INSIDE THE ISSUE

> ACA Premium Relief
> MHA’s Budget Suggestions
> Healthcare Decision Making
> MGBHP-Fallon Merger
> Workplace Violence Webinar
> Stuart Altman
> MHA: 90 Years of Partnering for Patients

MONDAY REPORT

ACA Subsidy Extension Uncertain in DC; State Steps in With Relief

Governor Maura Healey announced last Thursday that the state would use $250 million from the Commonwealth Care Trust Fund (CCTF) to assist some Massachusetts residents who have lost enhanced premium tax credits due to the inability of Congress to act on the issue.

The enhanced tax credits, which allow millions of people in the U.S. to pay premiums for health plans under the Affordable Care Act, were provided during the pandemic and have been extended since then. But due to opposition from the Trump administration and Congressional Republicans, the credits ended on January 1. More than 22 million people across the U.S. and about 270,000 in Massachusetts saw their premiums increase – some more than doubling – due to the inaction.

However, last Thursday, 17 Republicans in the House broke ranks and joined Democrats, including the entire Massachusetts delegation, to vote 230-196 in favor of a bill to extend the ACA enhanced premium tax credits (EPTCs) for three years. Despite this progress, the future of the EPTCs remains uncertain. The Senate already voted down a three-year extension in December, and Republicans there as well as the president have voiced opposition to the enhanced credits. However, there are still ongoing Senate efforts to reach a compromise that would potentially include a two-year, retroactive extension of the EPTCs, paired with minimum premium payment requirements and a cap on income eligibility. A draft of this Senate proposal has yet to be released publicly but it is the likelier of the two bills to potentially become law.

Governor Healey last Thursday said Massachusetts could not afford to wait for Congress to act, although she urged it to do so. “President Trump and Congressional Republicans need to do their jobs and extend these federal credits so that people can afford the health insurance that they need,” she said.

The Commonwealth Care Trust Fund that is fueling the state’s new $250 million investment was created in 2006 and is funded by a variety of sources, including revenue from the tobacco tax, surcharges and assessments on employers who don’t offer insurance or meet affordability standards, member premiums, and state general fund contributions. The purpose of the trust fund is to support programs administered by the Health Connector, as well as to support the Health Safety Net program.

Of the 270,000 people in Massachusetts currently enrolled in ConnectorCare – they make below 400% of the federal poverty level – about one-quarter will see no increase in their premiums due to the funding from the CCTF, according to Health Connector Executive Director Audrey Morse Gasteier. The others will experience increases that are far less than what was projected to occur if the state had not stepped in with assistance. However, around 36,000 legally present, non-citizen residents in Massachusetts lost heavily subsidized ConnectorCare Plan Type 1 health coverage starting January 1, due to new federal laws that ended eligibility for some immigrants below the federal poverty level. These people are now eligible for coverage through the Health Safety Net, which faces persistent shortfalls (see story below). Another 27,000 individuals with incomes more than 400% FPL also lost coverage on January 1 due the lack of the EPTC extension.

MHA to Healey Administration: “Viability” of Health System at Risk

The state’s yearly budget writing process has begun with the Healey-Driscoll administration expected to release its so-called “House 1” budget for Fiscal Year 2027 by the end of the month.

In response to that timeline, MHA at the end of December sent Administration & Finance Secretary Matthew Gorzkowicz a comment letter laying out the hospital community’s broad-brush finance and policy recommendations for inclusion in the budget.

“Next year’s state budget comes at a pivotal point in time for the commonwealth as it relates to healthcare coverage and financing,” MHA President & CEO Steve Walsh wrote. “A new 1115 Medicaid waiver will be crafted while the state prepares for the full implications of the One Big Beautiful Bill Act (OBBBA). Hundreds of thousands of residents are expected to lose health coverage, and the viability of healthcare providers and the services they provide will be tested by changes mandated by OBBBA. MHA and the hospital community seek to be effective partners with the administration in addressing the immense challenges confronting MassHealth, the Health Connector, and Health Safety Net programs in FY2027 and beyond.”

The letter stresses the importance of adequately funding the Health Safety Net, especially in light of the fact that 36,000 ConnectorCare members have lost coverage and will now have to rely on the Health Safety Net when seeking care. (Last year, the state passed a law that will transfer money out of the Commonwealth Care Trust Fund to help fund safety net deficits. Part of the CCTF is now being used for premium relief as noted in the story above.) MHA estimates the loss of ConnectorCare coverage for the 36,000 will increase Health Safety Net demand by $60 million in FY2026 and $105 million in FY2027.

Noting that the Commonwealth Care Trust Fund would have been used to support ConnectorCare Plan Type 1 coverage losses, MHA had identified this as potential resource to support the Health Safety Net. State law permits the Commonwealth Care Trust Fund to be used for hospital and community health center expenses covered by the Health Safety Net. It is unclear what funds now remain in Commonwealth Care Trust Fund; MHA has warned that without relief, hospitals alone will be asked to finance the cost of providing care to this population that has traditionally been covered by the state and federal government.

In its budget letter, MHA cites the future healthcare coverage and funding problems stemming from provisions of the OBBBA and writes, “As the administration plans its FY2027 MassHealth budget, it is critical that hospitals not be asked to shoulder any further financial or administrative burdens as they seek to partner with the state in navigating through these OBBBA ramifications.”

