The DPC Coalition Told a Texas House Committee Where the Model May Not Work

Lobby groups don’t usually volunteer their weak spots. On September 1, in a Texas House hearing room, the Direct Primary Care Coalition’s witness did.

Scott Burns testified before the House Select Committee on Health Care Affordability, an interim panel chaired by Rep. James Frank, a Wichita Falls Republican. Burns told members that direct primary care can address “80 to 90 percent” of a patient’s health issues, The Texan reported. Then he said the model “may not work” in rural areas, because small communities have a hard time competing for physicians against larger markets.

Reported flat like that, it reads as a small moment. It was also the most useful thing said about DPC all day, and it came from the one witness with every reason to leave it out.

What the committee was actually doing

No bill was on the table. The hearing notice shows a 9 a.m. start in room E2.016 and invited testimony only, organized around four charges: potential improvements to the delivery system and “emerging financing models that reduce the cost of health care,” ways to “encourage flexibility and innovation in plan design,” options that “eliminate barriers for small and mid-size employers to offer health care coverage,” and ways to “improve consumer engagement and encourage opportunities to evaluate cost and quality of health care.”

Frank opened by saying Texas “overpays for healthcare” and put the blame on incentives. “Prices lack transparency,” he said, and customers “are given little agency in shopping.”

Interim hearings gather material for a session that hasn’t started. Nothing was filed, nothing was voted, and nothing binds anyone. What a hearing like this does produce is a record of who got a seat, and the seating chart is worth reading.

Direct-pay witnesses sat on nearly every panel

The committee’s official witness list shows Burns registered twice, once for “Health Care Delivery & Finance Systems” and once for “Innovations in Health Care Plans-Affordability & Access.” David Balat of the Direct Care Alliance registered for three of the four topics. Jay Kempton of the Free Market Medical Association took the innovations panel.

They sat alongside the Texas Hospital Association, the Texas Association of Health Plans, the Teacher Retirement System of Texas, the Texas Medical Association, Sidecar Health, Curative, and Mark Cuban, who spent his time on a five-point plan for drug pricing.

Membership medicine spent years explaining itself to state legislatures from outside the room. In this one its witnesses turned up on nearly every posted topic.

What Burns asked the committee for

Burns pointed at what it takes to open a practice at all. “It is so hard for us to find people,” he said, naming regulations and paperwork as the drag, and arguing the priority should be making it easier to get a practice up and running.

Lane Aiena, appearing for the Texas Academy of Family Physicians, made a version of the same case from the independent-practice side. Smaller practices, he said, are being squeezed by rising costs, paperwork, and regulation.

Set that against what the hospitals brought. Association president John Hawkins testified that “even after the state’s supplemental payments, Texas hospitals absorbed $9 billion in totally unreimbursed Medicaid and uninsured costs in 2025 alone.” One witness put a $9 billion hole in front of the committee. The other asked to have the startup path cleared. Lawmakers hearing both in the same room will notice which request costs the state less.

The rural number sitting under the caveat

Burns’s caveat lands somewhere specific. As of 2024, roughly one in five rural Texas counties had no licensed primary care physician, a figure drawn from the state’s Rural Texas Strong initiative. Texas is set to receive $1.4 billion over five years for rural health work. Twenty-three percent of the award goes to a workforce initiative, the second-largest of six buckets, and the people it names are community health workers, mid-level practitioners, allied health professionals, behavioral health providers and paramedics.

Direct primary care doesn’t answer that. A flat monthly fee paid straight to a practice changes how a physician who is already there gets paid. It doesn’t place one in a county that has none. Where there’s nobody to sign up with, membership design is beside the point.

The Tension the Model Lives Inside

DPC sells physicians autonomy and a panel small enough to know. Both depend on enough patients within driving distance who can carry a monthly fee. By Burns’s own account, the counties that struggle hardest to hold a physician are the ones least able to support that. They’re also the counties whose numbers legislators read aloud when they talk about a primary care shortage.

Burns named that in the room instead of around it, and the fix he proposed, an easier path to opening a practice, is at least aimed at the binding constraint rather than past it. Whether it moves the rural number is not something one interim hearing can settle.