My DPC Story Direct Primary Care’s Inflection Point: What HR1 Within the "One Big Beautiful Bill" Means for Physicians and Patients

A New Era for DPC

Direct Primary Care (DPC) has long been positioned as a transformative force in healthcare, offering physicians the autonomy to deliver personalized, accessible care outside the constraints of traditional insurance-driven models. For clinicians already in the DPC world—or those exploring this path—the recent episode of the MYDPC Story Podcast, “Copy of DPC Coalition BBB Update,” is a goldmine. In this blog, we’ll unpack the strategic choices, legislative triumphs, and emerging opportunities discussed by My DPC Story's host Dr. Maryal Concepcion and her guests, equipping you with insights to reflect on and enhance your own DPC journey.

Section 1: The Legislative Gamechanger - What HR1 Means for DPC

HSAs and DPC: “Mission Completed”

Over a decade of advocacy has culminated in a historic legislative win for the DPC movement: Health Savings Accounts (HSAs) are now fully compatible with DPC memberships. As explained by Jay Keese, Executive Director of the Direct Primary Care Coalition, the passage of HR1- the “One Big Beautiful Bill” - brings DPC into the mainstream of employer-sponsored benefits.

Where once the tax code was a barrier - excluding patients with DPC agreements from HSA eligibility - the Primary Care Enhancement Act’s language now allows anyone with a DPC agreement under $150 per month ($300 for family agreements) to use HSA funds for membership fees, without jeopardizing future contributions. This “triple tax preferred” money (tax-free on contribution, growth, and withdrawal for qualified expenses) now supports direct relationships between patients and their primary care doctors.

Key Takeaways for the DPC Strategist:

• Patients can fund DPC memberships through HSAs without risking eligibility.

• The $150 individual/$300 family threshold is indexed for inflation.

• DPC agreements must offer primary care only, not bundled specialized labs or pharmaceuticals, aligning with both IRS and Medicare definitions.

How will you communicate this new opportunity to your patients and local employers? Are your practice fees and service offerings aligned to maximize HSA compatibility?

Section 2: Strategic Opportunities - Working with Employers, Brokers, and Insurers

Shifting Mindsets and Building New Alliances

Jeff Turner, a California health insurance broker, highlights the chance for brokers—for years marginalized in a tangled HMO landscape—to help bring DPC to underserved markets. Jay Keese stresses it’s time for physicians to rethink insurers not as adversaries, but as potential partners: national players like AHIP have supported HSAs-for-DPC legislation.

Employers, from large corporations to local businesses, are eager to offer value-rich health benefits. With two-thirds of employer plans now high-deductible and HSA-linked, the removal of the old ceiling opens a vast new segment for DPC practices. Rather than viewing insurers and brokers as obstacles, you can position yourself as a solution to their quest for value and engagement.

Two Emerging Models:

1. Bundled DPC-Insurance Arrangements: Directly integrated with traditional plans, brokers play a key role in structuring these packages and negotiating terms.

2. A La Carte DPC Memberships: Employers contribute a set amount to an employee’s HSA, allowing the patient to select any DPC doctor, putting physician choice center stage.

Do you see more potential in joining integrated networks or maintaining independence via individual contracts? What relationships can you leverage or start building with local employers and brokers?

Section 3: Navigating the IRS Rulemaking and Service Requirements

What Will the Guidance Look Like and How Should You Prepare?

Full implementation of the new law depends on final IRS guidance, expected by January 1. As discussed by Jay Keese and Dr. Phil Eskew, specifics are forthcoming, but the core requirements are clear:

• Agreements must be “affordable” as defined ($150/month individual, $300/month family).

• Services covered should be for traditional primary care, with any non-primary services (pharmaceuticals, labs) itemized separately.

• Telehealth is explicitly included; virtual DPC relationships qualify under the law.

Most DPC agreements already fit these criteria. Some may need discrete changes, especially those above the fee cap or bundling extras.

Consider reviewing your contracts: Are they clear on what constitutes primary care and separate from ancillary services? Will you need to adjust your fee structure, itemization, or billing practices?

Section 4: Pricing Strategies When Balancing Accessibility and Sustainability

Rethinking Fees in a Time of Demand

With the $150 individual/$300 family threshold as the HSA-compatible “bright line,” Dr. Lisa Chacko and others raise important questions about annual billing, itemizing services, and differential pricing for HSA-eligible versus non-eligible patients. The consensus: flexibility is allowed (such as charging those with HSAs the capped rate and others higher), but be mindful of both market forces and regulatory caveats.

Bundling more for those who pay cash remains possible; however, HSAs can only be used for qualified primary care services. As Dr. Garrison Bliss cautions, the temptation to raise prices or expand panels should be weighed against the core value of accessible, relationship-based care.

Is your current pricing below or above the new threshold? How might adjusting fees - up or down - change your practice demographics and workload? How do you maintain accessibility for patients while ensuring practice sustainability?

Section 5: Broader Growth: ACA Marketplace, Telehealth, and Workforce Expansion

New Markets and Models

HR1 also opens the door to integrating HSAs with high-deductible plans at the Bronze and Catastrophic levels on ACA exchanges. For DPC practices willing to engage this population, it’s a vast new market, one previously out of reach. Virtual care is now explicitly supported, enabling practices across geography and time zones.

But with opportunity comes responsibility. As Dr. Garrison Bliss urges, DPC practices are likely to see surges in demand. The choices you make regarding panel size, partnering, and contract terms will shape both the reality for your patients and the sustainability of your practice.

“Don’t just sign something because they hand it to you,” Bliss warns. Venture-backed aggregators may promise rapid growth, but can undermine autonomy and clinical quality. Expanding responsibly also means mentoring other clinicians and partnering for care continuity.

How prepared are you for a new wave of interest? What guardrails or decision criteria will you set for accepting new business, especially from larger entities or aggregators? Can you imagine joining with others to grow capacity and maintain excellent care?

Section 6: Advocacy and Staying Ahead - The Role of the DPC Coalition

Navigating Change as a Community

Policy and practice are now aligned as never before, but the DPC movement’s future depends on ongoing advocacy and collective dialogue. Dr. Concepcion and Jay Keese encourage physicians, brokers, patients, and advocates to join the DPC Coalition (dpcare.org) and be active at both state and federal levels.

Whether your state has yet to pass protective DPC legislation, or you’re encountering regulatory or payer barriers, coalition membership provides access to shared knowledge, lobbying efforts, and practical guidance.

Are you engaged with DPC advocacy, locally or nationally? What challenges—regulatory, market, or clinical—might benefit from the support and insight of a broader movement?

Reflecting on Your Own DPC Strategy

This episode, and the journey behind it, offers both celebration and caution for DPC clinicians. The model’s primary values—time, access, relationship, autonomy—are preserved and advanced by thoughtful engagement with new legislation, careful strategic partnerships, and an unwavering focus on the needs of patients.

Reflect on These Guiding Questions:

• How does the new HSA legislation shift your practice’s options and opportunities?

• Are you ready to grow sustainably—and to welcome more patients, more team members, and more community connections?

• What role will you play in advocacy, education, and shaping the next phase of DPC?

As Jay Keese noted, “world domination for DPC” is no longer a pipe dream—it is a horizon within reach. Now is the time for every DPC physician to step up, shape their practice, and help ensure this model delivers the meaningful, quality primary care our communities deserve.

Resources Mentioned:

• Direct Primary Care Coalition membership and updates

• MYDPC Story Podcast - practical guides and startup resources

Whether you are a solo DPC physician or part of a growing team, use these insights to reflect, strategize, and add your story to the evolving history of DPC in America.

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