DAY IN DC FOR THE GOOD OF PATIENTS-empowering physicians to put patients first.

In the Oath of Hippocrates, physicians promise to work for the good of their patients, according to the best of their ability and judgment, and to do no harm. We support a return to this ethic in American medicine, and oppose policies that harm patients by subjugating care to the interest of the government and third parties.

Reform Issues:

  • Overregulation and mandates restrict access, stifle innovation, impede transparency, block competition & raise costs.
  • Fraud, waste, and shortages are rampant because special favors to middlemen.
  • Employer-based and government-run insurance discourages rational insurance practices.
  • Medicare and Medicaid are bankrupting the federal government, states, and doctors.
  • In the era of COVID, the consequences of usurping of patient and physician autonomy and freedoms are becoming increasingly apparent and dangerous.

Proposed Solutions: to protect freedom, increase options, encourage competition, and unwind unsustainable spending.

  1. End mask, vaccine, and other mandates and policies that intrude on patient autonomy. This also includes protecting Americans from World Health Organization policies that too often become mandates.
  2. Protect physician and patient freedom of speech in all venues, including the Internet. The government and media must not limit legal speech and must be transparent about their sources of funding and control. (See Texas HB 20.)
  3. Protect physician and patient autonomy in treatment and vaccination decisions. Early treatment for COVID saves lives and should not be improperly blocked by government or other bureaucrats. See AZ SB 1416 and MO HB 2149). Vaccine mandates are hurting vulnerable patients at low risk for COVID and must end. (See FL HB 1B, 3B, 5B, 7B).
  4. Protect due process rights of physicians who too often face retaliation, simply for advocating for patients, by employers, hospital administrators, licensing boards, and others who control their ability to practice. Needed reforms include repealing HCQIA’s qualified immunity for sham peer review, reform of the National Practitioner Databank, and rights for physicians employed by private equity controlled corporations.
  5. Work toward independence from China CCP medications, tech, manufacturing, goods and WHO influence.
  6. End regulations blocking alternatives to ACA, employment-based, Medicare, and Medicaid plans, while allowing those who wish to keep their current government plan to do so.
  7. End ACA’s ban on physician owned hospitals. Section 6001 of the Affordable Care Act of amended section 1877 of the Social Security Act to generally prohibited those who know best how to care for patients from running the facilities where care for the most seriously ill and injured often takes place.
  8. Encourage transparency. Health care entities receiving taxpayer-subsidized funds from any source must disclose all prices that are accepted as payment in full for products and services furnished to individual consumers. Transparency by agencies (FDA, CDC, NIH, etc.) that control and influence health policy and treatment guidelines is also paramount. Transparency in training, so that patients know the qualifications of the clinicians caring for them, is also needed as patients are increasingly pushed to obtain care from individuals with significantly less training than physicians. Databases disclosing potential conflicts of interest must include all entities receiving or offering payments (e.g. device and pharmaceutical manufacturers, PBMs, GPOs, hospitals, insurers) not just physicians.
  9. Remove legal protection for kickbacks. Remedy GPO and PBM abuse of safe harbors by encouraging Congress to repeal 42 U.S.C. § 1320a-7b(b)(3)(C) and amplifying HHS-OIG efforts to stop exploitation of 42 C.F.R. § 1001.952(j) and related regulations. Ending kickbacks is a crucial aspect of ending America’s reliance on China for drugs and supplies.
  10. Decouple Social Security benefits from Medicare Part A. Citizens should be permitted to disenroll from Medicare Part A without forgoing Social Security payments. This would immediately decrease government spending and open the potential for a true insurance market for the over-65 population.
  11. Repeal Medicaid rules that decrease Medicaid patients’ access to independent physicians. ACA requires physicians ordering and prescribing for Medicaid patients to be enrolled in Medicaid. This creates barriers for Medicaid patients who seek care from independent physicians but wish to use Medicaid benefits for prescriptions, diagnostics, and hospital fees. This is a particular problem for Medicaid patients seeking treatment for opioid addiction.
  12. Explicitly define direct patient care (DPC) agreements as medical care (instead of insurance) so patients can use their HSAs, HRAs and FSAs for DPC.
  13. Expand Health Savings Accounts (HSAs).  Examples of needed reform include repealing the requirement that an individual making a tax-deductible contribution to an HSA be covered by a high deductible health care plan; increasing the maximum HSA contribution level; allowing Medicare eligible individuals to contribute to an HSA. HSA reform will help end tax discrimination. Individual’s payments for medical care should not be taxed differently than payments made by employers.
  14. End Restrictions on Health Sharing Ministries. Open the door for secular charitable sharing plans. Health Care Sharing Plans engage in voluntary sharing and are not a contractual transfer of risk.
  15. Encourage indemnity insurance and competition instead of managed care HMO plans. No limited networks of physicians and facilities.
  16. Address shortcomings of the No Surprises Act, that unfairly increase insurance company control over the ability of patients’ to access care from the physicians of their choice on mutually agreeable terms and that increase red tape for physicians.
  17. Increase options for addressing pre-existing conditions. Invigoration of competition, by implementing the above changes, would bring a variety of products for patients with pre-existing conditions, including reinsurance, and inexpensive guaranteed issue and renewability protections, and most importantly, lower overall cost of care.

