How the OBBBA Paves the Way for a Primary Care Restructuring
Americans in need of primary care will soon have more options, thanks to the One Big Beautiful Bill Act (OBBBA).
The recently passed law allows patients to use money from tax-advantaged health savings accounts to pay for direct primary care for the first time.
Direct primary care, or DPC, is a model in which patients can pay their doctors a monthly fee in return for generally unlimited access to routine care.
This innovative arrangement makes it easier to consult with a primary care physician on short notice. It can also be more cost-effective than paying for doctor visits through traditional insurance claims.
By expanding access to direct primary care, the new law will bring greater choice and competition to a part of the health sector that sorely needs both.
In its current form, DPC first took shape in the early 2000s.
And it has only become more common in the years since.
Between 2022 and 2023 alone, the share of family physicians operating a direct primary care practice rose from 3% to 9%, according to a survey by the American Academy of Family Physicians.
Under this model, patients pay a flat monthly rate — usually ranging from $50 to $100 for adults — for ready access to a primary care doctor.
In the vast majority of cases, DPC practices offer same-day appointments.
That's a massive improvement over the status quo.
The average wait time for family medicine visits in the United States was 29 days last year.
Among other things, this combination of flat rates and quick access makes it far less costly for patients to look after their health through regular preventative visits to the doctor — as multiple visits in the same month won't lead to additional charges.
But the benefits of direct primary care aren't limited to patients.
The model also makes life easier for doctors.
Physicians operating a DPC practice are considerably more likely than their counterparts to report having no sense of burnout.
Despite the obvious advantages to this model, direct primary care has remained off-limits for large portions of the country.
Those with high-deductible health plans and HSAs could not use their savings to cover direct primary care subscription fees — nor could they contribute to their HSAs if they had signed up for a DPC arrangement.
Those two prohibitions will be gone starting January 1, 2026.
OBBBA also lets employers contribute money directly to employees' HSAs, which can then be used to pay DPC subscription fees.
Finally, the law makes HSAs more widely available by allowing both bronze and catastrophic Obamacare plans to be coupled with these accounts.
This alone is an important step toward introducing more choice and competition into our healthcare system.
When patients are in-charge of their healthcare dollars through a health savings account there is a strong incentive for them to shop around for the best-value care.
Such consumerism puts pressure on providers to compete for patients' business on both price and quality.
This component of the new law also paves the way for a future in which patients can purchase a bare-bones exchange plan, couple it with an HSA, and use their contributions to access timely, affordable care through a DPC practice.
These changes might not seem revolutionary. But they could have a transformational effect on how primary care is delivered in the United States.
For one, OBBBA will create significant new demand for DPC arrangements.
In response, doctors will have a strong incentive to embrace the model.
The result could be a potential explosion in the number of Americans who receive care through a DPC practice.
As this model becomes more popular, competition between direct primary care providers will only grow fiercer — a dynamic which promises to lower costs and increase quality for millions of American patients.
Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is "The World's Medicine Chest: How America Achieved Pharmaceutical Supremacy -- and How to Keep It." Follow her on X @sallypipes. Read Sally Pipes' Reports — More Here.