INSIDE THE ISSUE

> Warren Gets Tough on Healthcare Abuse
> 340B Rebate Pilot Again?
> People Dislike Prior Auths
> Report on PFACs
> MHQP on Disparities

MONDAY REPORT

Senator Warren Focuses on Healthcare

The commonwealth’s senior U.S. Senator, Elizabeth Warren (D), has recently re-focused her attention on healthcare, introducing bills to limit vertically integrated healthcare entities, and to monitor and potentially penalize private equity investments in the sector. She also led a Congressional effort to focus attention on how recent Immigration and Customs Enforcement (ICE) actions may adversely affect children’s health.

Warren joined with Sen. Josh Hawley, the Republican from Missouri, to introduce the Break Up Big Medicine Act, which would prohibit pharmacy benefit managers, insurers, and prescription drug or medical device wholesalers from being under common ownership with certain medical service providers.

In recent years, attention has focused on how certain companies control various aspects of the healthcare supply chain. CVS, for one example, controls a large portion of the nation’s drug business through its pharmacy benefit management (PBM) arm Caremark, while also operating walk-in clinics as well as the large health insurance company Aetna. CVS says the integration leads to efficiencies; critics say the conglomerates are only efficient at increasing their profits.

“The largest insurance conglomerates are also some of the largest employers of physicians in the country,” according to a fact sheet Warren released. “The three largest PBMs—middlemen between insurance companies and pharmacies—manage 80% of prescription drug claims, and are each owned by a company that also owns a health insurance company and a pharmacy chain. At the same time, just three prescription drug wholesalers control 98% of U.S. drug distribution, and have been busy acquiring companies that purchase and prescribe prescription drugs like specialty medical practices.”

“In their quest to put profits over people, Big Pharma and the insurance companies continue to gobble up every independent healthcare provider and pharmacy they can find,” Hawley said.

Corporate Crimes Against Healthcare Act of 2026

Also last week, Warren joined her Massachusetts colleague in the Senate, Ed Markey (D), and others to introduce the Corporate Crimes Against Healthcare Act of 2026, which would hold investors – specifically private equity investors – accountable if their actions cause the financial downfall of healthcare entities. The legislation was spurred by the example of Steward Health Care, which resulted in the hospitals it owned being saddled with enormous rent payments to the entity that owned the land the hospitals were on; that and other factors ultimately drove the system into bankruptcy. Warren’s Corporate Crimes act establishes criminal penalties for “executives who loot healthcare entities” and provides state attorneys general with the power to claw back compensation from investor executives.

“Private equity companies routinely saddle companies they acquire with massive debt, sell off valuable assets, and extract exorbitant dividends and fees,” Warren wrote in a fact sheet accompanying the bill. “Unfortunately, lax corporate accountability and transparency laws have provided cover for private equity’s parasitic practices, allowing insiders to plunder hospitals, nursing homes, provider practices, and other healthcare entities with impunity.”

Joining Warren and Markey in introducing the bill were Senators Richard Blumenthal (D-Conn.), Peter Welch (D-Vt.), and Jeff Merkley (D-Ore.), along with Representative Maggie Goodlander (D-N.H.).

“Grave Concerns” About ICE

Warren also took the lead this month in getting 55 Members of Congress to sign a letter to U.S. Health and Human Services Secretary Robert Kennedy expressing their “grave concerns about children’s exposure to increasingly violent ICE and Customs and Border Protection operations and the impacts of that exposure on their health, wellbeing, and long-term development.”

Unlike previous administrations, the Trump White House rescinded ICE’s “sensitive locations policy” that protected schools, places of worship, hospitals, and other sensitive places from ICE raids. “Since then, ICE has carried out raids at schools, day care centers, and even a child’s birthday party,” Warren and 54 of her colleagues wrote. “ICE has adopted more militarized and chaotic arrest tactics, including smashing car windows and raining glass on drivers and passengers, deploying tear gas in residential neighborhoods and schools, and unleashing ‘attack dogs.’”

The letter specifically asks Kennedy, given HHS’s role in protecting the health and wellbeing of children, to answer specific questions relating to how ICE’s actions may have affected children’s mental health and development. Among those signing the letter, were Massachusetts Representatives Stephen Lynch and Seth Moulton, both Democrats.

At the end of January, Governor Healey announced legislation to limit the ability of ICE to conduct enforcement actions in “protected areas,” including hospitals, courthouses, schools, childcare programs, and churches. She also signed an executive order limiting agreements that would allow state and local agencies to act as immigration enforcement agents. Her order prohibits civil arrests by federal immigration officers in non-public areas of state facilities, except when authorized by a judicial warrant or judicial order, and prohibits certain state facilities from being used as ICE staging or processing areas.

HRSA May Be Ready to Restart 340B Rebate Pilot Rulemaking

On Tuesday, February 3, the U.S. House of Representatives passed a package containing five of six remaining appropriations bills, iLast Monday, February 9, the Health Resources and Services Administration (HRSA) submitted a pre-rulemaking notice regarding its 340B Rebate Model Pilot Program to the White House Office of Management and Budget for review.