Conclusion: Congress has passed law after law that disrupts the patient-physician relationship, corrupts medical decision making, and increases costs. During the COVID era, overregulation and regulatory capture is a greater threat to our nation than ever.   Harmful laws and policies cannot be fixed by adding new regulatory burdens or further usurping patient and physician autonomy. True reform starts with repealing laws and correcting errors, restoring the freedom, under constitutionally limited government, that made America great.

PETITION: Tell NJ Governor to Rescind Order Blocking Patient Access to Hydroxychloroquine (609) 292-6000

NEW ACTION ITEM: Sign the petition to NJ Governor Murphy to repeal his prohibition of physician prescriptions for patients impacted by the #COVID19 #Coronavirus #Pandemic.

After you sign the petition: Call New Jersey’s governor Murphy (609) 292-6000 to rescind his rule restricting early treatment of COVID-19 coronavirus patients. His rule is dangerous and likely would make people sicker and worsen the death toll. Call him, email or web page contact him and demand he reverse his rule. Let doctors be doctors.


Join the physicians who are speaking out! The below letter from physicians explains the urgency for this request.

Doctor’s Letter to Governor

Dear Governor Murphy,

Based on the current circumstances of an extremely contagious deadly COVID19 virus that is creating chaos in our state and the world, your order to restrict physicians from writing prescriptions to treat their patients with Hydroxychloroquine (HCQ), we believe, is contrary to the best practices of medical care. We, as perhaps you, believe in the sanctity of the patient-physician relationship in personalized individual management and care, and that it must lie in the knowledge and wisdom between those two entities and not artificially imposed by others.

Your administration’s order of restriction to use HCQ, prevents patients’ access to a potential life-saving medicine, especially when administered in the early phase of the disease. (1) Creating such a mandate may risk the lives of many New Jersey residents.

Timely access to these medications may mean the difference between life or death for patients facing the battle of their lives. We respectfully suggest that working with New Jersey’s robust pharmaceutical industry to increase the supply of these drugs, both for NJ and the rest of America would benefit the residents of New Jersey and across the country.

Early treatment is crucial for keeping patients out of the hospital and off ventilators. Delaying treatment results in the opposite, more sick patients ending up in overburdened facilities.
HCQ prevents the virus from gaining access to the human cell and in doing so it prevents the infection. Additionally, in those patients who already have infection in their system, HCQ prevents access to the cellular structure called Endoplasmic Reticulum where it replicates. Preventing such replication, reduces the viral load and hence allows the human immune system to fight off the infection. Without this drug, many valuable human lives will be cut short with such an order as proposed and promulgated by your administration. (2)

Other State Governors of Nevada and Michigan formulated similar mechanisms of restrictions to the use of Hydroxychloroquine but seeing the burgeoning loss of life quickly reversed course. If restriction is to prevent hoarding of the medication, then perhaps using the Texas model of limiting the drug dosing for 10 days (20 pills) might be more appropriate. It prevents harm to our vulnerable, sick and infirmed patients. (3)

HCQ has many decades of history as used in the care of patients with Malaria and Rheumatoid Arthritis. Knowing its very low toxicity and it poses very little if any threat to the patient, clinicians in New York, Kansas, elsewhere are reportedly preventing deaths and ARDS/ventilator dependent long ICU stays. Waiting for placebo-controlled trials is not a wartime battlefield strategy, given the urgency of treatment.

As physicians it is our duty to treat patients with the best available therapy and available evidence to circumvent disease at its earliest phase, so as to prevent the loss of life and any future morbidity. It is with that wisdom and acquired knowledge that we respectfully ask you to reconsider this restrictive mandate.

That these drugs are effective against COVID-19 has been proven in laboratory experiments. (4) And now evidence is mounting that these drugs are working to decrease viral load in patients. Decreased viral loads means patients not only avoid the hospital but are less infectious to others.(1) There is growing evidence that early administration even in mild cases of COVID-19 prevents progression to worse disease, likely attenuating the need for ventilators and ICU beds and improves symptoms. (5) This will decrease the burden on the healthcare system and upon the doctors and nurses that bear the ultimately responsibility of the patient’s care.

The information available from across the world suggests that the prudent course of action is not to put hurdles in the path of patient care by restricting most valuable medications that can protect a human life. In fact, India is officially recommending health care professionals and family members of sick patients prophylactically take HCQ. (6) The New York Times reports of a recent study: “Cough, fever and pneumonia went away faster, and the disease seemed less likely to turn severe in people who received hydroxychloroquine than in a comparison group not given the drug.” (7)

We respectfully ask that you review this decision, given the influence of such overwhelming evidence to the contrary. It is with great respect and urgency that we ask you to reconsider this decision that can potentially cause a significant loss of life in the state of New Jersey. Each patient care decision is unique to an individual and their own personal situation and value system. Patients and their physicians must carefully weigh the risks and benefits of every potential intervention. The confidential patient-physician relationship must be held sacrosanct for this purpose.

