Alaska House to vote on establishing subscription-based health care

The Alaska House of Representatives is poised to vote on a bill that — if adopted — would legalize subscription-based access to medical providers.

Direct health care agreements allow patients to pay a monthly subscription fee to access specified medical care. It has been described as both an alternative to traditional health insurance and as a service that can improve access to care for people with high-deductible insurance plans or difficulty accessing certain medical services through their insurance. Such plans are also used by people willing to pay large sums in exchange for getting personalized, on-demand care known as “concierge medicine.”

The bill passed the Alaska Senate last May. It advanced through a House Labor and Commerce Committee hearing last year but was not scheduled for a floor vote before the Legislature adjourned. The House finally considered amendments to the bill on Friday, setting it up for a House floor vote on whether to pass the measure next week.

Senate Bill 45 has been championed by conservative advocacy groups Alaska Policy Forum and Americans for Prosperity. They contend it will reduce health care costs by cutting the red tape and paperwork inherent to private health insurance plans.

Skeptics of the measure say it could embolden health care providers to discriminate against patients who suffer from serious medical conditions by setting unaffordable service rates, and further limit health care options for patients who depend on public health insurance like Medicare and Medicaid.

The House considered more than a dozen amendments to the bill during a contentious three-hour floor session Friday.

Lawmakers agreed to limit the bill to apply exclusively to primary care providers, meaning specialists will not be allowed to offer direct health agreements.

They also agreed to mandate that primary care providers offering such agreements must continue accepting new patients enrolled in Medicare, and must maintain a practice in which at least 20% of patients are enrolled in Medicare or lack health insurance entirely. A similar provision was included in the version of the bill adopted by the Senate last year, but it was stripped from the bill by the House Labor and Commerce Committee earlier this year.

Supporters say the provision is needed to avoid further exacerbating a known lack of providers in Alaska willing to accept patients enrolled in Medicare.

Rep. Zack Fields, an Anchorage Democrat, attempted to amend the bill to require clinics entering into direct agreements to be owned by Alaska residents, in an effort to stave off private equity firms that have increasingly been buying clinics across the country.

That amendment narrowly failed in a 20-18 vote.

“In the absence of a health care provider stake, a person who takes an oath to provide high-quality care, you’re going to have Wall Street people trying to sign up as many people for these policies while providing the least care possible. That’s not a good road to go down,” said Fields.

Lawmakers also voted down, in a 20-17 split, an amendment proposed by Rep. Jennie Armstrong, an Anchorage Democrat, that would have explicitly banned providers from discriminating against patients in the provision of direct agreements on the basis of “sexual orientation, gender identity, gender expression.”

Alaska law does not specifically ban such discrimination, on the advice of the state’s Attorney General Treg Taylor.

Under existing state law, direct health care agreements are not allowed. Yet some providers are already offering such agreements and have been doing so for several years. Division of Insurance Director Lori Wing-Heier said last year that if the state doesn’t legalize the plans, the state could begin taking action against providers who offer such plans without a state statute allowing them.

If the House passes the bill next week, it would have to go back to the Senate for final approval because of changes made to the bill by the House.