The action shortly followed the administration dropping its defense of a lawsuit from the American Hospital Association and others preventing the pilot program from going into effect on January 1, 2026. That lawsuit claimed that the administration had not gone through appropriate notice and comment procedures prior to implementation of the model.

Last Monday’s notice indicates that the administration likely intends to restart the rulemaking process for the pilot program, including a new notice and comment period. It is unclear whether the program details will change from what was previously proposed.

What Irks Patients the Most? Prior Auths

During a week in January, the non-partisan research and polling group KFF asked about 1,400 adults – both English and Spanish speakers, Democrats and Republicans, including self-identified MAGA and MAHA supporters – about the greatest challenges they face aside from costs in the healthcare system, and the respondents cited “prior authorization” as their top problem by a wide margin.

Prior auth frustration outpolled patients’ difficulty in understanding their insurance bills, getting appointments when they need them, or finding providers who accept their insurance. About 70% of insured adults say prior authorizations are a burden and a third of that group called it a “major” burden.

“The complexity of the health system drives patients crazy, can have real consequences, and disproportionately affects people who are sick,” KFF President and CEO Drew Altman said. “Prior authorization review is the poster child for that complexity.”

Nearly half of insured adults also say they have experienced their health insurance company “denying care, delaying care, or requiring them to try alternatives.”

In Massachusetts there is a recognition that prior authorizations are a problem. Last month, Governor Maura Healey announced that the Division of Insurance (DOI) will issue regulations to eliminate prior authorization requirements imposed by fully funded commercial carriers under the DOI’s jurisdiction for many services, including emergency and urgent care, primary care, certain chronic conditions and their associated prescription drugs, occupational and physical therapy, substance use disorder treatment, post-acute care services provided on weekends and holidays, and certain prescription drugs. For many years, MHA, the Massachusetts Medical Society, and Health Care For All have supported legislation that would bring additional, commonsense reforms to the prior authorization process.

A new affordability working group the governor created is exploring other ways to lower healthcare costs and reduce patient frustrations.

Patient & Family Councils Are Key Elements of Health System

In Massachusetts since 2008, all acute and post-acute care hospitals have been mandated to establish Patient and Family Advisory Councils (PFACs), which by law are required to report their activities annually to the Department of Public Health.

In 2024, the Betsy Lehman Center took over the task from Health Care For All of publishing annual reports on the PFACs and providing them with technical support.

Last week, the Betsy Lehman Center released its first annual report on the PFACs, capping a year in which the center introduced educational forums, coaching and technical assistance, networking opportunities, and more robust data collection and feedback. The report highlights successful collaborations between the councils and hospital administration in the past year, including improving an emergency department layout, billing practices, and patient rounding.

“Massachusetts hospitals place patients and families at the center of everything they do, and nothing embodies that mission more than the work of their dedicated PFACs,” said Patricia Noga, R.N., MHA’s vice president of clinical affairs. “It has been gratifying to see the role of PFACs grow over the years, along with a myriad of PFAC accomplishments that help steer decisions that improve the healthcare experience for countless of our friends and neighbors across communities in the state.” Noga applauded the leadership of the Betsy Lehman Center as well as the PFAC volunteers whose experiences “help our system advance patient-centered care with their contributions, compassion, and creativity.”

MHQP Survey Finds Disparities in Screening and Self-Management

Behavioral health screenings and self-management support (that is, the actions of a provider’s office in screening their patients for depression and helping them manage their health) are improving across the state – but not for everyone.

That’s one of the conclusions from MHQP’s 2025 statewide Patient Experience Survey. The screenings and support have consistently ranked among the lowest-scoring elements of the survey, MHQP says, although the overall number has improved over the past three years – but only among White individuals; Black and Asian patients in 2025 experienced a drop in behavioral health screenings and self-management support from the previous year. The 2025 results were collected from patients of 4,037 primary care clinicians at 583 practices across the state. MHQP’s consumer-facing website is at Healthcare Compass MA.

MHA hospitals have been leaders in attempting to draw attention to the need for incorporating mental healthcare into primary care at a time when there is a shortage of mental health specialists.

For example, Cambridge Health Alliance’s Primary Care Behavioral Health Integration (PCBHI) and Child and Adolescent Mental Health Integration (CAMHI) programs work together with teams and providers in primary care to offer a variety of services at primary care sites for behavioral health concerns, including depression, anxiety, ADHD, alcohol and substance use disorders, and chronic pain. Some of CHA’s tailored services focus specifically on screenings and self-management tools.

And Boston Medical Center last fall published a study in JAMA Network Open that showed how children receiving behavioral health services through BMC’s TEAM UP model (Transforming and Expanding Access to Mental Health Care Universally in Pediatrics) have fewer behavioral health symptoms.

In addition, some pending bills at the State House focus on supporting and funding behavioral health collaborative care models. These include H.2220/S.1390, An Act Relative to Access to Psychiatric Collaborative Care, sponsored by Rep. Kathleen LaNatra (D-Kingston) and Rep. Julian Cyr (D-Provincetown).

John LoDico, Editor