Best health,

Craig M. Wax DO, Family Medicine
Parvez Dara, MD, Hematology/Oncology
Jim Thomas, MD, Interventional Radiology
Theresa Thomas, MD
Joeseph J. Fallon, Jr., MD, Endocrinology
Carl J. Minniti Jr., MD Medical Oncology & Hematology
Charles Dietzek, DO Vascular Surgery
Indrani Sen Hightower, MD, Neurology
Alieta Eck, MD, Family Medicine
Kelly Victory, MD, Trauma and Emergency Medicine,
Disaster Preparedness and Response
Christine Saba, MD, Pediatrics
Kim Legg Corba, DO, Family Medicine
Marion Mass, MD, Pediatrics
Katerina Lindley, DO, Family Medicine
Theresa Thomas, MD, Internal Medicine
Thomas W Kendall, MD
Family Medicine
Robert Campbell MD
Pain Management
Jane Hughes, MD, Ophthalmology
Kris Held, MD, Ophthalmology
Michael J. A. Robb, M.D., Oto-Neurology

Marilyn M. Singleton, MD, Anesthesiology

Kenneth A. Fisher, M.D. Nephrologist

Marlene J. Wust-Smith, M.D., Pediatrician

Leah Huston, MD, Emergency Medicine

Karladine Graves, DO, Family Medicine

Elaina George, MD, Ear Nose Throat

Scott Stevens, MD, Ophthalmology

N. Lois Adams, B. Pharm, MBA, CRPh

Joel L. Strom, D.D.S.,M.S., General Dentistry
Independent Physicians for Patient Independence


  1. Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial
  2. COVID-19 Drug Therapy – Potential Options
  3. Gov. Whitner reverses course on coronavirus drugs
  4. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro
  5. Efficacy of hydroxychloroquine in patients with COVID-19
  6. Recommendation for empiric use of hydroxy-chloroquine for prophylaxis of SARS-CoV-2 infection
  7. Malaria Drug Helps Virus Patients Improve, in Small Study

ALERT: Opportunity to Help ALL patients access Direct Care with latest Coronavirus aid bill

Update 3/22/2020: It appears that the flawed language has been removed from consideration! Now it is time to ask the Senate to ADD good language from S. 3112, the Personalized Care Act.

Please contact your Senators ASAP with the following request: Please include S. 3112, the Personalized Care Act in the upcoming bill to address the Coronavirus epidemic. Allow all patients to use Health Savings Accounts for direct care arrangements with their trusted doctors, without unnecessary red tape and limits on patients’ options.

Phone numbers for all Senators and the email addresses of their healthcare legislative staff can be found at:

Empowering patients to access low cost, high quality medical care, from independent physicians is more urgent than ever!

Tell Congress to Remove Flawed Direct Primary Care Language from Emergency Legislation

Dear AAPS Members and Friends,

Earlier this week we alerted you to provisions in the House coronavirus relief bill that are harmful to small medical practices and all small businesses.  The bill was made slightly less bad before it ultimately passed and was signed by the President.

You can read more about the changes and impact for small businesses here:

Now the Senate is working on a third bill related to the ongoing situation with COVID-19. 

A 247-page draft of the bill is now online here:

It has a number of health policy related items tucked into it, for instance a temporary suspension of Medicare sequestration payment reductions.  It also has provisions easing FDA regulations that may impede timely care, and requires that “each provider of a diagnostic test for COVID-19 shall make public the cash price for such test on a public internet website of such provider.”

One immediate concern about the latest bill is that it contains flawed language (Sec. 4403) intended to fix the incompatibility of Health Savings Accounts and Direct Primary Care caused by current IRS law and policy.

A solution for this problem is needed, but the Senate language mirrors problematic policies from past versions of related legislation.

For instance:

1. The bill caps patients’ “aggregate” direct primary care fees at $150/month. Most DPC fees are well under that amount but imposing price controls on care paid for from HSAs would be a dangerous precedent.  And the cap also limits the flexibility of physicians and patients to tailor agreements based on individual patient needs. 

2. The bill limits DPC agreements to “primary care practitioners as defined in section 1833(x)(2)(A) of the Social Security Act.” It also imposes other limits on the types of care that can be included in agreements. These limitations are unwise and also improperly limits the options of patients and physicians.

3. The bill adds DPC to the the section of IRS code that lists types of insurance eligible for payment from HSAs. Labeling DPC as a type of insurance, or type of coverage, is not the right way to correct the flaws in the IRS code and increases the risk of overregulation of innovative DPC practices.

Here’s what you can do:

1) Ask your Senators to remove Section 4403:

Please call your Senators ASAP and ask them to“Remove Sec. 4403 from the 3rd coronavirus bill and replace it with S. 3112, the Personalized Care Act.  Sec. 4403 overregulates innovative direct care arrangements that are increasing patient access to low cost, high quality medical care. This flawed language will do more harm than good. Congress instead should enact S. 3112 and allow all patients to use Health Savings Accounts for direct care arrangements without unnecessary limits on patients’ options.”  

You can find your Senators’ phone numbers at:

Alternatively, you may phone the United States Capitol switchboard at (202) 224-3121. A switchboard operator will connect you directly with the Senate office you request.

2) Next call your House members and tell them the same thing!

Contact info at or Capitol switchboard at (202) 224-3121

3) Finally call President Trump to warn him about this bad provision and ask him to demand Congress remove it:

White House Phone #:  (202) 456-1111.

White House Contact Form:

Please share this alert and encourage others to call. Thank you!

Possible COVID-19 case: Why private independent physicians are a better patient care choice

On Saturday morning at about 10 AM on March 14, I saw a patient for and infectious illness. He was a 51-year-old, military veteran, with a history of hyperlipidemia, cervical DJD, depression and low testosterone. He works as a government entitlement interviewer at a State/county office. His job includes computer data entry while interviewing candidates of all backgrounds for Government benefit eligibility.

