Democrats Won Congress. Three Republican Leads on DPC Bills Are Leaving

Three Republicans who lead federal direct primary care bills won’t be in Congress by the end of January.

Dan Crenshaw lost his Texas primary in March. Bill Cassidy lost his Louisiana primary in May. Marsha Blackburn won Tennessee’s governor race on Tuesday and will vacate her Senate seat. The same night, CBS News projected Democrats would win the Senate and the House. Counting continues, and Alaska and Mississippi were still open Wednesday morning.

The HSA change available to DPC practices is law and doesn’t depend on any of them. The bills they lead do.

Who holds what

Bill	What it would do	Lead	After this cycle
H.R. 1162	Lets state Medicaid programs use DPC	Crenshaw	Lost primary
S. 3298	Senate version of the same bill	Blackburn	Elected governor
S. 1719	Treats DPC fees as medical care, HSA compatible	Cassidy, with Jeanne Shaheen	Lost primary, and Shaheen is retiring
S. 5269	Hybrid monthly Medicare primary care payment	Sheldon Whitehouse, with Cassidy	Cassidy lost primary

The first three have the same record. Each was referred to committee, and that referral is still the latest action: February 2025 for H.R. 1162, May 2025 for S. 1719, December 2025 for S. 3298. That happened with Republicans running both chambers.

So the party change matters less than it looks. DPC’s standalone bills weren’t moving before Tuesday. The federal win DPC did get this Congress, section 71308, traveled inside H.R. 1.

Sponsors matter now for a duller reason. Bills that don’t pass in this Congress are dead unless reintroduced in the next one. H.R. 1162, S. 3298 and S. 1719 each need someone to file them again.

The Medicaid bill has the clearest way back

Our read: H.R. 1162 is the likeliest to survive the turnover, because it was never only a Republican bill.

Three of its seven cosponsors are Democrats: Kim Schrier, Brittany Pettersen and Jake Auchincloss. Schrier sits on Energy and Commerce and its Health subcommittee, and Energy and Commerce holds the bill. She had 57.5% in the first count of her race. An earlier version, H.R. 3836, passed the House by voice vote in the last Congress.

The bill clarifies that states may do this and requires nothing of them. That’s a modest ask of a majority that says its first Medicaid job is elsewhere.

S. 1719 has a weaker case, because section 71308 already made DPC arrangements compatible with HSAs. The two texts still differ. For one, the bill’s text doesn’t list prescription drugs among the services left out of primary care, and section 71308 does, for everything but vaccines. A practice that wants that revisited loses the bill’s sponsor and its first-listed cosponsor, because Shaheen is retiring too. The House bill of the same name, H.R. 1026, has a different lead, Lloyd Smucker.

The gavel that counts is Finance

Today’s Washington health story is Medicare for All. STAT reports that Ron Wyden is expected to lead the Finance Committee and that Bernie Sanders is the presumptive next chair of the health committee, and that an overhaul is unlikely in the near term.

For DPC, the Finance job is the one to follow. S. 3298, S. 1719 and S. 5269 all sit there, not at the health committee. Whitehouse is a Finance member, which gives the Pay PCPs Act a Democratic lead inside the room. That bill would let Medicare pay primary care partly by the month, with claims alongside, and its Republican partner leaves in January.

Two other departures touch this beat. Roger Marshall, author of the Patients Deserve Price Tags Act, lost in Kansas. His bill has sat on the Senate calendar since July 27, and 14 of its 25 cosponsors are Democrats. Mariannette Miller-Meeks, who cowrote an HSA column for DPC a week ago, lost in Iowa.

What stays put

Section 71308 applies to months beginning after Dec. 31, 2025, and the text sets no end date. The $150 monthly limit, or $300 for an arrangement covering more than one person, adjusts for inflation after 2026.

No House Democrat voted for the law that carries it. The final roll call shows 212 Democrats against and none in favor. But the agenda House Democratic Leader Hakeem Jeffries described in October was to “reverse the Medicaid cuts and extend the Affordable Care Act tax credits.” DPC’s HSA language isn’t on that list, and President Trump keeps his veto.

What To Watch

The first filing in January. The new Congress starts that month. If the Medicaid bill comes back with Schrier or another Democrat at the top, it survived the turnover. If it comes back with no Democratic lead, or doesn’t come back, you’ll know how much of it was Crenshaw.

Blackburn’s replacement. She picks her own successor after her inauguration, which comes in January. The appointee serves until a 2028 special election. S. 3298 has no cosponsors, so nobody inherits it by default.

Wyden’s first health agenda. If the committee’s early work is Medicaid and tax credits alone, DPC’s Senate bills wait. If you’ve been counting on a Medicaid path for your practice, you might plan as if it’s at least another year out.