AB8 creates a new statutory framework for direct primary care agreements in Wisconsin and expressly removes valid agreements from the state’s insurance laws. The bill defines a direct primary care agreement as a written contract between a health care provider and a patient, the patient’s legal representative, or an employer, under which the provider offers primary care services for a subscription fee over a set period of time. To qualify, the agreement must include required disclosures, specify services, fees, duration, and termination terms, and prohibit fee-for-service billing to insurers or other third parties for services covered by the subscription fee.
The bill also sets rules for who may enter into, decline, or terminate these agreements. Providers could not refuse or end an agreement solely because of a patient’s health status, and they would be limited to specified reasons for declining or terminating a contract, such as capacity limits, inability to provide appropriate care, nonpayment, fraud, abusive behavior, or a dysfunctional therapeutic relationship. The bill further bars discrimination in direct primary care based on race, color, national origin, religion, sex, disability, age, sexual orientation, or gender identity, while preserving the authority of state regulators over providers and over contracts that do not meet the bill’s definition of valid direct primary care agreements.
AB8 would amend Wisconsin statutes by creating s. 146.78 and adding valid direct primary care agreements to the insurance code’s exclusions in s. 600.01 (1) (b) 13. In practical terms, this would clarify that compliant direct primary care arrangements are not treated as health insurance, while also warning patients that such agreements may not satisfy federal coverage requirements and may not count toward deductibles or out-of-pocket maximums. The bill also allows providers participating in direct primary care to join insurer networks only if they can meet the carrier’s participation terms.
The overall sentiment reflected in the bill text is supportive of direct primary care as an alternative care model, with an emphasis on consumer disclosures, provider flexibility, and anti-discrimination protections. Because there were no committee transcripts or recorded votes provided, there is no documented floor or committee debate to indicate broader support or opposition. The bill ultimately failed to pass pursuant to Senate Joint Resolution 1.
The main points of potential contention are the bill’s treatment of direct primary care as outside insurance regulation, the limits it places on provider discretion in accepting or terminating patients, and the interaction between direct primary care agreements and existing health coverage rules. Employers, insurers, providers, and patients could all be affected by how the bill defines covered services, billing restrictions, and the extent to which these agreements interact with employer-sponsored or individual health plans.
AB8 would create a new section of Wisconsin law governing direct primary care agreements and would amend the insurance code to exclude valid agreements from the definition of insurance. It would affect health care providers offering primary care on a subscription basis, patients entering those arrangements, employers that may pay for them, and insurers whose networks or coverage rules may intersect with such contracts. The bill would also preserve oversight by the Department of Safety and Professional Services, the Department of Agriculture, Trade and Consumer Protection, and the Office of the Commissioner of Insurance for noncompliant contracts or other regulated activity.
The bill appears generally favorable toward direct primary care and is structured to legitimize and standardize those arrangements rather than restrict them. Its text emphasizes patient disclosures, anti-discrimination protections, and clear contract terms, suggesting a policy goal of encouraging the model while protecting consumers. No committee testimony or vote record was provided, so there is no additional evidence of public or legislative sentiment beyond the bill’s design and its eventual failure to pass.
Likely areas of contention include whether direct primary care should be exempt from insurance regulation, whether the required disclosures are sufficient to prevent consumer confusion, and whether the bill appropriately limits a provider’s ability to refuse or terminate patients. Insurers may be concerned about how these agreements interact with coverage obligations, deductibles, and network participation, while providers may view the patient-selection and termination rules as too restrictive. Patients and employers may also be concerned about paying subscription fees for services that do not count toward insurance cost-sharing or satisfy coverage mandates.