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MONDAY REPORT

Senate’s Primary Care Proposal Draws Praise – But Also Questions

The Massachusetts Senate last Thursday released its long-anticipated bill aimed at improving the state’s primary care infrastructure.

Primary care has earned a swell of attention over the past several years among patients struggling to find it, healthcare organizations attempting to invest in it, and policymakers attempting to fix it.

41% of Massachusetts residents report difficulty accessing primary care services. The Senate legislation, An Act relative to primary care for you, includes a long list of proposals intended to confront those gaps. Provisions to grow the workforce, establish new data collection from healthcare entities, and introduce new insurance supports for community health centers are all included.

A cornerstone of the bill is a new “expenditure target,” which would direct healthcare entities to devote 15% of their total spending to primary care by 2030 (noncompliance could result in monetary penalties). It is a simple and well-intended concept in theory, but also one that has prompted an immediate cascade of practical questions from across the healthcare sector.

Those questions stem from several places: how is it possible for a blanket approach to target the unique needs of each community? What happens to specialty care organizations that are also subject to the target? How are major community benefit and grant investments factored in, given the target is built around insurance claims? And – critically – how does it account for the deep losses hospitals are expected to take on following federal policy changes?

While those uncertainties remain, MHA applauded the Senate and state task force “for giving our struggling primary care system the attention it deserves,” emphasizing that hospitals are making “meaningful primary care investments” with the shared goal of patient access. At the same time, the association pointed back to the “systemic barriers” that have proven to be at the root of the system’s shortcomings.

A 2025 Health Policy Commission study identified several of the most glaring cracks in the local primary care infrastructure: low reimbursement rates that make it difficult for providers to maintain and scale services, intense administrative burdens that drive clinicians away, and a troubling dearth of workers entering – and staying in – the field. The commonwealth ranks in the bottom five of all states in the share of physicians who work in primary care, and its residency positions are growing slower than the national average.

“We look forward to engaging with the legislature to ensure those systemic barriers remain at the center of primary care reform debates, while urging serious caution around measures that would unintentionally weaken our local healthcare system even further – especially with the major disruptions of federal policy changes only beginning to be felt,” said Leigh Simons, MHA’s vice president of policy and regulatory affairs. “That includes measures that would inadvertently layer on even more complexity, overlook the innovation and investments already in motion, and replace the critical flexibility hospitals need to treat patients with a one-size-fits-all approach that discounts the unique nature of each organization and population.”

The legislation is expected to be put to a vote this Thursday, and then move to the House for consideration. Separately, the 25-member task force led by the Executive Office of Health and Human Services and HPC has been meeting since last September and is rounding out its own recommendations this month. Many of those closely mirror tenets of the Senate bill.

$100k Visa Fee Struck Down

Last September, the Trump administration announced that individuals seeking H-1B visas would be subject to a $100,000 application fee, stirring concerns from a range of sectors – including hospitals and health systems – about how the policy could further constrain their access to high-skill workers. Last week, a federal judge in Boston struck down that requirement, stating that it exceeded the powers of the executive office.

The national hospital community had been seeking an exemption from the policy, with 70% of facilities reporting it would impact patient care. More than two-thirds of hospitals that utilized or planned to utilize the H-1B program expected to pause, defer, or limit recruitment due to the change, according to a survey from the American Hospital Association.

“The [visa fee] Proclamation expresses concern about the share of foreign workers filling jobs in the science and technology fields, specifically focusing on the IT sector,” wrote Judge Leo Sorokin in his June 8 decision. “However, the Proclamation fails to consider or discuss these policy concerns as they pertain to other human-services sectors, such as education and healthcare.”

Sorokin sided with a coalition of 20 state attorneys general – including Massachusetts Attorney General Andrea Joy Campbell – that sought to halt the proclamation altogether through a lawsuit filed in late 2025. He ruled that the fees were essentially a tax and are therefore subject to signoff from Congress.

