By Sen. Patrick Colbeck
7th Senate District
We have all seen the headlines or the newscasts or actually shopped for health care coverage. Health care premiums in the era of the so-called “Affordable” Care Act are skyrocketing yet again. At the same time, deductibles are increasing and coverage is decreasing. Would you like to buck the trend and hear some good news for health care consumers?
Believe it or not, there is some good news to share.
Have you heard of Direct Primary Care Services (DPCS)? Employers or individuals can enter into monthly or annual service agreements where physicians agree to provide a specified list of services for a set price. These service agreements feature complete transparency and free doctors from the shackles of government and insurance company regulations regarding the delivery of care. Doctors can now deliver care in a manner that serves the best interest of the patient, not middlemen.
DPCS has been demonstrated to lower overall health care costs by at least 20 percent due in large part to a renewed focus upon preventive care. Under the DPCS model, doctors spend more time with the patient and less on paperwork. Most DPCS fees range between $50 and $125 per month depending on age. Some providers feature coverage for kids as low as $10 per month.
It is important to note that Direct Primary Care Services only provide coverage for primary care. What happens when you need to see a specialist or visit the hospital? If you wish to avoid a visit from the IRS for not meeting the requirements of a Qualified Health Plan under the so-called Affordable Care Act (aka Obamacare), you still need to obtain what is referred to as wraparound coverage.
What are these wraparound coverage options? Well, first I need to share some bad news. In today’s market, most traditional insurance providers do not yet offer health plans without primary care services coverage, so you would essentially be paying twice for such services when you sign a DPCS agreement. Furthermore, Medicaid and Medicare regulations regrettably do not allow for direct reimbursement of DPC services. I had attempted to launch a DPCS Medicaid Pilot in Michigan to get around this limitation as part of our last state budget, but my proposal to improve care and ultimately save taxpayers up to $3.5 billion per year was removed from the budget at the last minute during leadership discussions.
On the Medicare front, in 2012 the federal government launched the Comprehensive Patient Care Initiative, which features a hybrid between the DPCS model and the traditional fee-for-service model, but it expires in 2016 and Michigan is not one of the trial states.
The best options for wraparound coverage to complement a DPCS agreement would be Self-Insured Plans, Multi-Employer Welfare Arrangements (MEWAs), or Health Care Sharing Ministries such as Christian Medi-Share. Employers who have pursued these DPCS-compatible solutions have seen savings on the order of 30-60 percent without sacrificing quality of care. How’s that for a bit of good news?
Yet another bit of good news relates to the success of the cash-only business model for surgical procedures exemplified by the Surgery Center of Oklahoma. When insurance deductibles reach the $5,000 or $10,000 threshold, the value of paying insurance premiums comes into question. The Surgery Center of Oklahoma provides the answer to this question via out-the-door prices that in some cases are 90 percent less than what it costs under traditional insurance. Say goodbye to hospital bills featuring $1,300 for eye drops or $300 for aspirin. Go to SurgeryCenterOK.com to see transparent pricing on surgical procedures simply by selecting the part of the body requiring surgery. It is worth noting that the cost of your surgery may soon not have to include airfare to Oklahoma. I have heard rumblings about plans for a cash-only surgical center in Michigan.
So, in the wake of a seemingly endless stream of bad news about health care, please take heart that there are indeed people working on your behalf to provide you with lower cost, higher quality health care options. For more information on these options, please join us at one of our upcoming Health Care Forums throughout the state. Details can be found at www.SenatorPatrickColbeck.com or by calling us at (517) 373-7350.
Sen. Patrick Colbeck represents the 7th Senate District, which encompasses the cities of Livonia, Northville, Plymouth and Wayne, as well as the townships of Canton, Northville and Plymouth.