He related a two day history of flu like symptoms that included fever with maximum temperature of 102.9°F, muscle aches, fatigue, and dry cough. He denied any history of travel out of the country or exposure to others with that history.  His physical exam was consistent with viral syndrome and negative influenza A and B office testing.  Because of his symptoms, negative influenza testing, and potential workplace exposure history, I was concerned for the possibility of coronavirus Covid 19 Infection. Unfortunately, there were no testing materials for commercially available coronavirus tests. Current testing reports three days turnover time. 

After conversations earlier in the week with Quest and LabCorp, we are on the list to get testing materials next week.  I called the local hospital laboratory and they transferred me to the infectious disease nurse coordinator. She said she would try to get permission to collect a sample from the New Jersey health department and call us back. She called back half an hour later and said that she couldn’t contact anyone and therefore I could not take a sample. 

I was concerned that this might be either COVID19, a false negative influenza test or another infectious illness. My preference was to obtain a viral culture but there were none privately or publicly available, prior to initiation of treatment. As a private independent physician, I decided to treat for two scenarios with Tamiflu 75 twice a day times seven days for influenza and Hydroxychloroquine 200 mg twice a day for seven days as a possible treatment for COVID19. The patient was to self quarantine at home for seven days, stay out of work, and call us with updates. we told the patient to have his live-in girlfriend get in touch with her doctor immediately for potential evaluation and treatment, as she had similar symptoms.

At my direction, my office staff called the New Jersey health department. The number was consistently busy so we sent the patient home. The staff then tried the NJ coronavirus consumer hotline. The attendant said she couldn’t take any information but gave us another number for the NJ COVID19 hotline. 

Upon dialing the next number, we got a polite attendant who also couldn’t take information. I spoke directly with her and she gave me contact information for the County Health Department. I recognized those numbers for daily practice. I knew they would only be available Monday through Friday during business hours and not Saturday morning, which it was. I pressed for another number and was given what appeared to be a cell phone number. 

I called it and spoke with a county health department employee, finally. I discussed the case with her and she said she would call me back after she spoke with her supervisor. She then called back sometime later after the patient had gone and said that given the above case, the New Jersey state coronavirus criteria would not allow a sample to be taken, despite my concerns for moderate risk. 

The major ironies are that the governor, to this moment, despite urging in school closures, has not closed all New Jersey primary schools. Another major irony is that the New Jersey state health department was inaccessible when needed, but coincidentally sent an email with general governance later that afternoon, as opposed to weeks before. 

Fortunately, as a private independent family physician, I was not limited to a hospital system protocol, insurance protocol, or government protocol. I actually diagnosed and treated the patient, definitively and comprehensively, for major disease risk factors.  We will stay in touch with him via phone during the coming week while he is on himself quarantine and out of work. 

HR 3708: Is Pre-Deductible Coverage of Direct Primary Care a Feature or a Bug of The Primary Care Enhancement Act?

Aren’t HSAs intended to empower patient choice? Enabling plans and employers to influence the patient’s selection of primary care physician seems antithetical to this purpose.

DPC practices are rightly concerned about the numerous limitations HR 3708 would impose on their innovative model.  Yet, the limitations on HSA-eligible DPC arrangements are needed “to keep the cost score estimate of the legislation down,” the flawed argument goes.

But the tax impact occurs when dollars are put into an HSA and not when they are spent, so why so much fuss? Yes, the bill would cause more people to become eligible to fund their HSAs tax-free. That would indeed be a source of lost tax revenue. However, wouldn’t the cost in lost tax revenue be about the same irrespective of how a DPC arrangement is designed, assuming patients are funding their HSA up to the modest limits allowed per year anyhow?

Continue reading

Update: AAFP Should Stand Up for Patient Access to Independent DPC and Withdraw Support for HR 3708

Update: Here is Mr. Shawn Martin’s reply. He granted permission for IP4PI to share it with the understanding that it should not be considered an official statement from the AAFP.

On Oct 25, 2019, at 7:17 AM, Shawn Martin wrote:


Thank you for your email. I hope you are doing well. Your email outlines several areas of concern that we share and have been communicating to the various bill sponsors and Committees. We are working to make changes to the bill and I am confident that we will be able to do so.

AAFP policy only speaks to the allowable use of HSA funds for the periodic payment for primary care DPC practice. The bill language meets this objective. We are, however, very concerned with the exclusionary definition of services, specifically pharmaceuticals. Family physicians are not homogenous and the inclusion of a standardized definition and payment rate for “primary care” is concerning. We also are concerned that the allowable periodic payment amount is established irrespective of the patient and their health condition(s).

The other concern we are advancing is the simple fact that the language would apply the permissible use of the HSA to the periodic payment and not the patient themselves. This is nuanced, but basically the permissible amount should apply only to the patient/HSA holder and should have no impact on the practice or the practice’s financial operations.

There are other structural issues, but these are the big items we are working on.

Have a nice weekend – SM

Update 2: From: Shawn Martin, Date: October 25, 2019 at 2:06:39 PM EDT

October 25, 2019 at 2:06:39 PM EDT

I think the challenge in the next few weeks is this – is there a pathway to codify the permissible use of HSA funds for the explicit purpose of periodic membership payments and, if yes, what is the scope of services for such a permissible payment.

The relationship between not permissible (current) and permissible at $x (as proposed in legislation) is not the point in my mind.  The point is providing clarity in statute that an individual may use their HSA funds for a defined purpose – in this case periodic payments to a DPC practice.  Any limitation on the amount of a permissible expenditure is secondary to the permissibility question more generally.  There are defined limits on tax advantage accounts broadly – FSA, CTC, mortgage deduction, SALT, etc.

