CHARLESTON, W. Va. (April 22, 2021) – On Monday, West Virginia Gov. Jim Justice signed a bill into law that expands policies to help facilitate healthcare freedom outside of government regulatory schemes.

Del. Steve Westfall (R-Ripley) introduced House Bill 2877 (HB2877) on March 3. In 2017, West Virginia enacted a law 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.

That law also stipulates that neither direct primary care providers nor their agents are required to obtain a certification of authority or license under chapter thirty-three to market, sell, or offer to sell a direct primary care agreement.

HB2877 expands direct health care agreements beyond primary care to include all “medical care services.”  The new law defines “medical care services ” as “a screen, assessment, diagnosis or treatment for the purpose of promotion of health or the detection and management of disease or injury within the competency and training” of a medical care provider.

The enactment of HB2877 opens the door for specialists, chiropractors, and other healthcare providers to open practices based on the direct primary care model implemented in 2017.

On March 31, the Senate Health and Human Services Committee passed HB2877. The House previously passed HB2877 by a 98-0 vote. Today, the full Senate concurred with a vote of 34-0. With Gov. Justice’s signature, the law goes into effect July 4, 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. 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.

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.


HB2877 underscores an important strategic point. Passing bills that take a step forward sets the stage, even if they aren’t perfect. Once the door is open, the way is cleared for additional steps. You can’t take the second step before you take the first.

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 HB2877 takes another step toward healthcare freedom in West Virginia and creates a stepping stone to further action to nullify the onerous Affordable Care act. With this new law in place, the people of West Virginia should take further steps to fully extricate themselves from Obamacare for good.

Mike Maharrey

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