But many DPC supporters are assuming that the House DPC provision is not returning.

The change: Federal regulations now keep owners of health saving accounts from using HSA cash to pay DPC costs.

The House tax package would let HSA owners spend up to $150 per month on DPC costs for an individual membership and up to $300 per month for a family membership.

Republicans in Congress have not talked publicly about why Senate committees have left out the HSA provision or whether there's a possibility the provision could reappear.

Direct primary care basics: A typical direct primary care practice provides comprehensive preventive and routine care, including checkups and ordinary sick care, in exchange for membership payments.

From the physician's point of view, a DPC arrangement provides a way to make providing everyday health care simpler, more flexible and, potentially, more profitable.

Some employers may worry whether DPC practices will make good on their promises and whether health plan participant use of the practices will limit plans' ability to encourage use of valuable care, prevent use of potentially harmful care and detect major problems, such as big influenza outbreaks, earlier.

But employers who like the plans see them as a way to save money while improving patients' access to routine care.

The politics: The direct primary care movement has been popular in Washington.

One House direct primary care bill introduced in February by Rep. Lloyd Smucker, R-Pa., has three Democratic cosponsors as well as five Republican cosponsors.

The DPC movement has been especially popular with some of the physicians who serve in Congress, such as Rep. Robert Onder, R-Mo., who is one of the Smucker bill cosponsors.

Republican leaders in Congress hope to finish work on a big budget and tax bill by July 4.

Congress could pass a DPC bill through some other channel, but, because Republican leaders are making passing the tax bill such a high priority, any provisions included in that package appear to have a much higher probability of becoming law than an ordinary bill.\

DPC supporter reactions: Dr. Shawn Martin, the chief executive officer of the American Academy of Family Physicians, mentioned the omission in a commentary posted on LinkedIn.

The missing HSA provision is a "popular primary care innovation that would potentially increase access to affordable care for millions of patients through direct primary care," Martin wrote.

Martin also expressed concerns about Medicaid funding provisions, Medicare pay provisions and other provisions in the Senate Finance draft.

Dr. Shane Purcell, a family physician who helps run a DPC practice in South Carolina, posted, "Primary care dumped on again" on X.

Congressional Republican efforts to pass a big budget and tax bill may run into a new obstacle: frustration from the physicians who own and run direct primary care practices.

"The cavalry ain't coming," Purcell wrote. "We go alone. Opt out. Drop insurance. Direct pay."