PIERRE, S.D. (March 12, 2021) – Last week, South Dakota Gov. Kristi Noem signed a bill that will help facilitate healthcare freedom outside of government insurance regulatory schemes.
Rep. Tamara St. John (R-Sisseton), along with 10 Republican cosponsors, introduced House Bill 1131 (HB1131) on Jan. 28. The legislation specifies that direct primary care agreements (sometimes called medical retainer agreements) do not constitute insurance, thereby freeing doctors from the onerous requirements and regulations under the state insurance code. The new law stipulates that “a primary care provider or agent of a health care provider is not required to obtain a certificate of authority or license under this act to market, sell, or offer to sell a direct primary care agreement.”
The new law also includes provisions defining direct primary care agreements and establishing modest requirements.
On March 8, the Senate passed HB1131 by a 35-0 vote. The House passed the measure 63-2. With Gov. Noem’s signature, the law goes into effect July 1, 2021.
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. 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.
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.
A FIRST STEP
Even while controlling both houses of Congress, the Republicans never did repeal Obamacare. And if they had passed one of their “repeal and replace” bills, the changes to the ACA proposed by the GOP would have arguably made things worse. The Republican Congress did zero out the penalty for not buying health insurance in their tax reform bill, all other Obamacare rules and regulations remain in place. And in all likelihood, Democrat-controlled Congress will likely reinstitute the penalty and could expand government intervention into the healthcare marketplace.
Regardless, state actions can help completely bring down the Affordable Care Act, or any national healthcare plan 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 prices 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 of 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.
The enactment of HB1131 takes the first step toward healthcare freedom in South Dakota and creates a stepping stone to further action to nullify the onerous Affordable Care act. With this new law in place, the people of South Dakota can now take further steps to fully extricate themselves from Obamacare for good.
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