Pandemic effects on DPC enrollment

Possibilities to think about:

  1. DPC members who lose employer coverage will have the ability to go to ACA-compliant marketplace plans. Many of these will reach the low income levels at which ACA provides robust cost-sharing reduction is available. The relative desirability of DPC will fall.
  2. Some DPC members who lose income will become Medicaid eligible, especially in expansion states.
  3. Some states that have not done so yet will accept Medicaid expansion, reducing the number of those whose health plan was “DPC + hope.”
  4. A high percentage of DPC members have HDHP plans (technically illicit). HDHP plans have bigger advantages for higher income people. A general downward slide in income coupled to an opportunity to change plans if group coverage is lost due to job loss will likely see a shift out of HDHP plans. Even if those shifting don’t see incomes low enough for the robust cost sharing, they will have less incentive for DPC.
  5. Some DPC members will not be able to keep up their monthly payments. Some of them, especially those with relatively low utilization in the past, are going to be upset if they are discharged from the practice.
  6. More people will hit, or expect to hit, full amount of deductibles or MOOPs, reducing the relative value of DPC membership.
  7. For a while at least, there will be less “high-touch” medicine of any kind. This reduces the relative value of DPC subscription model.

More to some. Use comments to tell me of other issues.

Based on the above, I expect DPC clinic to lose subscribers this year. A DPC/HDHP fix, if part of Covid-stimulus, would have moved the needle somewhat toward more subscribers; it did not happen.

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