Not because doctors don't exist. Because fewer and fewer people are actually attached to one.
When people can't get a doctor, they use the most expensive room in the building instead:
Average cost of treating a primary-care-treatable condition (UnitedHealth Group, 2019). Roughly two-thirds of ER visits by privately insured people are avoidable, about $32B a year.
Summa Health sold to for-profit HATCo (Oct 2025, $515M). The sale proceeds seed the new Trailhead Community Health Foundation, a health-only funder for Summit County that starts making grants late 2026 to early 2027. A township access program is exactly what conversion foundations exist to fund. First grant cycles favor bold, shovel-ready ideas.
As of Jan 1, 2026, federal law lets HSA holders pay Direct Primary Care membership fees from their HSA (up to $150/mo individual, $300/mo family). A township subsidy now stacks with residents' own tax-advantaged dollars.
Ohio law (ORC 3901.95, since 2019) says Direct Primary Care agreements are not insurance, so a township can buy memberships without becoming a regulated insurer. And Summit County voters just proved they'll fund health by levy: the ADM mental-health levy passed with 57% in Nov 2025.
Cities and counties across the country buy DPC for their employees. Our research found no US community that guarantees it for all residents. The first township that does this gets the model named after it, plus the funders, press, and physician recruits that come with being first.
| Model | What it is | Real-world cost | Fit for Copley |
|---|---|---|---|
| Direct Primary Care (DPC) memberships | Flat monthly fee per person, unlimited primary care, no insurance billing | $80/person/mo Midwest average (2026 survey) | Strong. Phase 1 engine |
| FQHC satellite (AxessPointe) | Community health center site; sliding fee, serves everyone | HRSA New Access Point grants up to $650K/yr; look-alike path open year-round | Strong. Phase 2 partner |
| Recruit-a-doctor (Havana, FL model) | Town provides rent-free office + equipment to attract a physician | Capital only; clinic runs itself | Strong. Phase 2 alternative |
| Free / charitable clinic | Volunteer-driven, uninsured only | Under $250K/yr typical | Partial. Doesn't serve all residents |
| School-based health center | Clinic in schools, hospital/FQHC sponsored | $50–130K startup, $90–210K/yr | Add-on with Copley-Fairlawn schools |
| Mobile health clinic | Van-based primary care/prevention | ~$632K/yr average operating | Costly per patient for a 21-sq-mi township |
Full sourcing in the research appendix (Research-Models.md). Precedents: Union County NC saved a county-reported $1.28M in year one buying DPC for ~2,000 employee lives (later contested, so we cite it as county-reported). Healthy San Francisco guaranteed a medical home to every uninsured resident at ~$280/enrollee/month (2008).
A part-time health navigator + a membership fund. Find every unattached resident, connect the insured ones to practices taking patients, and sponsor Direct Primary Care memberships for those who fall through the cracks, means-tested, starting with 250 residents.
Use the Phase 1 waitlist as proof of demand to recruit care into the township itself: an AxessPointe satellite site, or a DPC practice drawn by township-provided space (the Havana, Florida play: town supplies the building, doctor supplies the practice).
Convert grant-funded pilot into durable funding: Trailhead Foundation multi-year support, a senior-services levy for the senior half of the program (the one levy purpose Ohio townships clearly have), and JEDD revenue. Publish the playbook so other townships copy it.
| 250 DPC memberships × $80 × 12 | $240,000 |
| Navigator (PT, loaded) | $45,000 |
| Outreach + enrollment events | $15,000 |
| Admin/legal/eval | $10,000 |
| Total | $310,000 |
= about $17 per Copley resident per year. The township spends more than that plowing Ridgewood Road.
Decision between paths is made with real Phase 1 data: how many enrolled, who they are, what they need. Either path ends the same way: a doctor's office with a Copley address.
| Risk | Reality | Mitigation |
|---|---|---|
| Legal authority | No Ohio statute squarely authorizes a township-funded resident clinic. Hooks exist (ORC 5705.19 senior services, 505.14, Ch. 513) but nobody's tested them for this. | Summit County Prosecutor opinion before anything goes to trustees. Phase 1 can run entirely on philanthropic dollars through a 501(c)(3) fiscal sponsor if township funds are blocked. |
| "Copley doesn't need it" | Median income is $115K; the township won't qualify as a federal shortage area. | The pitch is attachment and age, not poverty: 1 in 5 residents is 65+, zero practices in-township, and ~1,000 uninsured neighbors the average hides. Verify with ACS S2701 pull before going public. |
| DPC savings claims | Union County's numbers are contested; no randomized trials exist. | We cite claims as reported, we don't promise savings, we promise access. The budget stands on its own without ROI math. |
| Provider recruitment | Primary care physicians are scarce everywhere. | Free space + guaranteed member base + loan repayment eligibility is the strongest recruiting package a small practice can be offered. |
| Grant timing | Trailhead's first cycles are late 2026–early 2027 and will be oversubscribed. | Be in their pipeline before the window opens. That's what this deck is for. |
ACS data pulls, prosecutor opinion request, meetings with trustees, SCPH, and AxessPointe. Form steering group of Copley residents.
LOIs to Trailhead + Akron Community Foundation the week their windows open. Fiscal sponsor secured. Township seed commitment on trustees' agenda.
Navigator hired, DPC partner practices contracted, first 250 members enrolled. Quarterly public scorecard begins.
Phase 1 data in hand, choose Path A (AxessPointe) or Path B (recruited practice). Space committed, provider signed.
Durable funding mix locked. Playbook published for every Ohio township that wants to copy it.