Massachusetts faces an onslaught of challenges to our health care system. Far too many of these challenges stem from drastic federal policy changes that will directly impact health coverage, care and financing over the next several years.
But while many of these changes are beyond the state’s control, one longstanding challenge that the state can move forward on is access to primary care.
Now is the time to act.
Despite our world class health care system, access to primary care is lagging. Out of 15 U.S. metropolitan areas surveyed in 2025, Boston had the longest wait times for a new patient appointment for a physical. A staggering one in three Massachusetts residents report difficulty accessing primary care.
And access issues are only getting worse. People are even less likely to have a primary care visit if they live in a zip code with a higher share of lower income residents or people of color. The data also shows the availability of primary care varies significantly across different areas of the state.
This data echoes what Health Care For All has heard for years on its statewide consumer HelpLine. Ana told her HelpLine counselor that she struggled with postpartum depression but couldn’t find a primary care provider or therapist in her area. Without this support, her mental health deteriorated until she ended up in the emergency room. Another caller’s diabetes went untreated because she couldn’t find a provider and she suffered devastating complications, including vision loss and organ damage. Beyond being personally devastating for patients and their families, such outcomes cost all of us more than effective preventive care ever would.
All of this sobering data comes despite studies showing that greater investment in primary care improves health outcomes and patient satisfaction while reducing hospitalizations, emergency room visits and the total cost of care.
These challenges are not insurmountable. There are existing policy and financing levers we can pull to address underinvestment in primary care. For example, other states, including Rhode Island, Colorado and Oregon, have successfully implemented primary care spending targets.
However, simply increasing spending on primary care will only move the needle so far. It will take a multipronged approach that makes a meaningful difference in people’s lives. We also must change the way we pay for primary care. Here, we can look at a homegrown model – MassHealth’s primary care sub-capitation program – shifting payment away from typical fee-for-service toward monthly payments that support team-based integrated care. We need to reduce barriers for patients and administrative burden for primary care providers. We also need to build the workforce through community-based training and residency programs. The Primary Care Task Force and the state Legislature have put forth proposals that do just this.
Changing the incentives in the health care system towards primary and preventive care requires a delicate balance between increasing spending on primary care without increasing the overall total cost of health care.
Savings from better access to primary care will happen over time, and it will be challenging to identify cost savings in other areas of the health care system in the short term. However, policymakers, health care leaders and advocates have proved time and again that we are up to the challenge.
Primary care is the foundation of a high-performing health system, providing accessible, comprehensive, and continuous care that improves health outcomes, advances equity, and lowers costs. The benefits of primary care reform for both patients and providers far outweigh the cost. As our health care system faces mounting pressures due to federal actions, it has never been more important to strengthen the foundation of this system – primary care.
Suzanne Curry is Director of Policy Initiatives at Health Care For All and a Member of the Primary Care Access, Delivery, and Payment Task Force.
