States across the country are introducing, passing, or vetoing bills that would directly affect direct primary care (DPC) practices, in regard to whether they are considered insurers. Some argue that because they require an upfront payment to cover an undetermined amount of services each month, they should fall under insurance regulations. Others contend that the DPC model is a physician-patient contract, without the “middle man” of insurance concerns.
Twenty-three states have passed laws regarding DPCs, their definitions, and their relationship to insurance, including whether they fall under insurance regulations. Eight states passed legislation in 2017. Those states with current legislation include: Washington, Utah, Oregon, West Virginia, Arizona, Louisiana, Michigan, Mississippi, Idaho, Oklahoma, Missouri, Kansas, Texas, Nebraska, Tennessee, Wyoming, Arkansas, Kentucky, Colorado, Indiana, Virginia, Alabama, and Maine.
The state of Oregon has DPC-related legislation in place that, in some opinions, needs to be revised and updated. The law does not explicitly state that DPC is not insurance. In addition, it grants the Oregon Department of Insurance the ability to investigate and subpoena DPC practices as well as broad authority to adopt new rules regarding DPC practices.
The state of Arizona has determined that “Direct primary care provider plans that are issued pursuant to title 44, chapter 11, article 25 are not insurance.” However, there are concerns that the legislation does not provide protection against insurance regulations since the definitions also include the phrase “if the plan does not assume financial risk or agree to indemnify for services provided by a third party.”
Bills regarding DPC regulations have been introduced in Florida and Georgia but have not yet passed due to timing issues or simply not being included in a vote. West Virginia and Arizona updated and revised their legislation in 2017, both of which are thought to be improvements on previously restrictive regulations. Pennsylvania has just recently introduced legislation related to DPCs.