Massachusetts Health & Hospital Association 
INSIDE THE ISSUE
> Primary Care Spending
> Enhanced Premium Tax Credits
> Gender Affirming Care Rollbacks
> Capacity Concerns in State
> Transition
MONDAY REPORT
Group Recommends Increasing Primary Care Spending in State
Last Monday, the Massachusetts Primary Care Access, Delivery, and Payment Task Force released its first report, which recommended that a target for spending on primary care in Massachusetts be set at 15% of total healthcare spending, or double the current primary care spending share, whichever is greater, within five years of 2026.
According to the overview document from the task force, “In 2021, the U.S. spent 4.7% of its total healthcare spending in primary care, compared to an average of 14% in other high-income nations, many who rank higher in health outcomes than the U.S.”
Massachusetts primary care spending, according to the Center for Health Information Analysis, is 6.7% of total spending – or 42% higher than the U.S. average.
“In Massachusetts, we have an outstanding healthcare system for treating those who are sick,” said Task Force Co-chair Kiame Mahaniah, M.D., the secretary of the Executive Office of Health and Human Services (EOHHS). “What we don’t have across our country at this point is a system that collectively works well to keep people healthy. These spending targets are an important tool to better align our healthcare spending with our values. Investments in primary care will not only yield future healthcare costs savings, but hold immeasurable value in the quality of life for our residents that comes with staying healthy.”
Creation of the 25-member task force was mandated by Chapter 343 of the Acts of 2024, An Act Enhancing the Market Review Process, which Governor Maura Healey signed in January 2025. The task force, co-chaired by EOHHS and the Massachusetts Health Policy Commission, first met in April 2025.
While the group recommended increasing primary care spending it said that new investment “must not raise overall healthcare cost growth or lead to new premium or cost-sharing increases.” The HPC and Division of Insurance would be given even more authority to “hold payers and providers accountable” for keeping costs in line. Details on how the target could be reached were not included in the recommendation.
Former Governor Charlie Baker first stressed the idea of increasing the primary care spend but the concept did not gain traction during his administration. The reasons behind the concept are clear: if people can maintain their health by having better access to routine care, they can help stem more serious and costly care down the road. Other states have started down the path to bolster primary care.
“Primary care is our most powerful tool for building healthier communities, easing the burdens on emergency rooms and caregivers, and connecting patients with the personalized services they need,” MHA said in a statement. “We commend state leaders for giving primary care the close attention it deserves. We look forward to engaging with policymakers and exploring how a spending target would be implemented in a meaningful, pragmatic, and collaborative manner – especially within the context of the growing pressures and current investments that exist within today’s delivery system.”
Dr. Eric Dickson, the president and CEO of UMass Memorial Health, who served on the task force, termed the group’s recommendation “a step forward.” He said addressing primary care reimbursement will be key to making the proposal work, as will reducing the administrative burdens that keep primary care providers away from spending time with patients.
House Forces January Vote on EPTC Extension
On December 17, the U.S. House of Representatives passed, along party lines, H.R. 6703, a Republican leadership proposal to address healthcare affordability. The bill does not include an extension of the enhanced premium tax credits (EPTC). The Massachusetts delegation voted nay on H.R. 6703.
Moderate House Republicans who have advocated for an EPTC extension then tried to negotiate a deal with Speaker Mike Johnson (R-La.) on an amendment to either include a clean, one-year extension of the EPTC, or a two-year extension with some reforms to income limits and eligibility verification. However, last week those negotiations fell through.
As a result, four Republican moderates signed onto a Democrat-led petition for a clean, three-year extension of the EPTC, pushing the proposal over the 218-signature threshold to force a floor vote that will take place in January. The Massachusetts House delegation supported this “discharge petition.”
The House GOP leadership bill, which will advance to the Senate, includes enhancements for association health plans, expanded catastrophic bronze plan eligibility, and reforms to pharmacy benefit manager regulations. The Senate is not expected to take up the House leadership bill and the path forward on a January EPTC extension vote also seems unclear, especially in the Senate where it must overcome a 60-vote threshold. In fact, a three-year extension of the EPTC already failed in the Senate on December 11, netting only 51 votes in favor.
