What the H.R. 1 Bill Means for Primary Care and Employer Health Benefits

Healthcare legislation can be hard to follow, but the H.R. 1 bill that passed earlier this year includes a variety of changes, especially for primary care access and employer-sponsored health benefits.

If you’re in human resources, a benefits broker, or someone trying to understand what this means for your team, it’s worth taking a closer look.

This article breaks down what the H.R. 1 bill does for the healthcare industry, how it impacts primary care and HSA-eligible expenses, and what it could mean for the future of benefit design.

What Is the H.R. 1 Bill?

The H.R.1 bill is new legislation that includes provisions regarding how people can use Health Savings Accounts (HSAs) and structure employer-sponsored health plans. One of the most important changes is in Section 71308, which reclassifies certain primary care fees (including direct primary care memberships) as HSA-eligible expenses.

In plain terms, starting January 1, 2026, people will be able to use their pre-tax HSA dollars to pay for monthly primary care membership fees. The bill sets monthly limits ($150 for individuals, $300 for families), but this still opens the door to more flexible care options.

For years, there’s been confusion around whether these types of primary care models were compatible with HSAs. That uncertainty made both patients and employers hesitant. H.R. 1 removes that roadblock and allows for more modern approaches to care delivery and benefit design.

What Does This Mean for Primary Care Practices and Patients?

Some provisions in H.R. 1  introduce a meaningful shift in how people can access and afford primary care. Starting in 2026, patients will be able to use pre-tax HSA dollars to pay for their primary care memberships (including direct primary care), making these models more accessible.

For direct primary care practices, this brings long-awaited clarity. They can now confidently tell patients that their membership fees are HSA-eligible, removing a major barrier that kept some people from giving this model a try.

For someone paying out of pocket for their direct primary care  membership today, being able to use HSA dollars in 2026 could make all the difference. It means the care they already love becomes even more affordable.

But this isn’t just about direct primary care. Other provisions in the bill  allows for a wider range of primary care models, especially those focused on simplicity, access, and relationship-based care. When there’s less financial friction, providers can spend more time caring for patients and less time navigating insurance hurdles.

The regulatory clarity also matters. Many clinics and virtual-first providers have been hesitant to expand without a solid legal foundation. Now, they have one. 

The Employer Angle: Why Some H.R. 1 Provisions Impact  Benefit Design

For those designing benefits packages, H.R. 1 opens up some new possibilities. Human Resource teams and benefits brokers can now combine primary care memberships with high-deductible health plans (HDHP) in ways that weren’t clearly allowed before.

This means employers can offer more pathways to care without being limited by traditional insurance networks. Employees get consistent, relationship-based care. Employers get more predictable costs.

This kind of benefit design also helps lower claims risk. When people have easier access to primary care, they’re more likely to catch small issues early, before they turn into larger (often more expensive) ones.

Beyond avoiding worsening conditions and emergency room visits, primary care plays a key role in managing chronic conditions like diabetes, high blood pressure, and asthma. With regular support, these conditions are often better controlled, which leads to fewer hospitalizations and lower long-term costs.

In fact, a study by Milliman found that patients enrolled in direct primary care models used fewer high-cost services and had lower overall healthcare spending compared to those in traditional PPO plans. It’s one more reason direct primary care can be a smart, sustainable option for employers.

An example might be:

A mid-sized company adds a primary care membership to their high-deductible plan. Employees now have HSA-compatible access to care without visit fees, and because it’s convenient and affordable, they’re actually using it. From mental health check-ins to chronic condition support, care is easier to get. After six months, employee satisfaction is up, and claims are trending down.

For benefits brokers, this is an opportunity to bring clients something different. Instead of just re-shopping plans each year, brokers can introduce more flexible, innovative care models that align with H.R. 1’s intent. That’s a conversation worth having with employers who want better outcomes and more control over healthcare costs.

What About Virtual Visits and Deductibles?

There’s another component of H.R. 1 that hasn’t gotten much attention and could still have a significant impact on virtual care delivery. Section 71306 reinstates the telehealth safe harbor for high-deductible health plans (HDHPs).

During the pandemic, the CARES Act allowed HDHPs to cover virtual visits before patients met their deductible. That provision expired in 2024, but H.R. 1 brings it back permanently and makes it retroactive to January 1, 2025.

This means employers can offer first-dollar coverage (virtual visits can be covered before the deductible is met) while maintaining HSA eligibility. Employees don’t have to pay out of pocket or meet their deductible before accessing telehealth services.

This supports virtual-first care models that can eliminate visit fees while keeping plans HSA-compatible. It means earlier access, better health outcomes, and lower overall claims costs. Employers still have the option to include or exclude visit fees based on what works best for their plan design.

What About Virtual or Hybrid Care Models?

H.R. 1 was written with direct primary care in mind, but it’s part of a broader shift toward more flexible ways of delivering care. Virtual-first and hybrid models that share direct primary care’s values (access, simplicity, and predictable costs) are part of that movement.

Companies like Nice Healthcare represent this kind of innovation in action. While not a traditional direct primary care model, Nice shares many of the same goals: making primary care more accessible, removing barriers, and helping people get care without surprise costs.

Virtual-first care means people can get help when and where they need it, without network restrictions or extra fees. These models reflect the intent behind H.R. 1, even if they don’t meet the exact definition of direct primary care.

Early evidence supports that approach. A recent JAMA study found that primary care practices using more telehealth had lower rates of low-value services (like unnecessary imaging or antibiotics) compared to those relying more heavily on in-person visits. It’s a strong signal that virtual-first care can support better outcomes, not just faster access.

Ultimately, these provisions help clear the way for care models that prioritize people and provide flexible solutions. When policies reduce friction, innovative care models can truly work better for patients, providers, and employers.

Final Take: Policy Is Catching Up With Demand

These new legislative changes are a step toward giving people more options, better access, and care that fits their lives. It’s a meaningful step forward for primary care innovation. Employers can design benefits that support their teams, and there are fewer regulatory hurdles that have stifled new care approaches. Patients get easier access to care, and employers have more tools for building better benefit plans. Now, innovative care models can be more widely available.

If you’re an employer exploring new ways to support your team’s health, this is the time to start those conversations. The regulatory landscape is shifting, and more options are available.

Want to learn more about modern care models and how employers are adapting?

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FAQ

What is the H.R. 1 Bill and how does it impact primary care?

H.R. 1 is new legislation affecting a broad variety of industries and initiatives. The bill includes provisions that allow people to use HSA funds to pay for primary care memberships – including direct primary care . 

Can patients use HSA funds for primary care?

Yes. Starting in 2026, employers can offer HSA-compatible plans that include primary care memberships. There are monthly limits ($150 for individuals, $300 for families), but the path is now clear.

Is primary care now tax-deductible under H.R. 1?

Yes. Primary care membership fees are now classified as qualified medical expenses. That means they can be paid for with pre-tax HSA dollars, as long as they fall within the monthly limits.

What does the H.R. 1 Bill mean for healthcare costs?

It removes restrictions on lower-cost care models like direct primary  and virtual-first care. This can help reduce emergency visits, reduce costs related to chronic conditions, and decrease long-term healthcare costs.

Can virtual visits be covered before meeting a deductible?

Yes. H.R. 1 brings back the “telehealth safe harbor” for high-deductible health plans (HDHPs). That means virtual visits can now be covered before someone meets their deductible. Employers can choose whether or not to apply visit fees.

When does H.R. 1 take effect?

The telehealth safe harbor is already active, retroactive to January 1, 2025. The HSA eligibility for primary care memberships starts January 1, 2026.