Its an interesting policy question that I have been kicking around since the ACA.  The HRA is cleaner because it is a defined contribution.  Anyway – look forward to the call with you and others.

10/24/2019 letter from IP4PI founder Craig M. Wax, DO to AAFP Senior Vice President for Advocacy, Practice Advancement and Policy, Shawn Martin:

Dear Shawn

Long time no see, or hear for that matter. I hope you and your family are well and that you landed safely at another entity. I’m writing to express concern about HR 3708 in the House and AAFP support of it. AAFP has been supportive of DPC in recent past and that support is much appreciated, but this bill, as written, would do more harm than good.

Enacting an aggregate cap on patient use of HSA funds for access to value-based care would be a bad precedent and the proposed prohibition on the ability of physicians to include medications in a DPC agreement is contrary to the best interests of patients.

In addition, all specialties, not just primary care, should be permitted to arrange innovative direct payment arrangements with the patient, eliminating the middleman and optimizing care with reduced cost.  HR 3708 appears to preclude the ability of a patient with diabetes from using HSA funds to pay for a monthly arrangement with an endocrinologist, for instance.

The bill also seems to risk the potential for States and others to misclassify DPC as an insurance plan by not properly and clearly defining DPC as medical care.

In its current form, this bill is unacceptable and I am disappointed that AAFP is supporting it. The previous Primary Care Enhancement Act from 2017 (HR 365) was an excellent template, while HR 3708 is flawed.

Please let me know what can be done to revoke AAFP support for this harmful legislation, and work for better options to support DPC and empower both physician and patient independence.

Best wishes for good health,
Craig M. Wax, DO
Family Physician
Independent physicians for patient independence
National Physicians Council on Healthcare Policy member
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
Twitter @drcraigwax 

Cost transparency in BILLING!

By Paul Kempen, MD, PhD

Price transparency is a fallacy regarding posting of lists of costs when insurance is involved. Perhaps transparency in BILLING is more reasonable to create individual outrage regarding outrageous bills. Please consider the following:

Cost transparency in BILLING!

I want to hear if anyone sees the following proposal as useful in separating physicians out from the “cost of care”. The issue of transparency is nebulous “going into” getting care for a number of reasons. Patients are often ill, in urgent need, in a “closed market” and poorly educated.  Perhaps it  would be useful to push for legislation creating transparency of ALL BILLS, especially those produced by insurance companies which serve to foster that impression that insurance somehow actually pays for care.  Insurance controls payments through ”negotiated prices”, limitation of care delivery and other aspects. I question if it would it be useful to have laws which Demand EVERY “This is NOT a bill” produced by corporate entities include the following data:


1) Itemized price charged (i.e. charge-master and/or “full billed price”)

2) Amount ACTUALLY PAID by insurance independent of  patient portion separated from negotiated deductions

3) What Medicare would have paid for every BILLED service in A) HOSPITAL and B) regional Doctor’s office

4) All facility fees separated from total cost as a separate component

Imagine if everyone SEES the “facility fee” and recognizes that doctor offices are CHEAPER!!

If everyone sees the hyperinflated insurance/hospital costs over physician offices

If everyone sees that the PATIENT is paying for care via the deductible and sees just how LITTLE insurance companies are paying from the large premium and this is NOT hidden in the “negotiated deductions” which gives an appearance of “saving money” for patients.

Anyone producing a bill MUST have access to such data and making everyone aware of these realities would create pressure on OVERCHARGES

75 Years After D-Day It’s Time to End a Failed WWII-Era Economics Experiment … and solve the surprise billing quagmire too

It’s a sign of the divisive times: even the American business community is throwing its own under the Congressional bus. In a letter to the Senate HELP committee, a broad coalition of employers, including the National Restaurant Association, Auto Care Association, and the National Association of Wholesaler-Distributors, is calling on Congress to impose price controls on others that they would not tolerate being placed on themselves.

Yes, even the “Small Business & Entrepreneurship Council,” is joining this coalition, whose arcane name is a throwback to 1970s era overregulation—ERIC, the ERISA Industry Committee—to ask for legislation that is anything but entrepreneurial.  

These businesses are part of the growing chorus asking Congress to “do something” to address “surprise” medical bills. But instead of focusing on the root causes of the problem, ERIC, and others are demanding heavy handed price controls that will harm the physicians who render life saving medical care — often small businesses themselves. 

And putting the squeeze on physicians with government set fees, that may not even cover costs bloated by complying with a sea of federal regulation, ultimately harms patients’ ability to obtain high-quality, timely care in situations where care is most needed.

Let’s take a closer look at the real cause of the problem, and solutions that will put patients in the driver’s seat instead of putting their access to care on the hot seat.

“Surprise, your insurance plan is not going to cover the care you received,” is another way to describe the situation. Of course, insurers want to limit their costs, as any business would, and those who provide care want to be paid well for their services. 

But how much should emergency medical care cost? In a functioning marketplace prices are determined through an immeasurable number of mutually beneficial transactions between customers and producers, not by federal fiat. 

But American medicine is anything put a healthy market. 

