Why It Matters
Massachusetts is grappling with a primary care shortage that has left patients waiting months for appointments and forced specialists to fill gaps that primary care physicians traditionally covered. A coalition of doctors from across medical specialties is now backing state legislation that would more than double the share of health spending devoted to primary care — a shift supporters say could ease pressure on the broader health system.
What Happened
Physicians including a cardiologist, gastroenterologist, ear, nose, and throat surgeon, and a family physician have united in support of legislation currently under debate on Beacon Hill. The Massachusetts State Senate has already passed the measure, which aims to address what advocates describe as chronic underinvestment in primary care across the state.
The bill would require that primary care receive at least 15 percent of overall health care spending in Massachusetts — more than double the current level. Importantly, the legislation mandates that the increase carry no net impact on overall health care costs, insurance premiums, or patient cost-sharing, a provision designed to neutralize opposition from insurers and employers concerned about rising costs.
The unusual breadth of physician support — spanning both primary care and specialty medicine — reflects growing recognition that the shortage of primary care access is disrupting the entire care system. When patients cannot get timely primary care appointments, specialists end up managing chronic conditions and routine concerns that fall outside their traditional role, while primary care clinicians are stretched to address issues that would normally require specialist input.
By the Numbers
Primary care currently accounts for less than 7 percent of health spending in Massachusetts, well below the 15 percent floor the legislation would establish. The gap between those figures illustrates the structural underinvestment physicians say has accumulated over decades.
A 2023 survey by the state’s Center for Health Information Analysis found that 41 percent of Massachusetts residents reported difficulty accessing health care — with the inability to secure a primary care appointment cited as the leading reason.
The workforce pipeline is also a concern. Fewer medical school graduates are choosing primary care careers, and a growing number of practicing physicians are either leaving independent practice or reducing their clinical hours, further thinning the available supply.
Zoom Out
Massachusetts is not alone in confronting this dynamic. Across the country, health systems have struggled with maldistribution of health spending that rewards procedural specialty care over longitudinal primary care relationships. Several states have explored funding mandates or payment reform as levers to rebalance incentives, but few have advanced legislation as specific as the Massachusetts approach, which sets a hard spending floor rather than relying on voluntary payer commitments.
The federal government has also acknowledged the primary care gap, with various Medicare payment advisory bodies recommending higher relative payment for evaluation and management services. But federal reform has moved slowly, leaving states to experiment independently.
The Massachusetts debate comes as the state legislature is managing several major health and fiscal decisions simultaneously. Lawmakers recently finalized a $63.4 billion state budget that moved through without vetoes, underscoring both the scale of state government operations and the fiscal environment in which any new health spending mandates would operate.
What’s Next
With the Senate having already passed its version of the legislation, attention shifts to the House and any conference process needed to reconcile differences. Supporters hope the bipartisan appeal of reducing patient wait times and stabilizing the physician workforce can carry the bill through the remaining legislative steps before the session concludes.
Whether the “no net cost” requirement embedded in the bill is achievable in practice will likely be a central point of scrutiny. Payers and insurers will need to redirect existing spending rather than simply increase total outlays — a structural challenge that could complicate implementation even if the bill is enacted.
Primary care advocates argue the status quo is already imposing hidden costs on the system through avoidable emergency room visits, delayed diagnoses, and the administrative burden placed on clinicians navigating an underfunded practice environment. The coalition of specialty physicians backing the legislation makes a similar argument: that stronger primary care infrastructure ultimately produces better outcomes for patients who eventually need specialty services.