“Today’s victory protects the integrity of the H-1B visa program as a tool to address severe labor shortages in vital industries like education, healthcare, and medical research,” said Campbell after the decision was handed down. “In Massachusetts, this win will ensure we can fill critical vacancies and hire world-class faculty and researchers at colleges and universities across the Commonwealth.”

Hospitals have cited the H-1B program’s importance in temporarily filling high-need positions when there are not enough domestic workers to do so. Those roles include physicians, nurse practitioners, and physician assistants – particularly in rural areas. In announcing the proclamation last year, the White House stated that visas have “been deliberately exploited to replace, rather than supplement, American workers with lower-paid, lower-skilled labor.” The administration has already indicated that it plans to appeal the decision.

Poll: What’s Driving Healthcare Costs?

As each component of the healthcare system weighs in with its perspective on how the nation can better control healthcare costs and improve affordability, a new poll sought input from the biggest stakeholder group of all: patients.

The Coalition to Strengthen America’s Healthcare surveyed 2,000 American voters and found that:

• 47% identified corporate health insurers as the primary driver of rising healthcare costs, followed by the federal government (36%) and drug companies (34%).
• 79% of respondents said they are concerned about corporate health insurers denying or delaying doctor-ordered treatments.
• 84% believe corporate health insurers have too much control over medical decisions.

Locally, steps have been taken in recent months to alleviate those frictions. The Massachusetts Payer-Provider Partnership (or MP3) was launched to unite and implement shared ideas between institutions that deliver care and organizations that pay for care. The Healey-Driscoll administration finalized regulations intended to streamline the much-maligned prior authorization process. State officials are once again paying close attention as insurers file rate proposals for 2027.

Regardless of causes or culprits, surveys show that healthcare costs are an increasing concern for Americans. Hospitals, facing major economic headwinds of their own, are making the case that durable long-term solutions require a willingness to address the full picture, including disruptions from high input costs, coverage instability, administrative burdens, and fundamental changes in how care is delivered and paid for.

Lahey Clinic Returns to Historic Name

Lahey Hospital & Medical Center is now Lahey Clinic, in a return to the still-familiar name that defined the Burlington-based hospital for nearly a century. Beth Israel Lahey Health announced the change earlier this month, in tandem with a multi-year fundraising effort.

Dr. Frank Lahey founded the clinic in 1923 as a place where physicians across specialties could practice together – a novel concept at the time. The hospital was an early adopter of clinical technology over the decades (it purchased its first X-ray machine in 1925) and developed into a hub for research and training. It moved its operations to Burlington in 1980 and now has a presence in locations throughout northeastern Massachusetts. It held the Hospital & Medical Center name for 14 years before the recent transition back to Lahey Clinic, “which reflects our philosophy of care, honors our legacy, and positions Lahey for the future,” according to Susan Moffatt-Bruce, MD, the hospital’s president and divisional president for the Beth Israel Lahey Health system.

Innovative Firsts

Massachusetts hospitals and health systems have always led the way in creating lifesaving clinical procedures to innovative models of care delivery. And for 90 years, MHA has stood alongside its member organizations as they advance a legacy of innovation, driven by a shared commitment to improving patient lives, empowering caregivers, and strengthening communities.

In recognition of these innovations, MHA has compiled stories from hospitals and health systems across the state and will feature them on this webpage and periodically in Monday Report.

UMass Memorial Health launched its virtual idea platform, Innovation Station, in 2012 to encourage caregivers to collaborate and develop actionable solutions to frontline challenges. Since then, the platform has achieved a caregiver participation rate of 95% and supported the implementation of more than 200,000 ideas.

Innovation Station empowers frontline teams to identify efficiency gaps, address everyday operational challenges, and surface issues the system might not otherwise detect. Over the past year alone, the platform has implemented more than 15,000 ideas and delivered $50 million in cost savings and revenue generation.

John LoDico, Editor