The Direct Primary Care Subsidy Play: Why Cuban’s HSA Idea Actually Makes Sense (Even If Nobody Wants To Admit It)

DISCLAIMER: The views and opinions expressed in this essay are solely my own and do not reflect the views, opinions, or positions of my employer, Datavant, or any of its affiliates.

---

If you are interested in joining my generalist healthcare angel syndicate, reach out to trey@onhealthcare.tech or send me a DM. Accredited investors only.

ABSTRACT

Mark Cuban recently floated an unconventional approach to ACA premium subsidies: redirect $100 per month into HSAs specifically earmarked for Direct Primary Care subscriptions, with remaining subsidies applied to premiums as originally intended. This proposal addresses a fundamental market failure where the existing subsidy structure inadvertently incentivizes high-deductible plans that create access barriers to primary care, the very services most likely to prevent expensive downstream utilization. The DPC model, which operates on a monthly subscription basis outside traditional insurance structures, has demonstrated potential to improve access, reduce administrative burden, and lower overall system costs through better preventive care and care coordination. However, implementation faces significant challenges including DPC provider availability across markets, regulatory complexity around HSA eligible expenses, political feasibility of subsidy restructuring, and the risk of unintended market distortions. For health tech investors, this concept illuminates several investment themes: the continued unbundling of primary care from traditional insurance, the infrastructure needed to support alternative payment models at scale, the technology requirements for managing hybrid insurance-DPC arrangements, and the consumer engagement challenges inherent in changing healthcare purchasing behavior. While Cuban’s specific proposal may never reach implementation, the underlying dynamics it addresses represent genuine market opportunities for companies building toward a post-fee-for-service primary care ecosystem.

TABLE OF CONTENTS

- The Problem Cuban Is Actually Trying To Solve

- Why Direct Primary Care Works (When It Works)

- The HSA Mechanism and Its Constraints

- Market Availability and the Rural Problem

- The Subsidy Economics Nobody Talks About

- Unintended Consequences and Second-Order Effects

- What This Means for Health Tech Investors

- Implementation Realities and Political Feasibility

The Problem Cuban Is Actually Trying To Solve

Mark Cuban’s LinkedIn posts tend to generate strong reactions in healthcare circles, and his latest foray into ACA subsidy reform is no exception. The proposal itself sounds simple enough: take $100 per month from the enhanced premium subsidies currently supporting marketplace plans and redirect it into HSAs that can only be used for Direct Primary Care monthly subscriptions, with the balance of subsidies applied to premiums as originally intended. His logic follows that having DPC should lower plan costs since better primary care access reduces expensive utilization, which should allow premiums to be lowered rather than raised even with reduced subsidy support.