A state task force focused on Massachusetts’ primary care access problems has a bold proposition — demand providers and insurers double what they spend on primary care.
The proposal follows a drumbeat of concern around primary care dating back years. State reports have tracked an increasing number of primary care physicians leaving the field and an anemic pipeline of new providers entering it. Simultaneously, four out of 10 people in Massachusetts in 2023 reported challenges accessing health care in the past year, an increase since 2021.
State officials have sought to stem the tide, with a state law creating a 25-person task force that began work this year, looking at reviewing reimbursement and recruitment within the workforce, and establishing a target for how much insurers should spend on primary care.
After months of meetings, the task force has an initial answer — create a primary care spending target. The goal would be to effectively double what the state spends on primary care, to around 15 percent, within five years. The most recent data show Massachusetts commercial insurers spend 6.7 percent of health care dollars on primary care.
“This recommendation is the first step towards a fundamental rebalancing of what we value in our health care system, putting the health of our residents and the stability of our world-class health care system first,” said David Seltz, executive director of the state’s Health Policy Commission and cochair of the task force. “Establishing a primary care spending target while addressing complementary goals related to workforce and patient care will strengthen primary care in the Commonwealth.”
As it stands, the United States spends only 5 to 7 percent of health care dollars on primary care, woefully below other high-income nations, which spend an average of 14 percent on primary care, the task force said. Specific states have sought to remedy that, with California, Oregon, Rhode Island, and Washington setting benchmarks for primary care spending.
The recommendations are light on details but big on vision. The investment in primary care should not cause a rise in overall health care spending, the task force said.
Additionally, insurers should not increase premiums to pay for the new outlay.
To enforce its wishes, the task force called on the Legislature to pass a bill setting the new spending target and giving it some teeth. That way, the Health Policy Commission and the Division of Insurance could hold payers and providers accountable.
Following the initial five-year period, the proposal suggests the commission should have the ability to set new five-year and annual targets.
Making investments in primary care without raising overall spending would require the money to come from somewhere else. That could mean health care providers and insurers would need to find administrative efficiencies or cut reimbursements to other types of doctors, though the proposal did not go into detail.
The recommendations are among several the task force is expected to make, including proposals to create workforce development plans to increase the supply of clinicians.
This isn’t the first time Massachusetts has sought to increase spending on primary care. In January 2020, then-Governor Charlie Baker called for providers and insurers to effectively double what they spent on primary care and mental health care, to a target of 30 percent over three years, up from around 11 to 15 percent at the time. But the plans fell by the wayside amid the COVID pandemic.
Primary care access has continued to erode since. A January 2025 report detailed that new patients wait for primary care appointments an average of 40 days in Boston, twice as long as the average of 15 other cities studied. Wait times also increased across the state. Patients reported they were increasingly seeking care in emergency departments because they couldn’t get an appointment.
Despite having the highest number of physicians per capita, Massachusetts has the fifth-lowest share of primary care doctors. And the workforce is aging, with an estimated half of primary care physicians over the age of 55, according to the report.
Lora Pellegrini, CEO of the insurer trade group, the Massachusetts Association of Health Plans, said the key is to prioritize investments in primary care without increasing total health care spending.
To accomplish the state task force’s recommendation, health systems would have to be on board, Pellegrini said. Nationally, an analysis of 2022 data showed nearly half of all primary care physicians were affiliated with a hospital.
“It would be very hard for the [insurance] carriers to implement increases in primary spending on their own,” she added. “Hospital systems have been resistant to that.”
At least one health system leader was skeptical of the proposal. Eric Dickson, CEO of UMass Memorial Health and a member of the task force, said he was hoping for more concrete actions from the group, such as establishing a floor for primary care reimbursement from commercial payers.
“Overall this is a step forward, although it’s hard to imagine we could actually double spending in primary care without driving the overall costs of healthcare up,” Dickson said in a statement.
He added that he worried the mandate could reduce investments in innovative care models that have been proven to reduce emergency visits and hospital admissions.
The new spending target drew enthusiastic support from other task force members, who represent a broad swath of health care stakeholders in the state, including Dr. Kiame Mahaniah, Massachusetts secretary of health and human services, the insurance commissioner, and the cochairs of the Joint Committee on Health Care Financing — Senator Cindy Friedman and Representative John Lawn.
Ashley Blackburn, the interim director for the advocacy organization Health Care For All, which is also a task force member, called the recommendation timely and important.
“In the wake of federal health care cuts, fortifying our state’s primary care system has never been more important,” Blackburn said in a statement.
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