When poor and working-class people can’t find decent health insurance they can afford, and when those who are insured face rising premiums and deductibles for plans that don’t always meet their needs, what is there left to do besides wait for a miracle?
Some are turning to direct primary care (DPC), where patients pay a monthly fee to get unlimited access to their physician. Advocates compare it to a gym membership.
Cherrie Jones and her daughter Darrica Byrd are two such patients in Indianapolis. They pay $80 a month each to see Dr. Richard Schuster of Schuster Family Medicine and Osteopathic Care. Jones, 57, was rear-ended in a car accident and has pain in her neck and arms. Byrd, 27, has had four back surgeries and deals with pain and muscle spasms.
The United States Census Bureau estimates that 14.1% of people under 65 years old in Indianapolis did not have health insurance in 2018. That was nearly four percentage points higher than the national average. The census bureau does not break down that data by race, but statewide numbers suggest the problem is especially dire for Blacks, who had an uninsured rate of 12% in 2017, according to data from the Henry J. Kaiser Family Foundation (KFF). That was compared to 8% for white Hoosiers.
Chris Habig is co-founder and CEO of Freedom Healthworks, a company that partners with physicians, including Dr. Schuster, to open a private practice and offer DPC. He said 10-15% of patients who see Freedom Healthworks physicians are uninsured. Even more could be underinsured. Habig and others in the health field often refer to this as being “functionally uninsured.”
Jones had medical insurance through her employer before switching to DCP, and Byrd was covered under her mother’s plan. Jones said she doesn’t remember what that insurance cost her per month since it came out of her paycheck. Employees in Indiana contributed an average of $121 per month to their employer-based health insurance in 2017, according to KFF.
Veronica Vernon, assistant professor of pharmacy practice at Butler University, called DPC a “really unique and exciting model” because it frees physicians from many of the requirements when dealing with insurance companies. Vernon added there are still “a lot of questions that need to be answered” about how exactly DPC affects patients and physicians. There’s currently a physician shortage, for example, so would that be exacerbated by giving physicians more flexibility in deciding how many patients they see?
Cost can be one advantage to the DPC model; plans range from $60 to $125 per person each month with Freedom Healthworks, depending on what services the physician provides. But Jones and Byrd said the simplicity compared to traditional insurance is another bonus.
“It’s well worth the $80,” Jones, 51, said of her monthly fee to see Dr. Schuster. “I have told so many people about him. I think it’s pretty cheap for what he does. I can be in pain every single week and go every single week.”
Byrd, who sometimes needs X-rays because of her back issues, said the referral process was more complicated under her mother’s old insurance, in part because doctors had to keep her in the same network.
This is where Habig feels like the DPC model can win out over traditional insurance. People want to have a relationship with their physicians, he said, which is difficult to do when money is tight and there are seemingly endless layers of bureaucracy.
“It’s a culture change,” Vernon said. “In the U.S., we’re very used to the traditional insurance model. Getting patients to think about this as an option is a shift in what we’re all used to.”
Even people who aren’t necessarily advocating for DPC have similar gripes and aspirations. Independent Sen. Bernie Sanders, who’s running for president, advocates for a nationalized health care system that would effectively undo private insurance. He consistently rails against the cost of insurance and says people like their doctors, not the insurance companies.
“I make sure we have a difference between health care and health insurance,” Habig said. “On the national scale, that health care reform is health insurance reform, and insurance by its nature is expensive and creates such a gulf for what care people can actually get.”
(Habig said there’s some “fundamental head-butting” between DPC advocates and those who want “Medicare for all.” As he sees it, Medicare for all provides the coverage, but DPC provides the care.)
Freedom Healthworks works with local businesses to give their employees a health care option, but Habig said that part of DPC has been slow to develop in Indianapolis because it’s a “strange market” where decision makers are hesitant to change.
Freedom Healthworks also doesn’t yet have a Black physician in the Indianapolis area, something Habig said he’s trying to change through recruiting.
Contact staff writer Tyler Fenwick at 317-762-7853. Follow him on Twitter @Ty_Fenwick.