The Senate Commerce and Human Resources Committee has advanced legislation that seeks to codify in state statute the ability for doctors and patients to do business with each other directly without an insurance company functioning as a third party between the two.
“This bill is patterned after legislation in the state of Utah,” explained Rep. Lynn Luker, R-Boise, in presenting what is known as “direct primary care.”
Sometimes described as a cash-based system of health care, direct primary care is a process where physicians and other health care professionals provide routine services to patients in exchange for the patient’s direct payment and without any insurance company reimbursement.
Within this business model, health care professionals will frequently offer their services on a monthly “membership fee” basis; in Idaho, growing numbers of both physicians and dentists have begun to use the direct primary care business model.
“This is not an insurance product and, therefore, does not need to be regulated by the Department of Insurance,” Luker told the committee. “It does, however, give people another avenue to seek health care. This sets up a simple format that everyone can agree with, it provides for routine health services and it can be combined with a high deductible insurance policy if one chooses.”
Luker was joined in speaking in favor of the bill by Sen. Steven Thayn, R-Emmett. “This allows doctors to focus more on prevention because under the current system doctors must see a lot of patients in order to get paid,” said Thayn, who co-presented the proposal with Luker.
”Direct primary care allows doctors to spend more time with their patients on preventative measures. We’ve already begun to see this practice emerge in New York, California and especially in the state of Washington,” said Thayn. He noted direct primary care services are now being sold via Washington state’s health insurance exchange. He said there was resistance in Washington, but that has now changed. “Initially the insurance industry fought this because they saw it as competition, but eventually they came to see that it helps lower their cost.”
During questioning, Sen. Dean Cameron, R-Rupert, asked Luker, “One of the primary purposes of the Idaho Department of Insurance is to regulate insurance and to protect consumers. In your view, who would protect consumers with this plan?”
Luker responded, “The normal process by which anyone is protected outside of insurance transactions. There is certainly the Idaho Medical Association, there are licensing agencies and other means.”
Cameron continued, “So if I am a physician and a consumer signs up for my service and then I skip town and go to Mexico, you’d suggest the consumer contact their lawyer or the Idaho Medical Association?”
“I don’t see how that approach is any different from any other business relationship,” Luker replied.
Sen. John Goedde, R-Coeur d’Alene, also a committee member, asked Luker, “Are you suggesting that this can be done now?”
“It probably can be, but this bill would set formality to it,” Luker said.
“If I have a car accident and need the services of a physician, those kinds of emergency services are outside the bounds of direct primary care,” Goedde observed. “My concern is that people might sign up for this in Idaho and then think that’s all they need.”
“This does not replace insurance,” Luker stated. “We can make it clear what people are getting and not getting.”
The committee agreed to send the bill for formal printing, the bill’s next step in the legislative process.