A New Bill Would Eliminate Cost-Sharing on Three Annual Primary Care Visits. Here Is What It Says, Where It Stands, and What It Does Not Change.

Legislation by DPC Insider — Policy Desk
#legislation#congress#insurance#primary-care-access#cost-sharing#behavioral-health
Sources: H.R. 9257 — Primary and Behavioral Health Care Access Act of 2026 | Congress.gov · S. 4754 — Primary and Behavioral Health Care Access Act of 2026 | Congress.gov · ACP Supports H.R. 9257, the Primary and Behavioral Health Care Access Act of 2026 | American College of Physicians · 2026 Healthcare Cost Report | Imagine360 · Underwood Introduces Legislation to Lower Cost of Primary Care, Mental Health Care, and Addiction Treatment | Representative Lauren Underwood · King Introduces Cost-Saving Health Bill to Have Insurance Plans Cover Three Primary Care Visits | U.S. Senator Angus King · Direct Primary Care 2024 Data Brief | American Academy of Family Physicians · STATE OF DIRECT PRIMARY CARE — DPCA Member Insights Committee, 2026

Forty-four percent of insured adults aged 18 to 64 in the United States delayed or skipped care or medications due to cost over the past year, according to a 2026 survey by Imagine360. These are people with coverage. Cost is what stopped them.

That is the problem H.R. 9257 is written to address.

What the Bill Says

The Primary and Behavioral Health Care Access Act of 2026 would require every group health plan and individual health insurance issuer to cover three primary care visits and three behavioral health visits per year without any cost-sharing. No copay. No deductible applied at the time of service. No coinsurance.

The legislation amends three federal statutes: the Employee Retirement Income Security Act, which governs employer-sponsored insurance plans; the Public Health Service Act, which covers the insurance market broadly; and the Internal Revenue Code. That scope means the requirement would apply across the coverage landscape — employer plans and individual market plans alike.

The three-visit provision is a floor, not a ceiling. A patient can still see a primary care physician more than three times a year. The bill’s coverage mandate does not extend past the third visit; existing plan terms govern any visits beyond it.

The House version was introduced on June 11, 2026, by Representative Lauren Underwood of Illinois, a registered nurse, and Representative Kim Schrier of Washington, a physician. Senator Angus King of Maine introduced the companion Senate bill, S. 4754.

Where It Stands

The House bill was referred on June 11 to three committees: Energy and Commerce; Education and Workforce; and Ways and Means.

The American College of Physicians filed a formal letter of support, citing evidence that cost-sharing — particularly deductibles — is associated with reduced use of care, including necessary care.

The bill’s path through the current Congress is uncertain. Republicans hold the majority in both chambers. H.R. 9257 is sponsored entirely by Democrats; no Republican co-sponsors have signed on. Senator King, an independent from Maine, leads the Senate companion in a Republican-majority chamber. The bill’s mechanism — a new mandate on private insurance — has drawn no Republican co-sponsors.

This is also not the first iteration of the proposal. A substantially similar bill, H.R. 9133, was introduced in the 118th Congress in 2024. It was referred to committee and did not advance to a floor vote.

The DPC Parallel — and the Distance Between Them

The cost barrier the bill targets is the same structural problem DPC was designed to eliminate from primary care. A patient who calculates whether a visit is worth the copay, or who waits until a problem is bad enough to justify meeting a deductible, is the patient DPC was designed for.

DPC’s answer is to remove the transaction from primary care entirely. A patient pays a monthly membership fee — the DPC Alliance physician survey puts the national average at $98.64 — and typically makes no additional payment at the time of a visit. The AAFP’s 2024 DPC data brief found DPC practices average a panel of about 400 patients. At that panel size, same-day access and direct physician communication are structurally possible. The AAFP’s data brief found that 98 percent of DPC practices offer same-day appointments and direct phone or text access.

H.R. 9257 takes a different approach to the same problem. It keeps the insurance structure in place and removes the financial deterrent at the front door for three visits per year.

What the bill’s mechanism does not change: panel sizes. Appointment availability. The same-day access question. The nature of the physician-patient relationship. A waiver of cost-sharing for three visits does not alter how many patients a physician carries or how much time is available per appointment.

That is not a criticism of the bill’s goal. A patient who skips a visit because a $30 copay is too much in a given month is a patient who might benefit from three guaranteed cost-free visits — whatever the structural limitations beyond that. The ACP’s reasoning is defensible on its own terms.

It is a distinction worth stating precisely, because H.R. 9257 and the DPC model are often discussed as though they are competing solutions to the same problem. They are. But they operate at different levels of the problem’s structure, and a change to one does not resolve or foreclose the other.

What To Watch

The bill’s immediate trajectory is three committee referrals in a chamber where it has attracted no majority-party co-sponsors. The realistic near-term signal is whether any committee schedules a hearing or a markup, which would indicate members see legislative interest in the concept even if the bill in its current form goes nowhere.

The ACP’s formal support keeps the proposal on the record as a professional-organization priority heading into the next Congress. H.R. 9257 is a reintroduction of H.R. 9133, which passed through the same committee referral process in 2024 without a floor vote.

The bill has already drawn endorsements from a broad set of mental health organizations — including NAMI, the American Psychological Association Services, the Depression and Bipolar Support Alliance, the American Foundation for Suicide Prevention, and the National Council for Mental Wellbeing — alongside the primary care community. The question to watch is whether that existing coalition translates into Republican support for the concept in a future Congress, even if not for this bill in its current form.

The access problem the bill names is not going away. Insured adults skipping or delaying care due to cost is a documented and worsening trend. Whether the legislative response ends up looking like a cost-sharing mandate, an expansion of the DPC HSA carve-out, a workforce investment, or something else depends on which coalition assembles first.