A New Hampshire Republican Says Direct-Pay Care Will Be a 2027 Priority. The Bill Behind the Phrase Amends the Residential Care and Health Facility Licensing Chapter.

Legislation by DPC Insider — Policy Desk
#new-hampshire#dpc-legislation#state-policy#direct-pay#facility-licensing
Sources: NH GOP Bets on Direct-Pay Health Care to Cut Costs · Official Docket of HB1562, New Hampshire General Court · HB 1562-FN, as amended by the House, relative to licensing requirements for health care facilities that operate on a membership-based business model · RSA 151:2-f Policies Required for Health Facilities and Special Health Care Service Licenses · RSA 151:2 License or Registration Required · RSA 329:1-e Direct Primary Care · 2025 AMA Prior Authorization Physician Survey · AAFP: Direct Primary Care · 42 U.S.C. 300gg Fair health insurance premiums

Rep. Jason Osborne said direct-pay health care “has been a priority of the New Hampshire House for a long time, and I can almost guarantee that it will continue to be a priority in the 2027 session,” NHJournal reported.

The bill that carried that phrase through the House this year says “direct primary care” exactly once, and not in any section that regulates anybody. The licensing sections amend RSA 151, the chapter on residential care and health facility licensing.

What HB 1562 actually did

The official docket is short. HB 1562 was introduced January 7 and referred to House Health, Human Services and Elderly Affairs. The committee reported it ought to pass with an amendment on February 11, on a 10-8 roll call, over a minority report of inexpedient to legislate. The House adopted the amendment and passed the bill 181-149 on March 11. On March 26 the Senate returned it to the House per Senate Rule 3-21, without objection. No Senate floor vote appears on the docket.

The amended analysis lists three things the bill does. It exempts direct-pay health care facilities from certain licensing requirements in RSA 151:2-f, it creates a patients’ bill of rights for those facilities, and it directs the Department of Health and Human Services to study direct-pay models.

That study is the one place the words “direct primary care” appear in the bill. Section 5 tells the commissioner to examine the impact of direct-pay models on the state’s health care system, “with special attention given to the impact of implementation of the direct primary care law, RSA 329:1-e and 2019, 330 (HB 508),” and to report by June 30, 2027. The sections that change what a facility may do never mention it.

RSA 151:2-f is the all-payer rule. It requires every facility licensed under RSA 151:2, I(a) or (d) to “adopt and enforce a written policy to assure that the facility provides its services to all persons who require the services the facility provides regardless of the source of payment.”

Look up those two subparagraphs and the scope gets concrete. Subparagraph (a) is hospitals. Subparagraph (d) is the outpatient list: ambulatory surgical centers, dialysis centers, walk-in care centers, birthing centers and similar entities.

That’s the fight. Whether a surgery center or a dialysis center in New Hampshire can open on a cash basis without the obligation to take every payer.

The rule the bill changes is written for licensed facilities

New Hampshire’s direct primary care law is RSA 329:1-e, enacted in 2019 and effective October 15 of that year. It sits in Title XXX, Occupations and Professions, under the chapter governing physicians and surgeons.

The statute says primary care delivered under a direct primary care agreement “is not insurance,” and that the provider “shall not be subject to the requirements of RSA 415, RSA 420, or the jurisdiction of the commissioner” when seven conditions are met. Those conditions govern the written agreement, the fee disclosure, the termination terms and the statements printed on the document itself.

Facility licensing appears nowhere in it, and RSA 151 hands back the same answer. RSA 151:2, II(e) says the chapter “shall not be construed to require licensing of” a list that includes “[p]hysicians’ offices and related facilities.” A solo DPC practice in Warner or Concord sits on that list. RSA 151:2-f, for its part, names who it binds: facilities licensed under RSA 151:2, I(a) or (d), and holders of a special health care service license under RSA 151:2-e. A practice that also runs one of the licensed facility types in subparagraph (d), or holds a special health care service license, is a different case.

This year’s bill leaves RSA 329:1-e alone except for the study it orders. The fight over it ran on other ground. Rep. Mark McLean, the bill’s prime sponsor, told NHJournal the New Hampshire Hospital Association is “in fierce opposition, as they feel it will erode the strength of the state’s already weakened critical-access hospitals,” and that the Diocese of Manchester and the counties have objected in the past over destabilizing nursing homes. Those are arguments about hospital payer mix and long-term care beds.

The practice they point to bills insurance

The clinic in the pitch is Delphi Enhanced Primary Care in Bedford, founded by Nick Vailas, a former state health and human services commissioner. NHJournal reports memberships there run $80 to $120 a month depending on the patient’s age, and that medical services are billed through insurance.

RSA 329:1-e requires a direct primary care agreement to state prominently that the provider “will not file any claims against the patient’s health insurance policy or plan for reimbursement of any primary care services covered by the agreement.” A practice that runs a membership alongside insurance billing is a hybrid. RSA 329:1-e writes its exemption as conditional, so all seven conditions, that no-claims statement included, have to be met.

The AAFP puts a DPC membership at $50 to $100 a month, covering the primary care itself, and pegs the average DPC panel near 413 patients. Fees vary by practice and location. Those two arrangements differ in what the fee buys and who else gets billed, not only in what they cost.

The cost argument comes from the free-market side

Jacob Rich, a health care policy analyst at the Reason Foundation, told NHJournal that direct-pay products improve the experience and won’t cut spending. “In fact, it’s probably going to increase costs,” he said.

His reasoning is structural. In the individual and small group market, Affordable Care Act rating rules let a premium vary only by family size, rating area, age and tobacco use, so an insurer there can’t discount one because a member belongs to a DPC practice. NHJournal cites the state Insurance Department putting exchange enrollment at 5 percent of residents, or 73,090 people.

Greg Moore, who directs the New Hampshire chapter of Americans for Prosperity, frames the problem as payer concentration. “Some 65 to 70 percent of the revenue that most hospitals across New Hampshire get comes from government health insurance programs like Medicare and Medicaid,” he said.

Meanwhile the burden DPC actually removes has a number on it. The 2025 AMA Prior Authorization Physician Survey found prior authorization consumes an average of 13 hours of physician and staff time each week. No facility licensing bill moves that figure.

Where DPC Fits

If you run a DPC practice in New Hampshire, your statute passed seven years ago and it works. RSA 329:1-e already puts you outside insurance regulation when its conditions are met, and the licensing sections of this year’s bill work on facilities licensed under RSA 151. The only part of it aimed at your law is the section 5 study, which asks the department to report on RSA 329:1-e rather than amend it.

Being the sympathetic example in someone else’s licensing fight still costs something. The model gets explained in public by people whose real interest is a surgery center, and the counterargument that lands, Rich’s point about ACA rating rules, is aimed at a claim DPC never has to make. DPC’s case is 13 hours a week and a panel of roughly 413.

Watch the 2027 bill for one thing. Whether it does anything to RSA 329:1-e beyond ordering a report on it. If it doesn’t, the phrase on the campaign door and the text in the drafting office are two different products.