People always need to have some level of access to affordable healthcare, but in a pandemic, it’s absolutely crucial. With the second wave of recession causing millions to lose their jobs and subsequently their employer-tied health insurance, we should rethink the norm of getting health coverage from an employer and instead consider signing up for direct primary care.
Since the beginning of February, over 45 million people have filed for unemployment benefits. Worse, the Kaiser Family Foundation estimated that 27 million people lost their employer-tied health insurance and will be unable to obtain replacement coverage.
The coronavirus is still surging across the country, and the federal response is buckling. Efforts such as expanding Medicaid coverage and Obamacare subsidies for recently laid-off folks fall short of providing coverage to everyone who needs it. The Kaiser Family Foundation claimed that the federal safety net will be unable to cover 1 in 5 people who have lost their employer-tied health insurance. Those that Medicaid won’t cover could face steep insurance premiums or, even worse, go uninsured.
The virus still poses a real threat that can cost families and individuals thousands of dollars in unreasonable out-of-pocket healthcare expenses.
Medications, hospitalizations, testings, and eventually vaccinations — these are expenses many families will likely have to navigate. To afford them, people will need reasonably low out-of-pocket costs. It’s unlikely that employer-sponsored insurance will be able to deliver.
In many instances, using insurance will hike up the price of healthcare charges compared to paying out-of-pocket. For example, in Texas, Pam LeBlanc and Jimmy Harvey both went to the Austin Emergency Center for a drive-thru COVID-19 test. They both received the exact same procedure. Harvey paid out of pocket and was charged $199 for his test. Meanwhile, LeBlanc had them bill her insurance. She was charged $6,408.
The problem with having healthcare providers bill private insurance is that providers know insurance companies can pay a lot more than the average individual and know they can get away with outrageous up-charging with little resistance.
Like many people on employer coverage, LeBlanc thought she would be insulated from bearing the bulk of the cost for her test, but still ended up paying $928. By using her insurance to pay for the test, she essentially gave the Austin Emergency Center a blank check to write a cost far exceeding the service’s value.
Insurance companies shouldn’t be allowed to dump inflated healthcare bills on patients, but in this matter, the government has proved an unreliable advocate. People need another option to obtain reasonably low out-of-pocket healthcare costs.
One possible avenue could be increasing the use of direct primary care arrangements. Unlike other health insurance, direct primary care consolidates healthcare to be strictly between a patient and physician. By eliminating insurance company involvement, most direct primary care practices circumvent unnecessary healthcare-cost inflation and tend to be extremely transparent in their pricing for services.
Critics of direct primary care detest that patients pay out-of-pocket for services rendered. But in most cases, direct primary care is far cheaper than paying for employer-sponsored insurance premiums or waiting for a hospital to overcharge an insurance company that eventually dumps excess costs onto the patient.
Kimberley Legg Corba, who owns Green Hills Direct Family Care in Allentown, Pennsylvania, reported that her clinic only charges a monthly fee of $60 (to patients ages 20-44), while the average cost of employer insurance premiums runs people $453 a month.
Additionally, since direct primary care clinics are dependent on patient satisfaction, prices for services tend to be far lower than what is charged by large health providers. For instance, when questioned about her clinic’s charges for coronavirus tests, Corba said, “We charged $50 in May, and the price has only increased to $100, due to additional lab expenses.”
Corba said direct primary care clinics in her area “have truly weathered the storm and are prepared to keep helping patients through the pandemic.” From conducting curbside coronavirus tests to alleviating symptoms, Green Hills Direct Family Care and clinics like it could prove to be a viable option to address the influx of unemployed people seeking affordable healthcare.
Granted, no system is perfect. Direct primary care has a few hurdles keeping it from being a more widely used model. Twila Brase, president of the Citizens’ Council for Health Freedom, said the “main hurdle for [direct primary care] is that it’s unable to treat catastrophic health issues, like trauma from car accidents or heart attacks.”
Direct primary care offers primary care and internal medicine services, such as wellness checks, diabetes care, suturing, pediatric care, monitoring of chronic medical conditions, gynecological care, and spirometry. Supplemental healthcare arrangements such as health savings accounts are typically needed to cover more severe ailments and specialty needs. “Unfortunately, current laws make HSAs tied to high deductible plans, which require people to pay large out-of-pocket costs before receiving the benefits of the account,” said Brase.
COVID-19 has created tumultuous conditions for millions of unemployed people, yet these conditions have laid out the foundation to reform the overpriced and inefficient status quo of employer-sponsored insurance. By supporting and changing some laws for direct primary care, people will have the potential to change healthcare fundamentally so that it’s more accessible and affordable.
Editor’s Note: This article was updated on Aug. 12 to include more details of what direct primary care offers.
Tanner Aliff is a Young Voices contributor, a former mental health evaluator for Providence Health, and a research fellow analyzing the impacts of COVID-19 on the U.S. economy and healthcare system.
