Access to primary care remains a significant challenge for many residents in Massachusetts, according to a recent report from the Center for Health Information and Analysis (CHIA). The report found that in 2025, 30.1 percent of Massachusetts residents experienced difficulty obtaining primary care services within the past year, with approximately 10 percent lacking a primary care physician altogether. Additionally, 25 percent of residents had not received any preventive care visits during the previous year.

In response to the ongoing issue, Massachusetts Senate leaders have introduced a legislative proposal aimed at improving access to primary care. The bill, scheduled for a vote this Thursday, incorporates several strategies to address the shortage and quality of primary care services across the state.

One of the key provisions in the bill is increasing the share of health care spending directed toward primary care. CHIA data indicates that in 2024, only 6.6 percent of commercial health insurance spending and 8.4 percent of MassHealth expenditures were allocated to primary care. Experts warn that insufficient compensation for primary care providers can discourage physicians from entering or remaining in the field, exacerbating shortages. This dynamic often pushes patients to seek care in more costly settings such as emergency departments.

Comparatively, the United States allocates a smaller portion of health care dollars to primary care than other high-income countries, with just 4.7 percent spent in 2021 versus an average of 14 percent internationally. Several states, including California, Oregon, and Rhode Island, have set targets to increase primary care spending. The Massachusetts Health Policy Commission’s Primary Care Task Force has recommended that the state aim to allocate 15 percent of health care spending toward primary care by 2031 or to double current spending levels—whichever is higher.

Under the Senate bill, the target spending goal would start at 9 percent and rise to 15 percent over three years. The Health Policy Commission would oversee enforcement by requiring providers and insurers who fail to meet the targets to implement performance improvement plans and potentially face fines. However, the legislation acknowledges the financial challenges providers face, particularly hospitals grappling with federal policy changes, emphasizing the need for careful monitoring to ensure spending shifts do not increase overall health care costs.

Another important aspect of the bill calls for moving away from the traditional fee-for-service insurance model toward payment structures that provide a fixed amount per patient for a range of services. Such models aim to reduce the administrative burden of billing and encourage more efficient care delivery. For instance, under fee-for-service, providers may be incentivized to schedule unnecessary office visits because phone consultations are not reimbursed. The task force has proposed a per-member per-month payment adjusted by patient risk, with additional funds for enhanced services like after-hours care and positive health outcomes. Developing a unified payment model across insurance plans and providers will require collaboration among state regulators and industry stakeholders, though MassHealth has already begun exploring this approach.

Lastly, the bill advocates using Massachusetts Medicaid funds to support medical residencies in primary care. Massachusetts is currently one of only seven states that do not allocate state Medicaid dollars for this purpose. Investing in residency programs would not only attract additional federal funding but would also enable the state to focus training efforts on high-need areas and specialties, particularly primary care at community health centers.

As the state confronts challenges including physician burnout and financial constraints within primary care, legislators hope that these measures will help expand access and improve quality of care. However, successfully implementing these changes will require coordinated effort and significant policy innovation.