From Sen. Julian Garrett:
The increasing costs of medical care for Medicaid patients continues to be a national problem. The costs are increasing faster than the increase in U.S. gross domestic product and are expected to continue to do so. At least 2 Midwest states, Indiana and Missouri, have bills that would allow them to establish pilot programs to allow the state to contract with Direct Primary Care providers for some Medicaid patients. A waiver from the federal government would be required to do this. Direct Primary Care allows patients to contract with doctors to pay a monthly fee that covers the cost of the more common medical services. There is no insurance or government involved in the case of private patients. The fees are very modest compared to the cost of health insurance premiums. The reason for this is that medical people are freed up to provide medical services instead of spending substantial time on paperwork and complying with various rules and regulations. Patients using this alternative need catastrophic insurance coverage for the treatment of more serious diseases. Of course, if this kind of plan was used for Medicaid patients, the government would be involved but only to pay the monthly fee, and to ensure that the services contracted for were being provided.
As far as I can tell, the Missouri and Indiana bills have not generated a lot of support so far. There are estimates that states could realize substantial savings by contracting with DPC providers. You may recall that I successfully floor managed a bill in the last legislative session to allow Iowans to contract with DPC providers on their own. There are not very many DPC providers in Iowa yet, but there are a few, mostly, but not all, in the Council Bluffs-Omaha area. I think it is worthwhile to consider whether Iowa might want to look into this alternative as a way to deal with the ever-increasing costs of Medicaid.