top of page

DPC Legislative Action Alert-Act Now

Friends and colleagues interested or involved in Direct Primary Care,

Your Members of Congress and Senators need to hear from you now!  The Primary Care Enhancement Act is among a group of reforms to HSAs being considered as Congress deals with market stabilization, cost sharing reductions and the Omnibus spending bill, which is moving this week. 


Please send a short email to the health staffers of your two Senators and member of Congress. 

 The two-part message is simple:  Please co-sponsor the Primary Care Enhancement Act (H.R. 365 in the House and S. 1358 in the Senate) and include this important language in the Omnibus spending bill pending before Congress this week.  If your member is already a co-sponsor, please thank them for their leadership and encourage them to do whatever they can to ensure that the bill rides on the Omnibus. H.R 365 Cosponsors are here, and S. 1358 Cosponsors here.  

 See sample letter below as an example

A few important notes:

 Please don’t spam. Send this only to your members, or members likely to serve your patient population.  Additionally, contact any members that you have a direct relationship with.  If patients are willing, have them send a note too.  It goes without saying that this is a request, so be polite and assume they support your position, even if you might suspect otherwise.  Emails from people with no connection to the member or state will not be helpful.  


In a single, brief paragraph describe why this is important to you, your patients, and their constituents of all ages and income levels who use HSAs. 


Emphasize that this is not about supporting the HSA as a reform, but about allowing all Americans unfettered access to primary care through DPC.  That’s the real reform. 

“Please co-sponsor the Primary Care Enhancement Act (H.R. 365 in the House and S. 1358 in the Senate) and include the language in the Omnibus spending bill pending before Congress this week. “

Members of the key authorizing committees are particularly important.  If you have a relationship with one or more of these members please act now:

Members of the House Ways and Means Committee Click here


Members of the Senate Finance Committee Click here



Sample Letter (from Jay Keese):


All Americans Need Access to Affordable Primary Care


Please Co-sponsor the Bipartisan Primary Care Enhancement Act (S. 1358/H.R. 365)


Dear Colleagues:

We write to request that you cosponsor the bipartisan Primary Care Enhancement Act, which would open up more access to affordable primary care. Direct Primary Care (DPC) is a membership-based alternative payment model for primary care in which patients, employers, or health plans pay a DPC physician practice monthly or periodic fees directly for unlimited access to primary care and prevention services. DPC affords the patient more time with the doctor—sometimes an hour per visit– giving the doctor the time to build a true relationship with their patients, so they can better understand and address their health needs.

DPC has been praised as an important healthcare delivery reform that is reducing costs and improving access to primary care. Employers report up to 20% savings on the total cost of care for their employees, by providing better health care up front in the primary care setting, reducing unnecessary hospital and specialty care, and drastically reducing administrative expenses.

Today, DPC is providing high-quality care at lower cost for individuals of all ages and incomes across America. By partnering with wrap-around insurance plans that cover non-primary care services, DPC practices now serve patients with private insurance, Medicare Advantage, and Medicaid managed care. As opposed to “concierge” physician practices, DPC practices typically charge a low monthly fee of $50-$100 per month and serve low and moderate-income patients. However, IRS interpretation of the tax code prevents Americans with Health Savings Accounts (HSAs) from using this promising alternative payment model.

The Primary Care Enhancement Act, S. 1358, clarifies two small provisions in the Internal Revenue Code that treat these innovative primary care arrangements for employees and individuals as health plans rather than medical services. More than twenty states have passed laws defining DPC as a medical service and not a health plan regulated by state insurance law. Likewise, Department of Health and Human Services (HHS) rules on Essential Health Benefits clearly state that DPC arrangements are medical services, not health insurance. However, the current IRS interpretation of the statute prohibits individuals with HSAs from funding their accounts if they have a DPC arrangement. Furthermore, individuals cannot use their existing HSA dollars to pay for the monthly or annual DPC fees as qualified medical expenses, even though the fees are giving them access to their primary care doctor and primary care services that would otherwise be HSA-eligible.


As more individuals and employers seek to utilize the DPC delivery model, it is important that an outdated tax barrier not get in the way of patients accessing this successful model of care.


While many of us have philosophical differences about HSA’s and their role in health care, our legislation is not an expansion of HSA’s themselves; rather, it is a narrow clarification providing tax equity for individuals who want to use DPC arrangements. We ask that you join us in this bipartisan effort to expand access and continue the movement towards better primary care at lower costs.

To be added as a cosponsor, please reach out to Matt Gallivan with Senator Cassidy ( or Nico Janssen with Senator Cantwell (

To cosponsor H.R. 365 in the House Please contact Andy Franke with Representative Blumenauer ( or Kristen Donheffner with Representative Blumenauer (


bottom of page