D4PCF Asks Trump Administration for Tax Protection of Direct Primary Care Members and Their Employers

An 8-page legal letter asks multiple federal departments to recognize DPC membership dues as tax-free medical expenses

WASHINGTON, January 4, 2019 — Last week the Internal Revenue Service (IRS) received an official request from the Docs 4 Patient Care Foundation (D4PCF) to recognize dues paid to direct primary care (DPC) practices as tax-free medical expenses reimbursable by employers.

Multiple federal departments ought to clarify “that the monthly fees associated with DPCs are qualified medical expenses which can be offset by HRA funds,” states the eight-page letter, which has 31 footnotes citing federal regulations and court cases.

DPC membership is not a form of insurance, so dues are a legitimate medical expense, D4PCF argues. Consequently, patients should be allowed to submit their monthly membership costs—which range from $40 to $150 per person—to their employers for tax-free reimbursement, if their employers offer health reimbursement accounts (HRAs).

The Trump administration appears amenable to the viewpoint that tax protection for DPC patients is long overdue, according to a statement made by D4PCF Board President Dr. Lee Gross upon filing the letter:

“The direct primary care community has spent many years frustrated by the lack of progress in fixing the HSA issue that has hamstrung the DPC movement for so long. D4PCF recognized an opportunity to advance this initiative through our multiple meetings with the executive branch, while also working through our legislative priorities.

“D4PCF engaged the Washington, D.C. law firm of Foley Hoag to draft a legal basis for allowing HRAs to be used for DPC memberships. This legal argument was submitted as a formal comment to the Departments of Health and Human Services, Treasury and Labor during the public comment period for the proposed rule for overhauling the use of HRAs across the country.

“We look forward to continuing to work with the Trump administration and Congress to expand access to this affordable care model for all Americans.”

D4PCF filed its letter as a comment on the proposed rule “Health Reimbursement Arrangements and Other Account-Based Group Health Plans” (REG-136724-17).

In November of 2018, Gross testified to the U.S. Senate Health, Education, Labor and Pensions Committee that removing barriers to DPC membership would immediately achieve multibillion-dollar savings for patients and taxpayers.

Docs 4 Patient Care Foundation is the only 501(c)(3) public policy think tank governed exclusively by doctors standing up for the health and freedom of patients and physicians. The D4PCF mission is to preserve the sanctity of the physician-patient relationship, promote quality care, support affordable access to care for all Americans, and protect the patient’s personal health care decisions.


  1. Thank you, Dr. Gross and D4PCF for standing up for patients and physicians that want to remain independent of the insurance cartel, of which there are millions.

  2. Hamilton McMenamy

    Great idea, and the same opening should be available to private individuals using their non-employer HSA’s.

  3. Drew Denby

    Direct Primary healthcare is the only sensible alternative to reactive insurance based health services. The concept of Insurance or reactive health care is counter-intuitive and relies on the patient being sick enough to need serious attention before it can be worthwhile getting treatment and using deductibles and co-pay payments. Making regular monthly payments to a direct primary care service to keep yourself healthy is the smart progressive way to do things. In my humble opinion.
    Drew Denby

  4. Tom McGue

    Direct primary care really raises the issue of the value of health care insurers. Health insurers and providers have a symbiotic relationship to support an excessive cost structure for healthcare in this country. Health insurance is a method of collecting and distributing money to Payers and and to providers. It is not a market based competitive environment. Direct Primary care is the first effort to undermine an expensive and valueless pay system.

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