JEFFERSON CITY, Mo. (Aug. 1, 2016) – Two provisions in a bill recently signed by Missouri Gov. Jay Nixon will help facilitate healthcare freedom and takes another small step toward setting the stage to nullify Obamacare and federal hemp prohibition in practice.

Rep. Keith Frederick filed House Bill 1682 (HB1682) last December. The legislation amends several sections of Missouri law relating to healthcare practitioners and adds several provisions.

One section titled the Medical Practice Freedom Act ensures that doctors in the state to can continue to operate outside of the insurance system. The new law prohibits state licensing boards from denying license approval based on a healthcare providers participation in any insurance program.

“Licensure approval for physicians, chiropractors, optometrists, and dentists in this state shall not be conditioned upon or related to participation in any public or private health insurance plan, public health care system, public service initiative, or emergency room coverage.”

This keeps the door open for doctors and other medical professionals to set up cash-only practices and structure their businesses in other creative ways without fear of losing their licenses.

Another provision in the new law prohibits any any state agency from punishing any individual or healthcare entity relating to the medical use and administration of hemp extract with respect to an eligible patient. This includes civil or criminal penalties, and revocation of licenses.

This takes a very small step toward nullifying federal prohibition of hemp. Cannabinoid oil has proven effective in treating seizures in some patients. Nevertheless, the federal government still essentially bans hemp in the U.S. While the new Missouri law will not allow hemp production in the state, and the federal ban remains in place, it does remove one layer of law, and it will open the door for doctors to utilize this treatment. That will create a market and may well lead to further action down the road. Experience shows that once a market develops, laws generally further relax to accommodate it.

Expanding Healthcare Freedom

In 2015, Missouri specified that direct primary care agreements (sometimes called medical retainer agreements) do not constitute insurance, thereby freeing doctors and patients from the onerous requirements and regulations under the state insurance code. These provisions in HB1682 provide another layer of protection, and remove a back-door way state regulators could have undermined direct primary care.

According to Michigan Capitol Confidential, by removing a third party payer from the equation, medical retainer agreements help both physicians and patients minimize costs. Jack Spencer writes:

“Under medical retainer agreements, patients make monthly payments to a physician who in return agrees to provide a menu of routine services at no extra charge. Because no insurance company stands between patient and doctor, the hassles and expense of bureaucratic red tape are eliminated, which have resulted in dramatic cost reductions. Routine primary care services (and the bureaucracy required to reimburse them) are estimated to consume 40 cents out of every dollar spent on insurance policies, so lower premiums for a given amount of coverage are another potential benefit.”

This represents the kind of cost control Obamacare promised, but failed to deliver. Last fall, Tom Woods interviewed a Kansas doctor who utilizes the direct primary care model. Dr. Josh Umbehr’s practice demonstrates the cost savings Florida patients could soon enjoy.

Under Obamacare, regulations define such programs as a primary care service and not a health insurance plan, and current IRS policy treats these monthly fee arrangements just like another health plan.


Oftentimes, supporters of Obamacare criticize opponents for not having any alternative. Direct primary care offers one.

These direct patient/doctor agreements allow a system uncontrolled by government regulations to develop. It makes doctors responsive to patients, not insurance company bureaucrats or government rule-makers. Allowing patients to contract directly with doctors via medical retainer agreements opens the market. Under such agreements, market forces will set price for services based on both demand instead of relying on central planners with a political agenda. The end-result will be better care delivered at a lower cost.

A free healthcare marketplace within a state will help spur de facto nullification the federal program by providing an affordable alternative. As patients flock to these arrangements, the old system will begin to crumble.

Mike Maharrey

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