Nebraska state employees could get access to a new health care option that minimizes the role of insurance under a bill pending in the Legislature.
Sen. Merv Riepe of Ralston presented a bill to a committee Wednesday that would let state workers enroll in a direct primary care plan.
Supporters said direct primary care allows doctors to spend more time with patients and reduces bureaucracy by cutting out the insurance middleman, although many consumers still buy high-deductible "wraparound" insurance to cover hospitalizations and access to specialists.
Under the plan, patients pay one recurring fee to a doctor for a variety of primary care services, such as check-ups and same-day appointments. In many cases, patients can also get medications and lab tests at or near wholesale prices.
"We want them to have the opportunity to try it," Riepe said after testifying before the Government, Military and Veterans Affairs Committee.
Riepe said the state would offer the plans in addition to regular insurance, and state employees could keep their traditional coverage if they want. Those who opt for a direct care plan could still get wraparound services from the state, although the costs aren't yet known. The bill would launch direct primary care as a three-year pilot program.
State officials don't yet know how much launching the program would cost or what the plans would offer if the measure passes, said Bryon Diamond, director of the Department of Administrative Services. Diamond said the state would likely continue to pay 79 percent of the costs, while employees pay 21 percent.
Nebraska is one of 23 states that have passed laws designed to promote direct primary care, according to the Direct Primary Care Coalition. Gov. Pete Ricketts signed the law in 2016, leading a small-but-growing number of Nebraska physicians to open their own no-insurance practices.
Rising insurance costs have forced many employers to raise deductibles to the point that it's too expensive for middle-class workers, and direct primary care "really comes to the rescue," said Dr. Joel Bessmer, an Omaha doctor who owns a direct primary care practice.
"For the amount of money you are spending on cellphones or cable TV, you can have a physician at your disposal 24 hours a day, seven days a week," Bessmer said.
Dr. Todd Johnson, who opened Nebraska's first direct primary care practice in 2016, said he has seen strong public interest in membership-based health care.
"We keep the middleman out, we keep the cost down and we keep the quality of care high," said Johnson, who is based in Lincoln.
The bill would apply to all employees who participate in the Nebraska State Insurance Program, which excludes employees of the University of Nebraska, as well as state and community colleges.
The head of Nebraska's largest state employee union said his organization hasn't taken a position on the bill because he still has unanswered questions.
John Antonich, the executive director of the Nebraska Association of Public Employees, said he was concerned that the three-year pilot program doesn't align with the union's two-year bargaining cycle. He said he also wants assurances that all of his members who choose direct primary care would have access to a health care provider.
"On its face it sounds OK, but what about areas of rural Nebraska?" said Antonich, who didn't testify at the hearing. "There aren't a lot of doctors out there. What happens when the pilot ends? Are people going to get thrown off their plan?"
Riepe said he was willing to adjust the program's time window to match it with the union's bargaining cycle. He said he expects the bill will receive a priority designation, increasing the odds that lawmakers debate it this year.
The bill received a warm reception from several lawmakers on the committee, who praised it as an innovative way to provide health care. It also received support from Blue Cross Blue Shield of Nebraska, the state's largest insurer.