With more and more patients turning to direct primary care (also known as “concierge medicine”) to control their health care costs and streamline interactions with their physician, you’d think our health care system would want to encourage it as a valuable option.
The Trump administration seemed to be on board, at least at first. Last summer, an executive order even directed the Treasury Department to “propose regulations to treat expenses related to certain types of arrangements, potentially including direct primary care arrangements . . . as eligible medical expenses.”
Sounds good, right? Well, unfortunately when it comes to government regulations saying it and doing it are two different things.
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In fact, the proposed IRS regulations (REG-109755-19), drafted in response to that executive order, only purport to increase the availability and accessibility of direct primary care. Instead of helping, the proposed regulations actually include a poison pill that would take direct primary care off the table for millions of patients.
Since direct primary care only covers, well, primary care, many patients (more than 21 million to be exact) choose to pair it with a high-deductible health care plan and a health savings account (HSA) to provide for additional expenses like specialists or tests. This model enhances their ability to easily access a physician who knows them and their medical needs while making fully informed decisions about additional health care costs in advance. Of course, it also allows for the tax-preferred savings that HSAs are known for.
But with HSAs come additional rules. Under law, to qualify for an HSA and the tax-advantaged benefits that come with it, individuals must be covered by a high-deductible health insurance plan. The idea behind this is that those with more out-of-pocket costs, or “skin in the game,” have a personal interest in driving down their health care costs and are therefore rewarded with an HSA.