Bay Staters scrambling to book an appointment with a primary care physician may eventually see relief under a sprawling bill the House passed Thursday night to significantly boost investment in the sector.
House Speaker Ron Mariano previously scoffed at the Senate’s primary care bill (S 3141), saying senators passed their version last month “without any idea of how much it was going to cost.” But the House bill (H 5618), which passed on a 158-0 vote just before 10 p.m., ultimately incorporates the two major hallmarks of the Senate approach: setting an aggregate primary care spending target and embracing a new payment model that moves away from the typical fee-for-service structure.
The House envisions the state gradually spending 15% of all healthcare dollars on primary care by 2036, while the Senate wants to reach that percentage much sooner, by 2030. Currently, just 6.6% of total commercial healthcare expenditures flow toward primary care, according to a dashboard from the Center for Health Information and Analysis.
“The bill before us aims to address this problem. It does so incrementally, increasing the expenditures to 9% in 2030, 12% in 2033 and 15% ultimately in 2036,” Rep. Greg Schwartz, a primary care physician, said during his inaugural speech on the House floor Thursday night.
“That’s a gradual increase over 10 years,” the Newton Democrat continued. “It’s a significant increase in the primary care portion, but still a relatively small proportion compared to the whole. And it’s done at a pace, under this bill, that gives our provider networks and insurance payers enough time to adjust their contracts with guidance from the state to achieve these goals smoothly.”
The House bill features only an aggregate primary care spending goal. The Senate also wants individual healthcare entities to reach the target. Mariano, asked how he became comfortable with the House’s approach to primary care reform, pointed to the longer glide path for reaching the target and said the bill differentiates between safety net hospitals and teaching hospitals.
“We make allowances for the different situations that different hospitals are in — some are financially a little bit better off than others, so they can pay to increase the public health outreach that other hospitals can’t afford to do,” Mariano told reporters after a private Democrat caucus earlier Thursday. “So we make it fairer. We put some options in there that we will count for participation and increasing in public participation that aren’t financial, like hiring an extra nurse to keep your health center open another couple hours.”
The House bill outlines a process for the Health Policy Commission to require so-called primary care commitments from healthcare entities that are exceeding the state’s cost growth benchmark. Exempt from those commitments are physician contracting units with patient panels at 15,000 or fewer or units that represent providers earning less than $25 million in annual net patient service revenue.
CHIA would be tasked with reviewing healthcare entities’ investments in primary care. CHIA would take into account whether the entity serves a “disproportionate share” of patients on public insurance and whether its “limited capacity” to boost investment in primary care is due to the entity’s payer mix, financial condition or the acuity of the population it treats.
Democratic Rep. John Lawn, co-chair of the Health Care Financing Committee, did not deliver opening floor remarks or join Mariano at the post-caucus scrum. A Mariano spokesperson did not answer a News Service question about why Lawn did not speak.
Instead, Republican Rep. Hannah Kane of Shrewsbury offered a synopsis of the legislation that’s expected to save money in the long run by reducing avoidable emergency department visits as patients gain expanded access to preventive care. The bill also requires that commercial insurers reimburse community health centers at the same rate as MassHealth, mandates coverage of mobile integrated health services, creates an accelerated Determination of Need process for certain community hospital projects, regulates the use of AI in insurance utilization reviews, calls for most manufacturer rebates for prescription drugs to be applied at the pharmacy counter, and boosts oversight of pharmacy benefit managers.
Mariano stood at the rostrum for the adoption of two amendments just before 3 p.m., one of which was a Lawn amendment (#110) that would enable civil actions alleging a defendant sexually abused a minor to commence “at any time after the acts alleged to have caused an injury or condition occurred.” Lawn in May wrote an op-ed in the Boston Globe supporting legislation that would eliminate the statute of limitations for child sexual abuse and reflecting on his own experience as a survivor.
There was limited floor discussion of the bill, with the House only kicking into full gear on the primary care bill after 9 p.m. Through private discussions, House leaders ended up combining more than 100 amendments into “Consolidated Amendment A.”
Within that mega-amendment, the House adopted policies dealing with biomarker testing and vaccines. Commercial insurers, as well as the Group Insurance Commission and MassHealth, would be required to cover biomarker testing, according to Mariano’s office. Oncology providers can use biomarker testing to determine more precise treatments for patients and avoid broader regimens such as chemotherapy and radiation.
The amendment updates the responsibilities of the Massachusetts Vaccine Program Advisory Council, which makes recommendations on the types of routine pediatric vaccines the state should buy as part of a universal purchasing program.
Echoing a House-backed budget policy rider, the amendment also installs a “provider immunization brand choice” requirement within the purchasing program, enabling participating healthcare providers to select any brand or type of vaccine that’s federally vetted and recommended by the CDC or national professional medical societies.
In an effort to tamp down on “pharmacy deserts,” the House adopted a Rep. Christopher Worrell amendment that requires the HPC to conduct an assessment at least every five years about the supply, distribution and capacity of pharmacy and pharmacological services. The analysis would identify the number of existing and potential pharmacy deserts, defined as the nearest pharmacy located more than two miles away in urban areas, more than five miles away in suburban areas and more than 15 miles away in rural areas. Pharmacies that plan to shutter would need to provide at least 60 days’ notice to the Board of Registration in Pharmacy, which would review whether the closure is likely to lead to a pharmacy desert.
The House and Senate must appoint negotiators Friday to reconcile the policy differences across their primary care packages.
Alison Kuznitz is a reporter for State House News Service and State Affairs Pro Massachusetts. Reach her at akuznitz@stateaffairs.com.