The fact that ERIC is demanding price controls points to a big reason this is the case. Employers are stuck between employees and their medical care thanks to the downstream consequences of wage controls in WWII that spawned tax-deductible employer-funded health benefits. D-Day was 75 years ago, and while Europe was freed, flawed government economic decisions from the War are still trapping Americans “in-network” with soaring medical prices, deductibles, and co-payments, not to mention premiums.

Because employers and other third parties are often in charge of paying the bill and negotiating costs, patients have lost their leverage and pricing becomes untethered from the marketplace mechanisms that, for instance, have put not just a chicken in every pot, but supercomputers in the pockets of virtually every American over age 13, and a car (or two) in nearly every garage.

It’s time to begin extracting the employer from the health care equation. ERIC and its members can be freed from the burden of overseeing and paying for their employees’ care. Employers don’t like shouldering this responsibility and employees shouldn’t want their employer interfering in the exam room or operating suite.  And, sorry Berniacs, Medicare for All is not the right way to go about winding down employer-based coverage.

One answer is to give patients better options to become independent of their employer for their care, like through expanding Health Savings Accounts with the flexibility to be used to buy catastrophic coverage or pay Direct Primary Care (DPC) arrangements.

Another more long term goal, but one in line with the American spirit of freedom and individualism is to end the $280 billion tax exclusion for employer-based insurance benefits altogether. Increase wages and salaries proportionately and cut taxes across the board. Employees can then decide for themselves how to spend their hard earned dollars, whether on insurance, directly on care, or however they choose.  

This would be a win-win-win, for employers, employees, and all patients. A re-energized marketplace will unleash more competition and more facilities and practices emulating the likes of the Surgery Center of Oklahoma (knee-replacements can be 50% less than through “coverage”) , Atlas MD (unlimited primary care for $50/month, $2 lab tests, and wholesale cost prescriptions), and Green Imaging (home of the $250 MRI) where direct-to-patient pricing, that eschews insurance contracts, is a fraction of what “in-network” options charge for the same care. And yes, competition even works to lower the cost of emergency care, as demonstrated by lower-cost transparent physician-run ER and urgent care options already popping up in Arizona, Oklahoma, Texas, and elsewhere across the U.S.

So instead of a surprise bill, patients will be pleasantly surprised at how affordable and accessible high-quality medical care is even for emergencies, when they, not their employer, insurance CEO, Member of Congress, or government bureaucrat are the customer.

Action Item: Visit and learn how to make an immediate difference in the fight to stop flawed legislation.

16 Bills to Expand Flexibility of Health Savings Accounts #HSA #HSAs

Thank you to Kim Corba, DO for compiling this list of bills under consideration in Congress intended to increase the flexibility of Health Savings Accounts.

H.R.3565 — 116th Congress (2019-2020) Veterans Health Savings Account Act Sponsor: Rep. Gosar, Paul A. [R-AZ-4] (Introduced 06/27/2019) Cosponsors: (7) Committees: House – Ways and Means Latest Action: House – 06/27/2019 Referred to the House Committee on Ways and Means.

This billallows veterans who receive hospital care or medical servicesunder any law administered by the Department of Veterans Affairs to remaineligible to participate in or contribute to a health savings account.

H.R.2177 — 116th Congress (2019-2020) Faith in Health Savings Accounts Act of 2019 Sponsor: Rep. Kelly, Mike [R-PA-16] (Introduced 04/09/2019) Cosponsors: (23) Committees: House – Ways and Means Latest Action: House – 04/09/2019 Referred to the House Committee on Ways and Means.

This billmodifies the requirements for health savings accounts (HSAs) to treat membership in atax-exempt health care sharing ministry as coverage under a high deductible health plan forpurposes of the tax deduction for contributions to an HSA.

H.R.603 — 116th Congress (2019-2020) Health Savings AccountExpansion Act of 2019 Sponsor: Rep. Gallagher, Mike [R-WI-8] (Introduced 01/16/2019) Cosponsors: (14) Committees: House – Ways and Means Latest Action: House – 03/01/2019Referred to the Subcommittee on Health.

This bill modifies the requirementsfor health savings accounts (HSAs) to:

  • increasethe maximum contribution amounts,
  • permitthe use of HSAs to pay health insurance premiums and for directprimary care service arrangements,
  • repealthe restriction on using HSAs for over-the-counter medications,
  • eliminatethe requirement that a participant in an HSA be enrolled in a highdeductible health care plan, and
  • decreasethe additional tax for HSA distributions not used for qualified medicalexpenses.

H.R.457 — 116th Congress (2019-2020) Health Savings Account Act Sponsor: Rep. Fortenberry, Jeff [R-NE-1] (Introduced 01/10/2019) Cosponsors: (0) Committees: House – Ways and Means Latest Action: House – 01/10/2019 Referred to the Subcommitteeon Health.

This bill modifies the requirementsfor health savings accounts (HSAs) to (1) increasethe maximum contribution limits for HSAs to match the sum of the annualdeductible and out-of-pocket expenses permitted under a highdeductible health plan, (2) allow individualswho receive primary care services in exchange for a fixed periodic fee orpayment to participate in an HSA, and (3) permit HSAs to beused for fitness center memberships.

The bill also allows a medical caretax deduction for periodic provider fees, including (1) periodicfees paid to a primary care physician for a defined set of medical services or theright to receive medical services on an as-needed basis; and (2) pre-paidprimary care services designed to screen for, diagnose, cure, mitigate, treat,or prevent disease and promote wellness.

