PROPOSED REGULATIONS UPDATE - June 9, 2020
WASHINGTON – The Internal Revenue Service today released proposed regulations addressing the treatment of certain medical care arrangements under section 213 of the Internal Revenue Code.
Section 213 of the Code allows individuals to take an itemized deduction for expenses for medical care, including insurance for medical care, to the extent the expenses exceed 7.5% of adjusted gross income.
The proposed regulations address direct primary care (DPC) arrangements and health care sharing ministry (HCSM) memberships, and provide the following guidance:
The proposed regulations respond to Executive Order 13877, which directs the Secretary of the Treasury, to the extent consistent with law, to “propose regulations to treat expenses related to certain types of arrangements, potentially including direct primary care arrangements and healthcare sharing ministries, as eligible medical expenses under Section 213(d)” of the Code.
LEGISLATIVE UPDATE - March 20, 2020
It appears that the unfavorable legislation we have all been actively opposing has been slipped into the new Senate relief bill for Coronavirus.
Please see page 171, Section 4403.
Any help opposing this addition would be greatly appreciated. It would be wiser to add Senator Cruz's bill which would expand tax relief for HSA to ALL people, not just those with HDHPs.
DPC Action and all of the independent DPC physicians and their patients across the country appreciate any time and consideration you may be able to provide us.
Feel free to reach out to me or anyone on the board of DPC Action if you would like to have a call about this.
This bill will move fast so i am afraid we don't have much time.
With much appreciation-
Kimberly Legg Corba, D.O.
Green Hills Direct Family Care, Inc.
AID's response - March 20, 2020
On behalf of AID, our position is that while we support the relief efforts Congress is trying to enact with regard to the coronavirus, we resent lawmakers’ attempts to inject their unrelated agendas into a last-minute emergency bills in the hopes they’ll get passed unnoticed. My members in particular take issue with Sec. 4403, beginning on page 171. The proposed bill should not limit the scope (by definition) of who provides primary care, or cap the compensation requirement, or otherwise impede the free-market engagement of patients and their chosen physician providers.
AID concurs with AAPS that Sec. 4403 should be removed from the 3rd coronavirus bill. “It overregulates innovative direct care arrangements that are increasing patient access to low cost, high quality medical care. Congress needs to allow patients to use Health Savings Accounts for direct care arrangements without unnecessary limits on patients' options.”
Suggested replacement language, if there is to be any, would be either of these bills:
Original HR 365 bill would be a good replacement: https://www.congress.gov/bill/115th-congress/house-bill/365
Or Sen. Cruz’s bill: https://www.congress.gov/bill/116th-congress/senate-bill/3112?s=1&r=5
Welcome to AID Direct, a gathering place for members who have direct-care or concierge practices, or who offer a cash-pay model, or would like to. Here you can find resources, industry updates, and a network of other members opting out of third-party payer arrangements to deliver health care their way. Created in response to member demand, AID Direct is a free member benefit that fills a gap in the market, and that is open to all specialties. If you are interested in joining this subgroup of AID, please contact us, and we will add you to the online directory, which lists direct-care doctors by state. Meanwhile, please subscribe to the forum below and join the discussion below, where members can ask and answer questions.
AID DIRECT FORUM
Through our online forum, members can get advice and information from other members and access non-physician professionals who may assist with starting, converting, or maintaining a direct-care medical practice. Please join the conversation.
Bye-bye health insurance: How direct primary care can save you money - Bravo!! Doctors (and patients) you can do this! We're helping our members who want to talk about it and explore the option through our AID Direct forum.
Allison Gormly - March 2, 2020
Michael Tetreault - Februbary 27, 2020
The Business of Better Health Care - A hotel magnate’s efforts to create a quality and cost-saving health system offer lessons for other employers.
Harris Rosen - February 14, 2020
Steve Twedt - January 20, 2020
Kenneth Fisher - July 29, 2019
Seka Palikuca - March 13, 2019
Robert Lamberts, MD - August 1, 2018
January 14, 2020 - Legislative Update
Currently, bills in both the House and Senate address the tax treatment of Direct Primary Care as it relates to a patient’s ability to pay fees using his or her HSA account, while continuing to fund that HSA account. Both issues relate to the tax code--IRC 213(d) and IRC 223(c), respectively. The proposed and upcoming rule from the White House’s June 24, 2019, Executive Order on Improving Price and Quality Transparency will fix the 213(d) tax issue, but the 223 (c) tax code requires legislative action.
As of Jan. 14, 2020, 19 HSA reform-related bills were in Congress. Four are Senate bills; two address the DPC/HSA issue. Fifteen are House bills; five address the HSA/DPC issue. One Senate bill (S.2999) and one House bill (HR3708) are unfavorable to independent, private practice DPC/Direct Care physicians and offices.
Any legislation clarifying that DPC arrangements are not health insurance under IRC 223 (c) creates an important distinction and will continue to advance the growth of direct care. Neither S2999 nor HR 3708 do that. Our position is that if patients can use HSAs/FSAs/HRAs/MSAs to pay for Direct Care, it will help them get affordable health care that would otherwise cost them far more out-of-pocket costs, especially if they have High Deductible Health Plans.
Dr. Kimberly Corba
HR 3708 entitled "To amend the Internal Revenue Code of 1986 to allow individuals with direct primary care service arrangements to remain eligible individuals for purposes of health savings accounts, and for other purposes" is a poorly crafted bill that will impact the market-based strides that Direct Primary Care has worked so hard to establish. This example of needless government control over something that is working is indicative of why we are where we are today in healthcare.
Our coalition stands behind Direct Primary Care as well as other models that provide affordability and accessibility to the American people. We will be signing on to a letter that expresses our displeasure with the bill. I have provided the link to HR 3708 below for all to read. Please feel free to reach out if you have any questions.
Texas Public Policy Foundation
American College of Private Physicians
Concierge Medicine Today
Dedicated to promoting and advocating for improved access to affordable health care through independent Direct Primary Care practices
Direct Primary Care (DPC) Alliance
Direct Primary Care (DPC) Frontier
Free Market Medical Association
Offering health-conscious individuals and families an affordable way to share medical care expenses in a like-minded community. Liberty HealthShare is not insurance.
The Sedera Health medical cost sharing model boldly challenges the insurance status quo. Through an innovative layering of healthcare services, we enable individuals and families access to high quality healthcare that is affordable, flexible and effective. You share medical funds with like-minded people and receive premium care, through an organization run with compassion.
Surgery Center of Oklahoma