MHA also highlighted other items of concern, ranging from a request that the administration ensures reimbursement for hospital-based crisis evaluations to asking that the administration consider policy interventions to limit insurers’ use of prior authorizations. MHA also asks the state to protect hospital access to 340B pharmacy benefits and to explore how to fund alternative transportation models to relieve the burden on EMS providers. MHA also asks the state to create a naloxone trust fund that would allow the state to leverage bulk purchasing power to obtain naloxone for hospitals at a significantly reduced cost.

As Legislature Re-Convenes, One Focus is on “Surrogate Decision-Making”

Hospitals across Massachusetts are continually strained by limited capacity and rising cost pressures that ultimately undermine both efficiency and the accessibility of patient care. One of the key policy proposals MHA is supporting this session to help alleviate these pressures focuses on “surrogate decision-making,” which addresses proxy challenges faced by older adults and individuals with complex medical conditions, who are unable to make care decisions for themselves.

The commonwealth lacks a clear statutory process for appointing a surrogate decision maker; as a result, hospitals are forced to seek court-appointed medical guardians before even routine care decisions can move forward. This process can take weeks, meaning patients may remain hospitalized longer than medically necessary, waiting for approvals rather than receiving timely, appropriate care. The delays place emotional strain on patients and families, contribute to overcrowded inpatient units, and divert clinical and administrative staff away from direct patient care.

Bills, including H.4329/S.1047, An Act Improving Medical Decision Making, offer a tool for addressing this issue by allowing clinicians to identify an appropriate surrogate, which, in turn, enables care teams to make timely decisions that align with the patient’s values and needs. Hospitals would no longer need to rely on the courts for routine care determinations – ultimately reducing the burdens on both the legal and the healthcare systems. The bill does however maintain judicial oversight for sensitive matters and mental health facility transfers, providing a balanced approach that supports hospital operations and ensures patients receive timely and safe treatment.

The Massachusetts Transitions from Acute Care to Post-Acute Care Task Force, on which MHA and hospital representatives served, supported a similar proposal; namely, it called for passage of legislation to establish a default surrogate hierarchy for patients lacking capacity and without an appointed healthcare proxy.

MGB Health Plan and Fallon Plan to Merge

Last Thursday, Mass General Brigham Health Plan announced that it planned to acquire Fallon Health Plan. According to the Center for Health Information and Analysis, as of March 2025, Fallon had 140,313 members and MGB Health Plan had 382,236 members. Fallon’s enrollment has dropped steadily from 2020, while MGB’s membership has grown during that time. Both plans suffered negative operating margins and negative profit margins in the past year.

The two insurers must receive approval from the Division of Insurance to complete the deal. According to a media release from MGB and Falllon, “There will be no immediate changes for members. Both organizations will provide updates as the process advances.”

Feb. 11: Strategies to Combat Workplace Violence in Healthcare

Workplace violence poses a significant public health threat to staff, patients, and the healthcare system. During this Betsy Lehman Center webinar on Wednesday, February 11 from noon to 1 p.m., Tyler Michaud, workplace violence prevention program manager at Lowell General Hospital, will provide forward-thinking strategies to mitigate the risk of workplace violence through leadership evolution, interdepartmental collaboration, training, program enhancement, and staff support. This free webinar is presented as part of the center’s Peer Support Learning Collaborative. Register here.

In Memoriam: Stuart Altman

One of the most influential members of the Massachusetts and national healthcare community over many decades, Stuart Altman, passed away on January 1 at age 88. Altman was the inaugural chair of the Massachusetts Health Policy Commission and the Sol C. Chaikin Professor of National Health Policy at Brandeis University’s Heller School for Social Policy and Management where he taught and mentored many who would go on to continue his work of attempting to improve the nation’s healthcare system. Nationally, he advised five presidential administrations, chaired the Prospective Payment Assessment Commission, and served on President Bill Clinton’s National Bipartisan Commission on the Future of Medicare.

MHA President & CEO Steve Walsh said of Altman, “We could talk in perpetuity about Stuart’s knowledge and commitment to healthcare policy. What is even more impressive and meaningful is how he approached all of his work with genuine kindness, infectious humor, and a gentle spirit. One could argue that it would be good for the healthcare system to follow Stuart’s proposals but even better for humanity to follow his behavior.”

A Note from MHA: 90 Years of Partnering for Patients

2026 marks the 90th year of MHA’s mission to uplift the commonwealth’s hospitals and health systems, caregivers, and patients. But this is more of a steppingstone than a milestone. For us, it’s about harnessing every lesson we have learned and every bridge we have built to create the future that patients deserve.

Over nine decades, Massachusetts’ healthcare system has come together and ignited breakthroughs that have changed countless lives across the globe. It has provided rewarding jobs to people from all walks of life and generated hundreds of billions of dollars for local communities. And, most importantly, it has stood tall and united for the patients who rely on its care 24/7/365 – through global pandemics and financial crises.

For 2026 and beyond, that means doing things differently. It means admitting that we can be better than the status quo and investing in bold, necessary change. Massachusetts has always led the way in healthcare innovation and now we must lead again.

It’s about doing what’s hard and doing it together – just as we always have.

Thank you for the role you play in making our healthcare sector a community and one that MHA has been proud to be a part of for the past 90 years.

Steve Walsh

MHA President & CEO

John LoDico, Editor