S.2440 — 116th Congress (2019-2020) Qualified Health Savings AccountDistribution Act of 2019 Sponsor: Sen. Sasse, Ben [R-NE] (Introduced 08/01/2019) Cosponsors: (0) Committees: Senate – Finance Latest Action: Senate – 08/01/2019 Read twice and referred to the Committeeon Finance.

Official text still being written.  Quick summary—this bill proposes funds can be moved from FSAs and HRAs into HSAs

S.2441 — 116th Congress (2019-2020) Health Savings Account Expansion Actof 2019 Sponsor: Sen. Sasse, Ben [R-NE] (Introduced 08/01/2019) Cosponsors: (0) Committees: Senate – Finance Latest Action: Senate – 08/01/2019 Read twice and referred to the Committeeon Finance.

Allow individuals who are not enrolled in a highdeductible health planto have access to health savings accounts

H.R.4576 — 116th Congress (2019-2020)To amend the InternalRevenue Code of 1986 to allow contributionsto health savings accounts in the case of individuals withspouses who have health flexible spending accounts. Sponsor: Rep. Wexton, Jennifer [D-VA-10] (Introduced09/27/2019) Cosponsors: (2) Committees: House – Ways andMeans LatestAction: House – 09/27/2019 Referred to the House Committee on Waysand Means.

As of09/30/2019 text has not been received for H.R.4576 – To amend theInternal Revenue Code of 1986 to allow contributions to health savings accounts in the case of individuals with spouses whohave health flexiblespending accounts.

H.R.4530 — 116th Congress (2019-2020) To amend the InternalRevenue Code of 1986 to permit individuals eligible forIndian Health Service assistance to qualifyfor health savings accounts. Sponsor: Rep. Moolenaar, John R. [R-MI-4] (Introduced09/26/2019) Cosponsors: (1) Committees: House – Ways andMeans LatestAction: House – 09/26/2019 Referred to the House Committee on Waysand Means.

As of09/30/2019 text has not been received for H.R.4530 – To amend the InternalRevenue Code of 1986 to permit individuals eligible for Indian Health Service assistance to qualify for health savings accounts.

S.12 — 116th Congress (2019-2020) Health Savings Actof 2019 Sponsor: Sen. Rubio, Marco [R-FL] (Introduced 01/03/2019) Cosponsors: (1)Committees: Senate – Finance Latest Action: Senate – 01/03/2019 Readtwice and referred to the Committee on Finance.

This bill modifies the requirementsfor health savings accounts (HSAs) to

  • rename highdeductible health plans as HSA-qualified health plans;
  • allow spouses who haveboth attained age 55 to make catch-up contributions to the same HSA;
  • make Medicare Part A(hospital insurance benefits) beneficiaries eligible to participate in an HSA;
  • allow individuals eligiblefor hospital care or medical services under a program of theIndian Health Service or a tribal organization to participate in anHSA;
  • allow members ofa health care sharing ministry to participate in an HSA;
  • allowindividuals who receive primary care services in exchange for a fixed periodicfee or payment, or who receive health care benefits from an onsitemedical clinic of an employer, to participate in an HSA;
  • include amounts paid forprescription and over-the-counter medicines or drugs as “qualified medicalexpenses” for which distributions from an HSA or othertax-preferred savings accounts may be used;
  • increase the limits on HSAcontributions to match the sum of the annual deductible and out-of-pocketexpenses permitted under a high deductible health plan; and
  • allow HSA distributions tobe used to purchase health insurance coverage.

The bill also: (1) exempts HSAs from creditor claims in bankruptcy,and (2) reauthorizes Medicaid health opportunity accounts.

The bill allows a medical care tax deduction for: (1) exerciseequipment, physical fitness programs, and membership at a fitness facility; (2)nutritional and dietary supplements; and (3) periodic fees paid to a primarycare physician and amounts paid for pre-paid primary care services.

 H.R.3796 — 116th Congress (2019-2020) Health Savings for Seniors Act Sponsor: Rep. Bera, Ami [D-CA-7] (Introduced 07/17/2019) Cosponsors: (1)Committees: House – Ways and Means Latest Action: House – 07/17/2019 Referred to the House Committee on Waysand Means.

This bill permits a Medicare beneficiary to participate in andcontribute to health savings accounts.

H.R.2878 — 116th Congress (2019-2020) Homecare for Seniors Act Sponsor: Rep. Porter, Katie [D-CA-45] (Introduced 05/21/2019) Cosponsors: (10) Committees: House – Ways and Means Latest Action: House – 05/21/2019Referred to the House Committee on Ways and Means

This bill allow tax-exempt distributions from health savings accounts (HSAs)to be used for qualified home care.

“Qualified home care” includes a contract to provide threeor more of the following services in the residence of the service recipient

  • assistance with eating,
  • assistance with toileting,
  • assistance withtransferring,
  • assistance with bathing,
  • assistance with dressing,
  • assistance withcontinence, and
  • medication adherence.

The Department of Health and Human Services must carry outa campaign to increase public awareness of the in-home service expenses thatare eligible for tax-free distribution from HSAs.

 S.1089 — 116th Congress (2019-2020) Restoring Access to Medication Act of 2019 Sponsor: Sen. Roberts, Pat [R-KS] (Introduced 04/09/2019) Cosponsors: (3)Committees: Senate – Finance Latest Action: Senate – 04/09/2019 Read twice and referred to the Committeeon Finance.