The EPTC expires on December 31, 2025, meaning that any January action on an extension would be retroactive, an especially complicated option. Loss of the credits is projected to result in 26,000 people in Massachusetts losing coverage and as many as 300,000 having their premiums spike upwards.
Trump Administration, House GOP Assail Gender Affirming Care
Last Thursday, the Trump administration announced that as a condition of participation in Medicaid and Medicare, hospitals will be prohibited from providing gender-affirming care to children under age 18.
The Centers for Medicare & Medicaid Services (CMS) will release notices of proposed rulemaking to halt what it calls “sex-rejecting procedures” that the administration said includes “pharmaceutical or surgical interventions of specified types that attempt to align a child’s physical appearance or body with an asserted identity different from their sex.”
As nearly every U.S. hospital relies on Medicaid or Medicare funding, the administration action, if ultimately enforced after surviving what are sure to be legal challenges, would effectively end a hospital’s ability to provide such care.
Massachusetts Attorney General Andrea Joy Campbell announced her office would “strongly oppose” the rule.
“Medically necessary healthcare for transgender youth saves lives and is essential to their emotional and physical wellbeing,” Campbell said. “While these proposed rules cruelly target our trans community, they will put millions of Americans’ healthcare at risk by forcing hospitals and medical providers to choose between receiving Medicaid and Medicare funding or abandoning their adolescent transgender patients. I will continue to stand up for the rule of law and the right of all Massachusetts residents to receive medically necessary healthcare and am prepared to take action if any unlawful rule is finalized.”
U.S. Secretary of Health & Human Services Robert Kennedy also released a declaration, stating that “standards of care recommended by certain medical organizations are unsupported by the weight of evidence and threaten the health and safety of children with gender dysphoria.” The declaration goes on to state that the Secretary “may” exclude individuals or entities from participation in any Federal healthcare program if the Secretary determines the individual or entity has “furnished or caused to be furnished items or services to patients of a quality which fails to meet professionally recognized standards of healthcare.”
DPH last week sent an advisory to notify pharmacies and practitioners who prescribe reproductive and gender-affirming medications of enhanced protections included in “Shield Law 2.0,” An Act Strengthening Health Care Protections in the Commonwealth. That law requires pharmacies, at the request of the prescribing practitioner, to label Schedule VI medications prescribed for reproductive or gender-affirming care with the name of the healthcare practice instead of the individual prescribing practitioner, to provide an extra layer of privacy and protection for the practitioner.
The U.S. Food and Drug Administration (FDA) also announced it would issue warning letters to manufacturers and retailers of breast binders who the FDA said are “illegally marketing” their products to children for the purposes of treating gender dysphoria. And the U.S. Health & Human Service’s Office for Civil Rights said it was working to reverse Biden administration efforts to classify “gender dysphoria” as a disability.
Also last week, by a vote of 216-211, Republicans in the U.S. House passed a bill that aims to prevent doctors from providing gender-affirming care. Under The Protect Children’s Innocence Act, anyone providing such care to a minor could face up to 10 years in prison.
State Responds to Capacity Challenges in Some Regions
The Department of Public Health, noting the uptick in flu cases and high occupancy levels at hospitals, last Friday moved state Regions 3, 4, and 5 (Northeast Mass. & North Shore, Boston and the Metro region, and the South Shore, Southcoast and Cape & Islands) from Tier 1 to Tier 2.
The tiering of regions originally began in 2020 during the pandemic and mainly influences how often regional coordinating calls between acute care hospitals are held. The regions moving into Tier 2 will begin regular calls on January 8 to, as this Capacity Planning and Response Guidance states, identify, analyze, and communicate ways to address capacity challenges.
Transition
Claire Seguin, DNP, has been appointed president and COO of Martha’s Vineyard Hospital, a part of the Mass General Brigham system, effective January 1. She is currently Chief Nursing Officer and Vice President of Operations at the hospital, as well as Interim Vice President of Operations for the Mass General Brigham Community Division. Seguin succeeds Denise Schepici, who has served as Martha’s Vineyard Hospital president and COO since 2018. Sequin received her DNP from Northeastern University, an MS from Curry College, and a BSN from UMass Boston. She has a Nurse Executive Advanced (NEA-BC) certification from the American Nurses Credentialing Center.