Submitted by: Robert A. Koshnick, MD, FAAFP, and Najaha Musse, MD

Desired actions:

• Advocate legislatively
• Advance the resolution nationally (to the AAFP Congress of Delegates)
• Bring awareness to members, the public, media and/or specific groups/stakeholders

WHEREAS direct primary care (DPC) can provide more personalized care, better access to care, better communication, more affordable care, increased preventive care, better chronic disease management and improved overall health outcomes;

WHEREAS health savings accounts (HSAs) provide tax-free contributions, tax-free growth and tax-free withdrawals if used for qualified health care expenses and empower people to shop for their medical care, increasing choices, competition and lowering costs;

WHEREAS Devenir and the HSA Council Demographic Survey found that, by the end of 2022, almost 72 million Americans had health savings accounts, but people with health savings accounts are not allowed legally to use them to pay for direct primary care because the IRS has ruled that DPC is insurance and not a qualified medical expense;

BE IT RESOLVED that the MAFP lobby our legislature to join thirty-two other states in identifying direct primary care as a qualified medical expense but not insurance;

BE IT FURTHER RESOLVED that the MAFP forward this resolution to the AAFP, asking them to support direct primary care access to health savings accounts and support health savings accounts for people for the reasons stated above.

Testimony

The AAFP has no position on health savings accounts that seventy-two million Americans have. The AAFP does support DPC. The AAFP should support health savings accounts for the reasons stated above. The AAFP should also support that people can pay for DPC with their HSAs.

Comments in support (8):

Nancy Baker – I think it’s appropriate for MN to join the other states who’ve already made this legislative ruling.

Eric Poulin – Support.

Chris Reif – Agree with Dr. Slattengren’s suggestions.

Najaha Musse – Given there is a bill in Congress (H.R. 5688) to amend IRS code of 1986 to allow HSA/FSA to be used towards DPC expenses, I support MAFP resolution to state 1) DPC is not an insurance and 2) DPC fee be a qualified medical expense.

Collin Beyer – Support.

Robert Koshnick – I talked with Dr. Musse, and she and I both agree to add an additional resolve as follows: Be it further resolved that the MAFP ask the AAFP to lobby that pre-tax HSA funds may be used to pay for DPC fees. Dr. Musse will be at the MAFP House of Delegates. I will not be able to attend because I have other commitments and family activities related to my brother-in-law’s funeral that day.

Nicholas Krawczyk – It is important for MAFP to demonstrate leadership on the future of family medicine.

Laura Slings – Please vote in favor of allowing MN residents to use HSA funds toward their Direct Primary Care (DPC) Membership. DPC provides an affordable Primary Care option for people who don’t qualify for state assistance but are unable to afford good health insurance on the exchange. Many people have high deductible insurance. Allowing DPC members to use an HSA improves access to high-quality care.

Comments against (3):

Andrew Slattengren – Current tax law makes DPC incompatible with health savings account (HSA) plans because the IRS defines DPC as insurance. Pushing this at a state level will not change IRS definitions. A similar resolution (2021-02 Self-Directed Medical Care) was adopted by a previous HOD that resolved similarly to this. Being more specific in this current resolution may help. I would support this resolution with edits that clearly state that the MAFP ask AAFP to lobby that pre-tax HSA funds may be used to pay DPC fees.

Roli Dwivedi – Not supporting as written. Will recommend editing as per Andrew’s suggestion.

Kim Krohn – Agree with above comment—being strategic with this issue.