This billrepeals provisions of the Internal Revenue Code, as added by the PatientProtection and Affordable Care Act, that limit payments for medicationsfrom health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs orinsulin (thus allowing distributions from such accounts for over-the-counterdrugs).

H.R.908 — 116th Congress (2019-2020) Stop Penalizing Working Seniors Act Sponsor: Rep. Latta, Robert E. [R-OH-5] (Introduced 01/30/2019) Cosponsors: (5)Committees: House – Ways and Means Latest Action: House – 01/30/2019 Referred to the House Committee on Waysand Means.

This bill allows Medicare-eligible individuals who are age 65 or olderto contribute to health savings accounts iftheir entitlement to Medicare benefits is limited to hospital insurancebenefits under Medicare Part A.

H.R.3708 — 116th Congress (2019-2020)Primary Care Enhancement Act of 2019Sponsor: Rep. Blumenauer, Earl [D-OR-3] (Introduced 07/11/2019) Cosponsors: (5)Committees: House – Ways and MeansLatest Action: House – 07/11/2019 Referred to the House Committee on Ways and Means.

This bill permits a taxpayer with a primary care service arrangement whose fixed periodic fee does not exceed $150 a month to participate in and contribute to a health savings account. Read about flaws in H.R. 3708 at

H.R.2163 — 116th Congress (2019-2020) Freedom for Families Act Sponsor: Rep. Biggs, Andy [R-AZ-5] (Introduced 04/09/2019) Cosponsors: (20) Committees: House – Ways and Means Latest Action: House – 04/09/2019 Referred to the House Committee on Waysand Means

To amend the Internal Revenue Code of 1986 to allow fortax-advantaged distributionsfrom health savings accounts during family or medicalleave, and for other purposes.

 H.R.3594 — 116th Congress (2019-2020) Healthcare Freedom Act of 2019 Sponsor: Rep. Roy, Chip [R-TX-21] (Introduced 06/28/2019) Cosponsors: (10) Committees: House – Ways and Means Latest Action: House – 06/28/2019 Referred to the House Committee on Waysand Means. 

This bill expands the availabilityof health savings accounts. It renamessuch accounts as “health freedom accounts” andallows all individuals to receive increased tax deductions for contributions tosuch accounts. The term “qualified medical expenses” is expanded toinclude costs associated with direct primary care, health caresharing ministries, and medical cost sharing organizations.

The bill also excludes employercontributions to health freedom accounts from employeegross income for income tax purposes.

President Trump’s Salute to Patients Promises Welcome Changes, But Special Interests Attack

The week before President Trump’s Independence Day “Salute to America” he gave a welcome Salute to Patients when he signed Executive Order 13877, “Improving Price and Quality Transparency in American Healthcare To Put Patients First.”

As free market champion Dr. Keith Smith of the Surgery Center of Oklahoma puts it, the “healthcare industry price gougers wore out their welcome” and were “kicked to the curb by President Trump.”

What does the order do? Its first priority is to end “opaque pricing structures,” that “benefit powerful special interest groups, such as large hospital systems and insurance companies,” but, “generally leave patients and taxpayers worse off than would a more transparent system.”

But there’s more: the order also aims to “enhance patients’ control over their own healthcare resources” by removing failed policies that impede patients from choosing to enroll in affordable Direct Primary Care practices or alternatives to big insurance like Health Care Sharing Ministries.

The bottom line is increasing patient freedom and choice is the centerpiece of President Trump’s order. However, make no mistake, it is also put a target squarely on the middlemen who have for too long taken advantage of backroom deals made with government cronies. And the middlemen are already fighting back with a vengeance and working to undermine the order.

Underestimating the special interests’ power to stop the good changes is not an option. Just last week the Pharmacy Benefits Manager (PBM) cartel killed a White House proposal that would begin to unwind corrupt kickbacks that result in out of control price hikes for life saving drugs through disingenuous propaganda that lower prices would somehow raise premiums.

And the fake news campaigns about the Transparency Order are already underway.

Thankfully physicians like Chad Savage, MD are debunking the industry lies:

No price transparency will not lead to higher prices. “This is akin to saying the best way to get a good price on a new Sony TV is to have no idea what it costs. If someone said that to you, you would rightly reject any future advice from that individual,” explains Dr. Savage.

Marni Jamison of the Association of Independent Doctors exposes another tactic of those who oppose transparency:

The cronies are “lawyering and lobbying up, busily working to undermine, narrow and water down the order. They are not going to give up the hundreds of billions of excess dollars flowing their way easily,” she writes and shares examples of weasel words insurers and mega health systems will attempt to use to corrupt the outcome.

Middlemen’s fingerprints are already evident on the order itself to some extent. For example the “Health Quality Roadmap” provisions empower the use of failed quality metrics that are already driving up the cost of care with out any benefit to outcomes. “Practitioners who practice according to the needs of their individual patients, not according to some standardized protocol approved by a third party whose only focus may be efficiency and cost-cutting, may be penalized,” warns Twila Brase of the Citizens’ Council for Health Freedom and award-winning author of Big Brother in the Exam Room. AAPS, while overall supportive of the order, flagged provisions as potentially harmful to privacy rights and urged that “patients’ right to consent to use of their data must also be respected.”

Winning these battles for patients and those who care for them will not be easy! But nothing worthwhile ever is. So let’s all Salute President Trump for taking these bold steps by stepping to help him fend off the special interests trying to thwart his welcome orders.