Mission Possible: ask Senate to empower patients and fix H.R. 6199

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An iPhone app consult with a nurse practitioner at the MinuteClinic will be your first stop for primary care if the CVS vision for the future of American medicine continues unabated. And managed care continues its takeover of Medicare and Medicaid as the programs speed towards insolvency. Is this the type of care you want for your children and grandchildren?

These days, putting patients ahead of corporate profits and government mandates seems like a plot right out of Mission Impossibleexplains Marilyn M. Singleton, MD, JD. “In trying to provide affordable, quality, personalized medical care, independent physicians face seemingly insurmountable obstacles: digging out from under piles of electronic paperwork, breaking free of third-party red tape, dodging hospital buyouts and shielding patients from data mining and privacy intrusions.”

Fortunately the independent physicians leading the direct care movement have declared “mission possible” and offer patients a high-quality, affordable alternative to the dystopian future plotted by CVS and Medicare-for-All proponents.

In a welcome change from business as usual on Capitol Hill, Congress could be on the verge of handing patients of independent doctors an important victory. Last month the House of Representatives passed H.R. 6199 intended to increase Health Savings Account (HSA) flexibility. H.R. 6199 is now headed to the Senate.

Section 3 of the bill would allow patients to use funds from their Health Savings Account (HSA) to pay certain DPC membership fees. Misguided IRS rules not only forbid this use of HSA money, but won’t allow contributions to an HSA if a person is a member of a DPC practice.

Prior to passage, the House removed a bad provision in the bill limiting HSA-eligible DPC arrangements to specific CPT codes.  But further changes are needed.

We hope the United States Senate will act quickly and will fix some remaining problems in the bill that tend to limit patient choice and perpetuate overregulation.

AAPS strongly urges the Senate to make the following revisions to Sec. 3 of HR 6199 and related measures:

1) Explicitly define DPC as medical care (instead of insurance) to avoid any conflict with state laws protecting DPC and so patients can use their HRAs and FSAs for DPC. This consideration is necessary; twenty-five states have passed legislation that states DPC is not an insurance plan and at least five more have pending bills.  Without this correction, there will be confusion at the state level.

2) Do not reuse the flawed definition of primary care in Sec. 1833(x)(2)(B) of the Social Security Act. The House removed the definition from H.R. 6199 and the Senate should make sure it stays out. This definition was intended to define services for the Primary Care Incentive Payment Program (PCIP) and would limit the scope of care that could be provided if used to define HSA-eligible DPC agreements. Women’s wellness exams are an example of a service that would have to be excluded.

3) Lift caps that ration the amount of care obtained through HSA-eligible DPC arrangements.

4) Remove constraints on specialty care agreements.

5) Address provisions in Sec. 4 of H.R. 6199 and Sections 7 and 8 of companion bill H.R. 6311 that improperly steer patients away from independent physicians.

For more specifics on the above changes, please see http://bit.ly/fix6199.

Please HELP us get this important message to the Senate.
Here Are Action Steps:

1) Write: Please take a moment to send a written message to your senators’ health staffers.

A list of email addresses for each senator’s health staff member can be found here: http://bit.ly/senatestaffhc

You can also help target the health staff of the Senate Finance Committee members. Here is a list with contact information: http://bit.ly/senatefinance

Here is a short template letter

My name is _____ from ______.  I am a constituent writing to ask you to support patient-friendly changes to Sec. 3 of H.R. 6199, and related measures, now under consideration in the Senate. The intention of this measure is to allow the use of Health Savings Accounts (HSAs) for Direct Primary Care (DPC).

A few changes will give patients more vitally needed control over their medical spending.

The requested improvements to Sec. 3 of H.R. 6199 include:

1) Explicitly define DPC as medical care (instead of insurance) to avoid any conflict with state laws protecting DPC and so patients can use their HRAs and FSAs for DPC. This consideration is necessary; twenty-five states have passed legislation that states DPC is not an insurance plan and at least five more have pending bills.  Without this correction, there will be confusion at the state level.

2) Do not reuse the flawed definition of primary care in Sec. 1833(x)(2)(B) of the Social Security Act. The House removed the definition from H.R. 6199 and the Senate should make sure it stays out. This definition was intended to define services for the Primary Care Incentive Payment Program (PCIP) and would limit the scope of care that could be provided if used to define HSA-eligible DPC agreements. Women’s wellness exams are an example of a service that would have to be excluded.

3) Lift caps that ration the amount of care obtained through HSA-eligible DPC arrangements.

4) Remove constraints on specialty care agreements.

I also ask that you help address provisions in Sec. 4 of H.R. 6199 and Sec. 7 and 8 of companion bill H.R. 6311 that improperly steer patients away from independent physicians.

For more specifics on the above changes please see http://bit.ly/fix6199.

2) Call: You can quickly reach your Senators’ offices by calling the Capitol Switchboard at (202) 224-3121.

Calling is the fastest way to make the biggest impact. After reaching a Senator’s office, ask for the staff member responsible for health care issues. Use the short template letter above as a guide for what to say.

3) Here are additional tools for speaking out:

If you are a DPC physician here are template letters tailored for your use:

Patients: If you are a patient or would like to give your patients instructions for speaking out and a draft patient letter, please see: http://bit.ly/patientdpcletter

Thank you for taking action. We can accomplish this mission if everyone takes a few minutes to speak out.

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