.@RepSanfelippo and @SenatorKapenga have brought back a revamped bill that would define and enshrine in state statute the market-based model of transparent health care. #wiright #wipolitics Click To Tweet
MacIver News Service | Jan. 21, 2018
By M.D. Kittle
MADISON — If Gov. Tony Evers really wants to expand affordable, accessible health care in Wisconsin he should look to a private-sector solution that is truly bending the health care cost curve, according to lawmakers championing direct primary care.
State Rep. Joe Sanfelippo (R-West Allis) and Sen. Chris Kapenga (R-Delafield) have brought back a revamped bill that would define and enshrine in state statute the market-based model of transparent health care.
The lawmakers made a few tweaks aimed at satisfying a twitchy health insurance industry worried about what removing the third-party middleman from health care will do to its profits.
“This isn’t intended to replace health insurance. This is intended to give families an affordable option,” Sanfelippo told MacIver News Service in the latest edition of MacIver NewsMakers.
In fact, direct primary care isn’t health insurance at all. It’s a method of delivering health care in which patients pay their primary care doctors directly via a monthly fee. It does bypass health insurance and the morass of red tape, inflated costs, and financial uncertainty that plague the traditional system of financing primary health care.
Before the lawmakers’ bill crashed and burned last session from the heat of industry and big-government special interests, several physicians testified at a health committee hearing about the real savings found in direct primary care. Under the traditional health insurance system, patients with sore throats, for instance, could pay as much as $200 for a strep culture. With direct primary care, the cost is generally part of the monthly subscription rate, which can run as low as $25 a month.
The fee covers most primary care services, including clinical, laboratory, and consulting services.
At the July hearing, Dr. Josh Umbehr told of a 21-year-old patient with a brain tumor who faced a $24,000 chemotherapy bill through her traditional insurance. Umbehr and his Witchita, Kan., clinic can provide the same treatments for $1,900, the doctor testified. The young woman and her family could handle $1,900 over six months, but they couldn’t cover a health care bill 12 times that amount.
Yet so many consumers remain caught in what Umbehr describes as the “shell game” of health insurance.
“We are predictably irrational when it comes to purchasing health insurance,” the physician told MacIver News Service following his appearance before the committee.
Under direct primary care models, prices are listed upfront, sometimes similar to meal prices on a casual-dining restaurant menu. Direct primary care delivers transparency, affordability, and greater access to physicians, Sanfelippo said.
“Direct primary care has become so popular because it gives consumers better health care and they get to spend more face time with actual physicians who, instead of having to fill out hours of paperwork every day, can just visit with a patient,” the lawmaker said.
The Direct Primary Care Coalition counts some 800 DPC practices in 48 states providing primary care access to well over 250,000 patients. Wisconsin boasts several providers. But direct primary care isn’t part of state statute. Sanfelippo’s and Kapenga’s bill would give it the protection and force of law.
At least 24 states have done so. Minnesota is attempting to join the ranks.
“You take that insurance company out of that whole mix. So when you do that, that frees up time and increases the relationship,” Republican Sen. Mary Kiffmeyer, a former nurse from Big Lake, Minn., recently told the Star Tribune. “All those middle things have cost. You remove that, now it’s direct from the physician.”
As in Wisconsin, Minnesota Republicans say they aren’t looking to “undermine” insurance. (Direct primary care certainly doesn’t cover all medical expenses, particularly catastrophic health care events.) They just see the clear benefits to consumers and the health care system overall in the market-centered, limited- red-tape model.
The savings are real.
As MacIver News Service first reported last year, the School District of La Crosse has seen significant savings through a health insurance package that includes direct primary care.
“It costs us one-third of what it would cost if those claims were coming from a preferred provider,” Patricia Sprang, executive director of the district’s business services’ department said.
In 2017, the district saved approximately $1.5 million with staff members and their family members opting to use fixed-cost, direct primary care, according to Sprang. Moreover, because DPC brought down the number of more expensive, traditional health insurance-based claims, the district saw no increase in its health insurance plan and no change to its benefits
“The less cost we can incur for the same services that we might receive otherwise, the better it is for us overall,” Sprang said.
The health insurance industry has expressed concerns about patient safety and the overall impact on the marketplace should Wisconsin codify direct primary care.
Sanfelippo points out that direct primary care providers are bound by the same rigorous licensure and public safety standards that doctors in the traditional health insurance system are subject to.
The updated bill drops language creating a pilot program that would employ a limited number of direct primary care contracts in the state’s medical assistance program.
“Unfortunately the Medicaid pilot language was one of the first casualties of the failure from the last session,” Sanfelippo said. “I think the opposition from inside the beltway here in Madison didn’t want to see us having less people on government health care. You’re on Medicaid, you’re supposed to be taken care of by the government. That introduces the private sector into it a little bit more and I think a lot of people opposed from the start were opposed to this.”
Wisconsin’s new governor, Democrat Tony Evers, has talked a lot about health care affordability and accessibility. Of course, Evers wants to take the Medicaid expansion money under Obamacare, the health care law that has driven health insurers out of the marketplace and insurance rates through the roof.
While the Republicans and the governor are expected to battle over Medicaid money, Sanfelippo said a nonpartisan solution to accessibility, affordability and transparency problems in health care is there for the taking.
The lawmaker believes the direct primary care bill will make it through the Legislature this time around. It remains to be seen whether Evers will be on board. Administration officials did not return MacIver News Service’s request for comment Friday.
“If he truly wants to help the people of Wisconsin have more affordable options in health care he’ll sign the bill. If he doesn’t it will be for purely political reasons and that will tell us what the next four years will look like,” Sanfelippo said.
Listen to the MacIver Newsmakers podcast conversation with Rep. Sanfelippo here: