Alaska House passes bill to allow direct health agreements

The Alaska House passed a bill Monday that would legalize subscription-based health care in Alaska.

“Direct health care agreements work similarly to a gym membership,” said Rep. Kevin McCabe, a Big Lake Republican who sponsored the legislation in the House. It would allow Alaskans to pay a monthly fee in return for primary care services rather than paying per visit.

Similar services are already allowed in other states. Some practices are already offering the service in Alaska, despite the fact that it is neither allowed nor regulated under state statutes.

The bill passed in a 28-12 vote. The bill could be taken up in another vote by the House on Tuesday. Because of changes made to the bill by House members, it would then return to the Senate — which adopted the bill in a 18-2 vote in May — for another vote.

McCabe said the bill would save costs by removing the need for private insurance providers — whom he called “third party middlemen” who are “skimming profits off of patient-provider relationships.”

The bill was amended on the House floor on Friday, restoring some of the provisions that had been included by the Senate when it passed that chamber last year, including a requirement for providers offering direct health care agreements to maintain a practice in which at least 20% of patients are either uninsured or enrolled in Medicare.

The provision was meant to address a significant shortage of providers in Alaska willing to accept Medicare, though critics said it would be easier for providers to satisfy the requirement by enrolling uninsured patients.

“When I think about the big issues that we’re facing in health care in this state, we need more access for primary care for our elders. This bill doesn’t quite touch up on that,” said Rep. Genevieve Mina, an Anchorage Democrat who voted against the bill.

One key change made to the bill by House members prevailed. The Senate had required that clinics offering direct health agreements be owned by Alaska-based physicians — a measure meant to stave off private equity investors from purchasing Alaska clinics. The House stripped that requirement, saying it would unnecessarily limit the kinds of practices that could offer such agreements.

Rep. Zack Fields, an Anchorage Democrat, said “parasitic private equity companies have invested heavily in a broad range of health care … and there are very disturbing examples of abuse” resulting from that investment, including by driving “doctors to accept more and more patients and provide less and less care.”

Wasilla Republican Sen. David Wilson, who sponsored the bill in the Senate, said Monday he did not know where Senate members stood given changes made in the House.

Wilson said he supported the removal of the requirement that clinics be owned by Alaska physicians.

“You would have to buy a really large provider network to make it portable and lucrative for a private equity firm,” said Wilson, adding that such large networks aren’t widespread in Alaska.

If the Senate votes against agreeing with the House version of the bill, the bill could be sent to a conference committee — where members of both chambers could agree to work out the differences between the two versions of the bill.

At the request of Republican Rep. David Eastman of Wasilla, the vote on the measure could be reconsidered by the House on Tuesday. Eastman said he had not had sufficient time to learn the implications of the bill after it had been amended by the House last week.