Podcast Summary:

In this episode of DPC Pediatricians, Dr. Phil Boucher and Dr. Marina Capella respond to recent legislation — the “One Big Beautiful Bill” — which is projected to strip 12–17 million people, including millions of children, of Medicaid coverage. They explore how Direct Primary Care (DPC) pediatricians can step in to help fill this critical gap.

Key Highlights:

A Massive Loss of Coverage Is ComingRecent federal legislation may result in millions of children losing access to Medicaid. This is expected to lead to downstream effects such as closures or service cuts at children’s hospitals and clinics, many of which rely heavily on Medicaid.

DPC Practices Can Serve the UnderservedDespite the perception that DPC is only for the affluent, both hosts emphasize that DPC pediatricians can and do care for uninsured and lower-income families.

Flat-Fee Visits Increase AccessMany immigrant or lower-income families avoid membership models due to psychological or financial barriers. Offering one-time flat-fee visits allows more flexible access, especially for acute concerns or school physicals.

“When families really need something, they will often find a way to pay for a visit — especially when it’s more affordable and faster than urgent care.”

Sliding Scale Memberships Can Be Life-ChangingBoth doctors offer discounted memberships (up to 50% or more) without requiring income verification. This flexibility enables care for families in tight situations while maintaining sustainability.

Creative, Community-Focused Care Models

* Providing free care to staff families

* Offering VFC vaccines and catching up under-vaccinated children

* Including developmental and speech screenings during other visits

The Idea of a Sponsorship FundDr. Marina shares a potential model: a community sponsorship fund supported by wealthier patients.

* Could be structured via optional membership tiers (e.g., pay extra to help another family)

* Note: These are not tax-deductible unless run through a formal nonprofit

* Personal relationships and transparency are key to getting buy-in from community members

Advocacy as a DPC SuperpowerDPC physicians have more time and flexibility to get involved in advocacy work than many traditional physicians.

* Participating in state chapters of the AAP or medical associations allows you to testify, vote, and influence policy

* Both hosts share stories of real-world legislative impact (e.g., protecting mandatory newborn screenings)

“You have more influence than you think. Legislators listen when a pediatrician speaks.”

A Hidden Win in the New Law: HSA EligibilityThe new bill also contains a small but helpful clarification: DPC is not health insurance, and up to $150 per member can be paid with HSA funds — a positive step for patients trying to use pre-tax dollars for care.

Takeaway Message:

Although millions may soon lose Medicaid, DPC pediatricians are uniquely positioned to help — by offering flexible access models, sliding scale memberships, advocacy, and community-driven solutions. With time, creativity, and a heart for service, DPC can bridge gaps in a changing healthcare landscape.

Special Announcement:Registration is now open for the first-everDirect Pediatric Care Virtual Summit – Fall 2025Free to attend at: dpcpediatrician.com/summitContent for every stage: curious, launching, growing, or thriving

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