A Majority of Delawareans Can't Find a Primary Care Doctor. A New Bill Wants to Fix That.

Delaware can only meet 16% of its primary care workforce need. Not 60%. Not 40%. Sixteen percent.

That means a majority of people in the state can’t find a primary care doctor through the traditional system at all.

On March 18, the state’s Senate Health Committee advanced Senate Bill 1, a sweeping piece of legislation designed to fix that crisis. The bill would force insurers to spend more on primary care and cap hospital prices that have been running at three times Medicare rates.

Three hours of heated testimony preceded the vote. Hospital lobbyists distributed maps showing jobs in legislators’ districts. The Delaware Healthcare Association warned of 4,000 job losses.

The fight over this bill tells you everything you need to know about why the traditional primary care system is struggling and why the direct primary care model keeps growing.

What the Bill Would Do

SB1 has two main parts.

The first part mandates primary care investment. Insurers operating in Delaware would have to spend at least 11.5% of their total medical costs on primary care. Not on outpatient services broadly. Not on “care” as a vague category. Specifically on primary care.

The bill builds on an earlier framework that helped push commercial primary care investment from roughly $30 million annually in 2022 to about $70 million in 2025. SB1 would extend and strengthen those requirements beyond their current 2027 sunset date.

The second part caps hospital prices at 250% of Medicare reimbursement rates. This is the provision that has hospital systems most alarmed. Data from the RAND Corporation found Delaware among only seven states where commercial insurers were paying over 300% of Medicare for hospital services.

Inpatient payments run about 11% higher than neighboring states. Outpatient payments run roughly 22% higher. ChristianaCare, Bayhealth, and Beebe Healthcare all exceeded 300% of Medicare for outpatient services in RAND’s analysis.

Both supporters and opponents of the bill agree on one number: the legislation could reduce healthcare spending by more than $400 million annually.

The Battle Lines

The SB1 hearing turned into a proxy war between two very different visions of healthcare.

Hospital systems showed up with lobbyists, job-loss projections, and district-by-district maps. The Delaware Healthcare Association projected $413 million in costs to hospital systems and warned the bill would reduce access to care for an aging population. It’s worth remembering that ChristianaCare successfully sued to block an earlier version of hospital cost review measures in 2024.

Independent physicians told a different story. Dr. Jim Gill, a physician with more than 35 years of experience, testified with rare candor for a committee room: “Let’s face it, no one went into primary care for the money, but we need enough funding to fully care for the people of Delaware.”

The Medical Society of Delaware argued that primary care practices can’t sustain themselves when insurers systematically underinvest in the primary care side of the equation. These practices already operate on thin margins in a system built around procedure-heavy specialist billing.

Senate Majority Leader Bryan Townsend wasn’t sympathetic to the lobbying. “The need of everyday Delawareans who are suffering from high health care costs,” he said, “trumps a map that a lobbyist wants to put in our face.”

The bill now moves to the Senate Finance Committee before a likely full Senate floor vote.

Why This Matters for DPC

Delaware’s shortage numbers aren’t unique. The specific percentages vary by state, but the structural dynamic is the same across the country. Fee-for-service reimbursement systematically underpays primary care relative to specialty and procedural medicine. The system rewards doing more tests, referrals, and procedures. It doesn’t reward knowing patients deeply.

And primary care, which runs on exactly that kind of long-term relationship, gets priced accordingly: low.

DPC physicians left that system because fixing it through internal advocacy wasn’t working. The DPC model didn’t ask insurers to pay more for primary care. It stopped billing insurers for primary care altogether and went directly to the people who actually wanted that care.

SB1 represents a different answer to the same problem. The legislative approach says: we can fix primary care by mandating that the insurance system properly fund it. That’s a reasonable position. Whether it can work at scale, against the lobbying power and legal resources of major hospital systems, is the open question.

A few things are worth watching.

The 11.5% spending floor could become a national model. Most states don’t mandate any minimum primary care investment. Delaware’s doubling of primary care investment since 2022 shows that mandates can move the needle. If SB1 passes and works, other states will take notice.

The hospital pricing fight reveals where the money goes. When both sides agree the bill would save $400 million a year, that tells you something about the current flow of dollars. They’re going to hospital reimbursements running at 300% of Medicare, not to primary care.

The workforce shortage is the long-term tailwind. When a state of one million people can only meet 16% of its primary care need, patients who can’t find a traditional primary care doctor are exactly the patients who you might find are open to a DPC membership model. They just need to know it exists.

What This Means

If you’re a DPC physician, the SB1 debate matters less for its specific provisions and more for what it reveals. This bill is an admission that the traditional system has failed primary care. Dramatic intervention from the state legislature is now required just to keep it viable. That’s not a DPC talking point. That’s Delaware’s Senate Majority Leader saying it into the record.

For those watching from other states, pay attention to whether SB1 survives the Finance Committee and floor vote. Hospital opposition is well-funded and has legal precedent on its side from the 2024 ChristianaCare lawsuit. If the bill passes anyway, it could open a new front in primary care investment legislation nationwide.

The underlying demand for accessible, relationship-based primary care isn’t going away. Delaware’s shortage numbers are a window into how far behind the traditional system has fallen. Whether the fix comes through legislation or through patients finding a different model on their own, the gap is real. Delaware just held three hours of Senate testimony confirming it.