FOR IMMEDIATE RELEASE | Source: AAPS
The growing Direct Primary Care (DPC) model is allowing patients and doctors to design their own “healthcare reform.” In exchange for a membership fee, patients receive timely access to unhurried visits, personalized care, and a range of other items that might include laboratory testing and medications, explains the Association of American Physicians and Surgeons (AAPS).
At present, payment for such arrangements is entirely with after-tax dollars. Far more expensive, employer-owned health plans are purchased with pre-tax dollars, without the burden of payroll or income taxes.
“Health Savings Accounts (HSAs) are supposed to help correct the unfair tax treatment of individually paid medical expenses,” stated AAPS executive director Jane M. Orient, M.D. “In addition, they constrain excess spending because people are more frugal with their own money.”
At present, people cannot use their HSA funds to pay their membership fees for a Direct Primary Care practice. Moreover, if they are members of a DPC practice, they may not even make a contribution to their HSA. Congress is considering a bill intended to change that.
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However, a “few small changes” were made in the original bill, H.R. 365, provisions from the Affordable Care Act were added in, then the number was changed to H.R. 6317. “The language is now so complex that you’d need a tax accountant to figure out whether your DPC agreement complies,” stated Dr. Orient. “Are you charging $151 instead of $150? Offering to suture a wound or to include something in the agreement that is not on the list of approved AMA codes, such as osteopathic manipulative therapy (OMT)? Forget using HSA funds or contributing to the HSA. Essentially this bill taxes patients of DPC doctors who don’t comply with ACA limitations and other new regulations.”
According to the Joint Committee on Taxation, restrictions are needed because of the calculated “cost” (“tax expenditures” or decrease in tax revenues) of $1.8 billion over 10 years. For comparison, the exclusion of employer health benefits “costs” about $3 trillion ($3,000 billion) over 10 years, 1700 times as much, according to the U.S. Treasury Department.
Added complexity benefits big entities that can afford a team of accountants and lawyers, Dr. Orient points out. “It appears that the revised bill gives corporate medicine a big advantage over small independent practices. It also shows that HSA money isn’t really yours. Therefore, AAPS cannot support H.R. 6317 in its current form.”
The Association of American Physicians and Surgeons (AAPS) is a national organization representing physicians in all specialties, founded in 1943.
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