Mass. Senate primary care bill raises financial questions
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Massachusetts state senators plan to vote on a bill seeking to increase primary care access, but questions remain about how it will be funded.
Why it matters: 75% of Massachusetts residents surveyed last year reported having a preventive care appointment in the last 12 months, down from over 81% in 2023.
- Primary care spending accounts for well under 10% of total health care spending in Massachusetts and much of the U.S., lagging behind other developed countries.
Catch up quick: The state Senate unveiled a primary care bill last week that would direct the health care sector to invest at least 15% of total spending on primary care a year, based on recommendations from a state task force.
- The bill calls for all insurers to adopt an alternative payment model typically used by Medicare to streamline health care payments.
- It would require providers to achieve this without raising overall health care spending — a tall order even without considering that hospitals are reporting losses.
By the numbers: Primary care spending in Massachusetts increased overall from $1.8 billion in 2024 to $2 billion last year, but spending on other services outpaced that category, per the state's Center for Health Information and Analysis.
- Commercial insurers dedicated 6.6% of total health care spending on primary care in 2024, the most recent data available.
- MassHealth spent 8.4% of its total spending on primary care.
- Medicare Advantage's share was just 4.2%.
How it works: The bill gives hospitals five years to reach the 15% threshold, imposing improvement plans and ultimately fines for providers that don't meet the new requirements.
- State regulators would charge $500,000 for the first violation and higher penalties for subsequent infractions.
- The bill would also develop a program to help fund residencies and training in primary care, behavioral health and other services in community-based settings.
What they're saying: Sen. Cindy Friedman, the bill's sponsor, said the legislation would reduce spending on billing issues and emergency or specialty services, but it won't be immediate.
Friction point: Hospital leaders and insurers support expanding primary care access, but they warned against creating a "one-size-fits-all" approach as hospitals report losses and face federal funding cuts and staff shortages.
The other side: Lora Pellegrini, CEO of the Massachusetts Association of Health Plans, said new spending requirements should be paired with an "achievable framework for offsetting those costs elsewhere in the system."
- She said the bill doesn't outline a clear path to achieve this without increasing overall spending and that the alternative payment model wouldn't work in the commercial market as it does for Medicare.
What's next: If the Senate approves the bill, it heads to the House.