Obamacare Relief

March 13, 2014

Aaron Monson

When the Affordable Care Act (ACA) was passed several years ago, many did not expect the obvious result: rising health insurance premiums, shrinking networks and policy options, and fewer doctors willing to take the plans offered in the exchanges. While the law probably will eventually result in more people carrying some type of health insurance, it seems obvious that it will not improve health care. Health insurance and health care are not the same thing – the one does not always guarantee the other. In fact, health insurance often complicates the health care transaction between the provider and consumer, leading to ultimately poorer quality health care.

If you are upset about the effect the law has had on your own options, you are not alone. A quiet revolution is taking place in primary care in response to the burdens imposed by Obamacare and health insurance in general. It’s a return to common sense called Direct Primary Care (DPC).

A good way to explain the concept is to use the example of automobile insurance. We buy car insurance to cover an automobile accident, not to cover the oil changes, wiper blades, tune ups, car washes, or any other regular maintenance. If these items were included in our car insurance benefits, we would doubtless pay much higher premiums. Instead, these items are excluded because they are predictable and can be planned and budgeted for. Where health care is concerned, this is also true of most primary care services.

If you take the primary care coverage out of the health insurance benefits, and instead opt to pay directly for those services, the cost of health insurance (for catastrophies only) goes way down. DPC practices agree to accept a small monthly membership fee that covers all or most of a member’s primary care needs, or will charge a flat fee of various tiered amounts depending on the complexity of the visit. The cost is transparent to both parties, and consequently is easily budgeted for.

In the few states where this is becoming more common, DPC monthly membership fees can vary quite a bit, from $25 to $199. When combined with a high deductible health plan (HDHP), the total cost of both can be much cheaper than carrying the more traditional health insurance that includes primary care benefits. While some may claim savings in the 50% range, the more likely savings runs in the 25% to 35% range, when comparing a traditional health plan against a combination HDHP and DPC membership.

As costs continue to rise, Riverton and Zenith Family Health expect this will become the wave of the future and are preparing to introduce a DPC service later this year. Stay tuned for more developments!