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: bit.ly/senfull2020

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:

https://www.shrm.org/resourcesandtools/legal-and-compliance/employment-law/pages/senate-to-vote-soon-on-coronavirus-paid-leave-mandate.aspx

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:
https://www.republicanleader.senate.gov/imo/media/doc/CARES%20Act%20Final%20-%20Mar%202020.pdf

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: 
https://www.senate.gov/general/contact_information/senators_cfm.cfm

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 https://www.house.gov/representatives 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: https://www.whitehouse.gov/contact/

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

Dear Senators Dr, Rand Paul, Ted Cruz and Mike Lee,

March 1, 2017

Dear Senators Dr, Rand Paul, Ted Cruz and Mike Lee,

Thank you for having the courage and taking action to hold your GOP congressional colleagues accountable to the citizens of the United States in demanding the full repeal of ACA/Obamacare.  It is highly complex, burdensome, unaffordably expensive and failing miserably to the detriment of our nation and its citizens. Bad law is bad law and must be fully repealed. Personal responsibility, free markets and true charity are the solutions to the nation’s healthcare ills.  Please see the IP4PI 14 point solution for healthcare freedom.

Please contact me anytime at the address and phone number above during office hours and at my mobile phone 000-000-0000 anytime. Thank you again for continuing to support the great citizens of our country as responsible individuals with freedom and liberty.

Best wishes for good health,

Craig M. Wax, DO

Family Physician, Media Host and Healthcare Policy Expert
National Physicians Council on Healthcare Policy member
Founder of IP4PI, Independent Physicians for Patient Independence
Practicing Physicians of America, VP for Healthcare Policy
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
http://wgls.rowan.edu/?feed=YOUR_HEALTH_MATTERS
Twitter @drcraigwax

CC:    Donald Trump, President, US
Mike Pence, Vice President, US
Mitch McConnell, Senate Majority Leader
Paul Ryan, Speaker of the House

The Latest Repeal, Partial Repeal, and Replace Plans

3/6/2017 update: The first official look at the GOP repeal and replace plan is out.

The Hill has links to the two portions of the legislation in their story here:
http://thehill.com/policy/healthcare/322609-gop-releases-bill-to-repeal-and-replace-obamacare

CLICK HERE for a two-page summary and CLICK HERE to read a section-by-section summary.

Many of the mandates are killed by the bill, for example the individual and employer mandates.  However the pre-existing coverage mandate remains. The taxes are mostly repealed. The infamous “Cadillac Tax” is kicked further down the road until 2025.

Medicaid expansion would be rolled back over several years and a per-enrollee capped allotment will be paid to states.

Subsidies are rearranged to be mostly age-based instead of income based and will be in the form of refundable tax credits.

Michael Hurd, PhD has a review of the plan: Obamacare Repeal: A Good Thing, But Still Not a Free Market https://drhurd.com/2017/03/06/63226/

2/27/2017 update: The alleged GOP repeal and replace plan under consideration has been leaked.  Highlights/Lowlights: it would repeal various mandates including the individual mandate; states would receive a capped per-enrollee federal contribution for Medicaid; current ACA income-based tax credits would transition to credits allocated by age of enrollee; and tax breaks would be limited for high-dollar employer-based coverage.

For more details and a link to the draft bill see: http://www.politico.com/story/2017/02/house-republicans-obamacare-repeal-package-235343

There are a few notable newcomers since our previous post on replacement plans:

  1. Ted Cruz has introduced a full repeal bill:S. 106, a bill to repeal the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 in its entirety was introduced by Sen. Ted Cruz (R-TX) and referred to the Senate Finance Committee.”
  2. S. 222 the ObamaCare Replacement Act by Dr. Rand Paul which repeals parts of ACA and replaces with more flexible HSAs (no HDHP requirement) and $5000 tax credits to fund the HSA. Read more at Reason.com: http://reason.com/blog/2017/01/25/sen-rand-paul-introduces-replacement-for
  3. Rep. Darrell Issa’s “Access to Insurance for All American’s Act” would offer federal employee health plans to all Americans  http://www.nbcsandiego.com/news/local/Congressman-Darrell-Issa-Proposes-Plan-to-Replace-Affordable-Care-Act-412059253.html.
  4. Cassidy/Collins contains portions of Cassidy/Sessions and would be a partial repeal tied to provisions that allow states to keep ObamaCare on a state by state basis or fund state-based market-oriented reforms: https://www.collins.senate.gov/newsroom/cassidy-collins-introduce-comprehensive-obamacare-replacement-plan
  5. AEI’s “Improving Health and Healthcare Plan” utilizes tax credits and expands HSAs to some extent. It also has an “auto enroll” feature that places non-enrollees in an HDHP.  http://www.forbes.com/sites/theapothecary/2016/12/30/how-aeis-improving-health-and-health-care-plan-would-repeal-and-replace-obamacare/#68d118953be6

And, of course, President Trump has started the ball rolling with his Executive Order on ObamaCare: http://www.cnn.com/2017/01/20/politics/trump-obamacare-executive-order/

Previously announced plans:

Congressman Tom Price’s plan

http://www.washingtonexaminer.com/prices-obamacare-replacement-would-shift-power-to-patients-which-is-why-special-interests-will-hate-it/article/2609165?custom_click=rss

Speaker Paul Ryan: A better way

http://abetterway.speaker.gov/

Congressman Sessions/Cassidy plan

http://www.goodmaninstitute.org/topics/health-reform-bill/

(Former Congressman) Dr. Paul Broun plan (needs new sponsor)

http://www.paulbroun.com/issues/health-care

Brat/Flake “HSA Expansion Act” would eliminate the “mandate” that HSA holders purchase a government-designed high-deductible health plan. “As a replacement for ObamaCare, Large HSAs would encourage innovative products like pre-existing conditions insurance that make coverage more affordable and secure.”

http://www.forbes.com/sites/michaelcannon/2016/06/02/five-things-you-need-to-know-about-the-bicameral-legislation-creating-large-hsas

The 2015 Burr, Hatch, Upton Patient Care Act could make a return:

http://www.forbes.com/sites/theapothecary/2016/12/28/how-the-patient-care-act-would-repeal-and-replace-obamacare/#7152a38a1805

Ideals and principles

National physicians’ coalition for freedom in medicine 2015

https://drive.google.com/file/d/0B6mnHrSAs12lUHhzS0ctMHFVRG1pMXZhZFVkbnFwWDVhNzNV/view

D4PC Rx for Healthcare Reform https://d4pcfoundation.org/about-us/the-physicians-prescription-for-health-care-reform/