Iowa House approves direct primary care option

It allows for agreements between doctors and patients

Rep. Dave Heaton

R-Mount Pleasant
Rep. Dave Heaton R-Mount Pleasant

DES MOINES — House Democrats made a number of unsuccessful attempts Thursday to end the private managed care of the state’s Medicaid program that serves more than 600,000 Iowans.

However, the minority party’s amendments to House File 2356 were ruled not germane — not relevant — to the bill that would allow people to enter into direct primary care contracts with medical providers.

After lengthy debate on the bill and the amendments, the House voted 94-1 to allow Iowans to enter into agreements with primary care providers for preventive and curative health care for themselves and their families as stipulated in the agreement. People signing such agreements would pay a monthly fee — presumably less than a full health insurance premium — to their health care provider.

Earlier this session, the bill was approved by the Human Resources Committee 22-0. It now goes to the Senate.

The bill by Rep. Dave Heaton, R-Mount Pleasant, was modeled on a bill approved by the Nebraska Legislature last year. It would open the door to direct primary care, an emerging health care delivery option, especially for individuals with high-deductible health insurance plans.

The advantage, Heaton said, is that it could provide a low-cost alternative to having health insurance. However, he added, the agreement would not be insurance, and Iowans might want or need insurance to cover prescriptions, hospitalizations and specialty care.

Democrats, who oppose the privatized management of Medicaid, used the bill as an attempt to require the Department of Human Services to terminate those contracts with managed care organizations. It also calls for the transfer of long-term services and supports population to fee-for-service program administration.


Rep. Cindy Winckler, D-Davenport, warned of “unintended consequences” of the option. Direct primary care providers could “cherry-pick,” entering into agreements with healthier people, which, she said, could result in higher health insurance costs.

Like Winckler, Rep. Art Staed, D-Cedar Rapids, voted for the bill, but said there hasn’t been enough discussion of direct primary care.

Rep. John Forbes, D-Des Moines, a pharmacist, said the bill provides an opportunity for people who can’t afford health insurance. Also, he said that doctors who offer direct primary care often spend more time with patients talking about their health conditions and changes they could make to improve their health.

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