An Act to create 146.78 and 600.01 (1) (b) 13. of the statutes; Relating to: agreements for direct primary care.
SB4 creates a new statutory framework for direct primary care agreements in Wisconsin and exempts valid agreements from the state’s insurance laws. The bill defines a direct primary care agreement as a written subscription-style contract between a health care provider and a patient, the patient’s legal representative, or an employer, under which the provider agrees to furnish specified primary care services for a set fee and term. To qualify, the agreement must be signed, describe and quantify the covered services, state the subscription fee and duration, allow termination on written notice, and prohibit fee-for-service billing to insurers or other third parties for services already covered by the subscription fee.
The bill also requires prominent disclosures that the arrangement is not health insurance, may not satisfy federal coverage requirements, and may not count toward deductibles or out-of-pocket maximums. It further permits patients to use employer arrangements, but makes clear that services outside the subscription fee remain the patient’s responsibility. The bill preserves regulatory authority for the Department of Safety and Professional Services, the Department of Agriculture, Trade and Consumer Protection, and the Office of the Commissioner of Insurance over contracts that do not meet the new statutory criteria or that otherwise qualify as insurance.
SB4 limits when providers may refuse or end a direct primary care agreement. A provider may not decline or terminate an agreement solely because of a patient’s health status, and may refuse to enter an agreement only if the practice is at capacity or cannot appropriately treat the patient’s condition. Termination is limited to specified reasons such as nonpayment, repeated failure to follow treatment plans, fraud, abusive conduct, discontinuation of the direct primary care practice, or a dysfunctional therapeutic relationship. The bill also states that providers participating in direct primary care may join insurer networks only if they can comply with the insurer’s participation terms.
The general sentiment reflected in the legislative history appears supportive enough for the bill to pass the Senate, including passage on third reading after rejecting Senate Amendment 1. However, the bill ultimately did not become law, as it later failed to pass notwithstanding the Governor’s objections. That outcome suggests the proposal had meaningful support in the Legislature but also enough opposition or executive resistance to prevent enactment.
The main points of contention are likely the bill’s treatment of direct primary care as outside insurance regulation, the restrictions on provider discretion in accepting or terminating patients, and the interaction between subscription-based primary care and existing health coverage rules. Supporters likely viewed the bill as clarifying the legality of direct primary care and protecting patient access, while critics may have been concerned about consumer confusion, insurer coordination, provider autonomy, and whether the model could function like insurance without being regulated as such.
SB4 would create s. 146.78 governing direct primary care agreements and add a corresponding exclusion in s. 600.01 for valid agreements, thereby removing qualifying contracts from the definition of insurance under Wisconsin law. It would affect health care providers, patients, employers offering direct primary care as a benefit, and insurers by setting minimum contract terms, disclosure requirements, and limits on billing and patient selection. It also preserves oversight for state regulators over nonqualifying contracts and insurance-like arrangements that do not meet the statutory criteria.
The bill appears to have had generally favorable legislative support, as shown by its passage in the Senate on third reading. At the same time, the final outcome indicates significant resistance remained, since it was ultimately vetoed and failed to pass over the Governor’s objections. Overall, the discussion and voting history suggest a policy idea with bipartisan interest but not enough consensus to become law.
The most notable contention centers on whether direct primary care should be carved out from insurance regulation and how far that exemption should go. Another likely point of dispute is the bill’s limits on provider discretion, especially the prohibition on rejecting or terminating patients solely based on health status and the narrow list of permissible termination reasons. Supporters likely emphasized access, transparency, and flexibility for patients and employers, while opponents likely focused on regulatory oversight, consumer protections, and the risk that subscription care could blur the line between medical services and insurance.