Virginia Lawmakers Approve Direct Primary Care Bills—Again

Published February 28, 2017

The Virginia House of Delegates and Senate have passed bills exempting direct primary care (DPC) practices from insurance regulations, reprising legislation vetoed by Gov. Terry McAuliffe (D) in 2016.

For an average monthly fee of approximately $80, DPC practices offer patients preventive care services, tests, labs, and a set number of doctor visits outlined in a private doctor-patient agreement.

House Bill 2053 and Senate Bill 800 specify DPC agreements are not forms of health insurance and thus cannot be regulated as insurance, as long as practices do not “require patients to pay monthly periodic fees prior to initiation of the direct agreement coverage period,” the bills state. DPC providers who also treat non-DPC, insured patients would have to abide by insurers’ rules for participation in networks.

SB 800 would also require DPC providers to give patients a written statement informing them DPC membership is not insurance and encouraging patients to buy insurance covering services outside the scope of their DPC agreement.

Second Attempt

SB 800, sponsored by Sen. William Stanley (R-Moneta) and Sen. George Barker (D-Alexandria), passed 39–0 on February 7. HB 2053, sponsored by Del. Steve Landes (R-Augusta County), passed 83–12 on February 2.

McAuliffe vetoed similar legislation in 2016 after HB 685 passed the House 97–0 and the Senate 23–17. The bill included extensive definitions of terminology related to DPC agreements the 2017 bills do not.

McAuliffe’s veto in 2016 followed the House’s rejection of his recommendation lawmakers postpone the bill’s effective date one year by requiring the legislature to confirm its approval of the bill in 2017. The veto was meant to allow time for “further scrutiny and study” of DPC, McAuliffe stated in his veto explanation, describing DPC legislation as “merely a stop-gap measure in a time when bolder steps are needed,” such as “bringing federal taxpayer dollars back to the Commonwealth to cover more than 400,000 hard-working Virginians.”

McAuliffe would have until March 25, 2017 to veto the new DPC legislation. Overriding a veto in Virginia requires a two-thirds majority in each chamber of the legislature.

Lawmaker Support

Landes says bipartisan, bicameral approval of DPC legislation two years in a row could persuade McAuliffe to sign the bill.

“The bill passed the House with bipartisan support,” Landes said. “I’m hopeful [identical] legislation will be approved by both bodies for Gov. McAuliffe to sign into law.”

The 2017 legislation defuses objections opponents raised in 2016, Landes says.

“Insurance companies have been making the argument that direct primary care plans should be regulated like insurance,” Landes said. “The amended legislation addresses these concerns, and doctors, small businesses, and health insurance companies should all be satisfied with what the House of Delegates has passed.”

The bills specify DPC agreements are not health insurance if physicians do not collect fees before treating patients.

The DPC model expands treatment options for patients and strengthens patient-physician relationships, Landes says.

“Direct primary care agreements will help provide additional health care choices,” Landes said. “Additionally, direct primary care agreements empower consumers, allowing them to work with their doctors directly.”

Physician Support

Dr. Maura McLaughlin, founder of Blue Ridge Family Practice, is a board-certified family physician and DPC provider in Charlottesville, Virginia. McLaughlin says lawmakers should consider DPC’s potential for lowering Medicaid costs and improving quality.

“In Washington state, the large DPC group Qliance worked with Medicaid to provide primary care through its DPC clinics to patients with Medicaid and demonstrated a savings of 20 percent for Medicaid while improving patient satisfaction,” McLaughlin said. “If a similar program were implemented in Virginia, we would be able to expand Medicaid in a cost-neutral manner. Imagine how many more people could be covered with the 20 percent savings in the Medicaid budget.”

McLaughlin says DPC saves her patients far more than 20 percent for some services.

“[One] patient was due for four needed tests, which I drew for $38 total with our discounted cash pricing,” McLaughlin said. “He told me those exact same four tests last year had cost him $1,300 with insurance.”

Emma Vinton ([email protected]) writes from Troy, Michigan.

Internet Info:

David Grandouiller, “Michigan DPCS Pilot Could Revolutionize Health Care Insurance and Save Billions,” Health Care News, The Heartland Institute, June 30, 2016:

Matthew Glans, “Virginia Should Remove Barriers for Direct Primary Care,” Research & Commentary, The Heartland Institute, March 1, 2016:–commentary-virginia-should-remove-barriers-for-direct-primary-care

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