BOISE, Idaho (Feb. 19, 2018) – An Idaho bill would further expand direct primary care in the state, taking another step toward healthcare freedom.

Introduced by the Senate Health and Welfare Committee on February 12, Senate Bill 1311 (S1311) would create a pilot program allowing patients in the state’s public health system to enter into direct primary care agreements. Under the proposed law, public health districts would be able to voluntarily participate in the program allowing them to pay for direct primary care services for those enrolled in each district.

A person would be eligible to enroll if they meet certain requirements, including:

  • At least 18 years old
  • Earns 185 percent or less of the federal poverty limit
  • Attends a financial literary course or health coaching program; they would have to complete the financial literary course or health coaching program to continue to receive direct primary care.

Under the pilot program, public health districts would pay up to $70 per month of the applicable direct primary care fee for no more than 10 months.

S1311 does not impose any additional regulations or requirements on direct primary care practices that accept patients from the public health system.

In 2015, Idaho Gov. Otters signed a bill specifying 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.

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. In 2015, Tom Woods interviewed a Kansas doctor who utilizes the direct primary care model. Dr. Josh Umbehr’s practice demonstrates the cost savings possible when doctors are unfettered from the bureaucratic health insurance system.

S1311 would further expand direct primary care in the state and shows the state wants to cash in on its proven cost reductions. But there is a potential downside to the proposed law if it opens the door to further regulation of direct primary care practices accepting state money in the future.


At this point, it doesn’t look like Republicans will repeal or even reform Obamacare, and the changes to the ACA proposed by the GOP would have arguably made things worse. Even with the penalty for not buying health insurance repealed by the Republican tax plan, all other Obamacare rules and regulations remain in place. Regardless, state actions can help completely bring down the Affordable Care Act, or any national healthcare plan the Congress comes up with in the future.

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 demand instead of relying on central planners with a political agenda. The end result will be better care delivered at a lower cost.

By incentivizing creative healthcare solutions, the market will naturally provide better options, such as the Surgery Center of Oklahoma, This facility operates completely outside of the insurance system, providing a low-cost alternative for many surgical procedures.

A more open 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 and others spurred by ingenuity and market forces, the old system will begin to crumble. Creating a structure for Medicaid patients to access direct primary care would likely incentivize more doctors to adopt the direct primary care model, expanding the market further.

Passage of S1311 would take another step toward healthcare freedom in Idaho and would create a stepping stone to further action to nullify the onerous Affordable Care act. Once in place, the people of Iowa could take further steps to fully extricate themselves from Obamacare for good.


S1311 has been referred to the Senate Health and Welfare Committee, where it will have to pass by a majority before it can receive a full Senate vote.

TJ Martinell

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