# A Revolutionary Course for U.S. Health Care: Advancing Direct Primary Care through Federal Policy Modifications

The health care landscape in the United States encounters a multitude of obstacles, including escalating expenses, disparities in access, and concerning levels of physician burnout. These challenges underscore the necessity for creative solutions to enhance care delivery, ease financial strains, and focus on the health and welfare of both patients and health care providers. Direct primary care (DPC), a membership-based health care model, has surfaced as a viable alternative that prioritizes patient-centric care, transparency in pricing, and fewer administrative hurdles. However, to fully unlock its potential, revisions to federal policy are crucial.

This article examines practical policy revisions within the context of current legislative mechanisms to promote the national adoption of DPC, broaden access to affordable care, and empower physicians to provide high-quality care more effectively.

—

## Introduction

Health care reform has been an enduring subject of debate in the United States for many years. The prevailing health care system is burdened by rising costs, inequitable access, and cumbersome administrative demands for physicians. These limitations lead to notable inefficiencies and adversely affect both patient care and physician satisfaction. Direct primary care presents a transformative model that directly confronts many of these challenges by removing third-party insurance from routine care, offering clear pricing, and nurturing relationships between patients and physicians.

In spite of its benefits, systemic obstacles such as outdated tax regulations, restrictive insurance policies, and insufficient funding for graduate medical education restrain the expansion of DPC. Federal policymaking, including strategies like budget reconciliation and regulatory rulemaking, can equip stakeholders with the necessary tools to diminish these barriers, speed up adoption, and spark health care innovation nationwide.

—

## Policy Proposals and Implementation Strategies

To fully harness the potential of direct primary care, the following federal policy changes and implementation pathways are vital:

### 1. Overhauling Tax Policy to Endorse DPC

#### **Clarification of DPC Memberships as Qualified Medical Expenses**
The Internal Revenue Service (IRS) currently does not explicitly acknowledge DPC memberships as qualified medical expenses (QMEs). Modifying this definition would permit patients to utilize tax-advantaged accounts, such as Health Savings Accounts (HSAs) and Medical Savings Accounts (MSAs), for DPC subscriptions. This straightforward policy update via agency rulemaking would align tax regulations with contemporary health care preferences and lessen financial obstacles for patients.

#### **Universal HSA Eligibility**
At present, only individuals with high-deductible health plans (HDHPs) are permitted to open or contribute to HSAs. Widening HSA eligibility—particularly for uninsured individuals and those with different types of coverage—would enable a larger segment of the population to save for health care on a tax-exempt basis. Congress could facilitate this through budget reconciliation, directly impacting federal revenue.

—

### 2. Balancing Tax Deductions for Health Care Expenses

The U.S. tax code offers substantial benefits for businesses in terms of deducting health insurance premiums as a business expense. However, this advantage does not extend to many individuals who acquire health insurance, engage in health-sharing plans, or pay for DPC memberships directly.

#### **Individual Tax Deductions for Health Plan Expenditures**
Extending similar tax-deductibility status to individuals would establish a more equitable tax landscape. This adjustment would eliminate disparities that disproportionately affect gig workers, freelancers, and the self-employed while fostering alternative health care models like DPC. Such reforms could encourage greater DPC uptake and promote patient-centered innovations.

—

### 3. Boosting Physician Autonomy through Regulatory Reform

For DPC to flourish as a scalable model, physicians must be allowed the flexibility to function outside the limitations of conventional insurance-based practices.

#### **Streamlined Medicare Opt-Out Procedures**
While many physicians seek to reduce administrative burdens, the process of opting out of Medicare to serve patients more directly is often cumbersome. Streamlining Medicare regulations via Centers for Medicare & Medicaid Services (CMS) rulemaking would motivate more providers to offer low-cost, direct care options to patients.

#### **Granting States Authority to Regulate Association Health Plans (AHPs)**
Transferring regulatory control over AHPs to individual states would incentivize innovative group insurance frameworks such as DPC-aligned cooperative plans for small businesses, freelancers, and community entities. This reform would broaden health care delivery choices while preserving patient protections.

—

### 4. Encouraging Transparency and Consumer Choice

A lack of price transparency in health care services presents substantial barriers to access, particularly for DPC practices that thrive on upfront pricing.

#### **Require Public Disclosure of Insurer-Negotiated Rates**
Mandating insurers to disclose negotiated rates through federal regulations enforced by the Department of Health and Human Services (HHS) would equalize competition. Enhanced transparency would enable patients to make more informed choices and complement the upfront pricing model adopted by DPC practices.

#### **Abolish Minimum Essential Coverage (MEC) Mandates**
Mechanisms such as catastrophic insurance plans or health-sharing options could provide consumers with alternative insurance choices. Modifying the Affordable Care Act (ACA) through budget reconciliation