As Donald Trump begins to transition into his presidency, the healthcare community has begun to make predictions about the impact of Trump’s policies on independent physicians. But what can direct primary care (DPC) providers expect to see the next four years?
Though a health care agenda has yet to be clearly outlined by Trump’s transition team, one of the tenets of health policy for both Republican lawmakers and Trump revolves around Health Savings Accounts or HSAs. These medical savings accounts allow taxpayers with high-deductible plans to use tax-free funds to pay for qualified medical expenses.
Currently, concierge practices that see patients enrolled in HSAs or Flexible Spending Accounts (FSAs) through an employer, can use their tax-exempt HSA or FSA funds to pay for their concierge physician’s annual fees. Annual fees charged by concierge practices include many medical services, including annual physicals. Unlike concierge physicians, physicians practicing within a DPC model currently cannot be reimbursed by HSA or FSA funds. This means that direct primary care is all but ignored in IRS code as it is not considered a “qualified medical expense,” under Sec. 213(d) of the Internal Revenue Code.
But with Republicans holding more power come January 20, it’s likely that HSAs could be expanded to include direct primary care monthly fee arrangements. Legislation could be introduced in Congress that would allow HSAs to work in conjunction with direct primary care practices.
If this happens, DPC physicians would benefit. An expansion of HSAs into direct primary care territory could not only incentivize more patients to seek care from DPC practitioners but also potentially encourage more physicians to open up DPC practices across the country.
At Elation, we support DPC practices and expanded access to all forms of high quality care. We hope president-elect Trump and our next Congress will allow patients to use alternative HSAs to pay for their DPC memberships.
It’s clear that IRS code has not kept up with the current state of healthcare and an inequity exists between concierge practices and DPC practices. Most importantly – however – patients need flexible options for the way they receive comprehensive primary care and expanding HSAs to include direct primary care accomplishes that.