Empowerment Act would expand freedom for physicians as well, Roberts says.

“We wrote the legislation in an empowering way and with a great deal of freedom for a doctor to practice direct primary care without the fear of being regulated like [a health maintenance organization] or insurance provider,” said Roberts.

‘An Absolute Winner’

Ultimately, the direct primary care legislation now before state lawmakers materialized from “the search for something to address the incredible harm Obamacare was doing to Tennessee,” Roberts said.

“As a conservative, finding a free-market solution that removes the government from the relationship between the patient and doctor without creating a government bureaucracy, without costing taxpayer dollars, without increasing regulation, and with creating affordable health care for Tennesseans is an absolute winner and a validation that our conservative ideas and principles work,” Roberts said.

Dustin Siggins ([email protected]) writes from Washington, DC.

Internet Info:

Matthew Glans, “Tennessee Considers Opening Doors to Direct Primary Care,” Research & Commentary, March 16, 2016: https://heartland.org/policy-documents/research-commentary-tennessee-considers-opening-doors-direct-primary-care

A Comprehensive Package to Reforming Healthcare, Beacon Center of Tennessee, November 2015: https://heartland.org/policy-documents/comprehensive-package-reforming-healthcare

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