With House vote, Beacon Hill inches closer to landmark primary care reforms

AFTER KEEPING onlookers guessing for weeks about the contours of its plan, the House made clear with a resounding vote Thursday that its leaders, too, want to force the Massachusetts health care industry to dedicate significantly more resources to a primary care sector in crisis.

Representatives embraced a sweeping bill that would more than double the share of health care spending that goes toward the front lines of care, plus erect new limitations around how insurers can use artificial intelligence and require more money from drug rebates to flow to patients.

Coming six weeks after a similar bill cleared the Senate, the House’s unanimous vote signals that lawmakers are ready to fashion a far-reaching bill that could fundamentally reshape the state’s health care landscape.

Wayne Altman, a family medicine physician in Arlington who has long been urging policymakers to improve support for primary care, said a final accord could become the most impactful health care legislation in Massachusetts since the reform package known as “Romneycare” was enacted two decades ago.

“Both of these bills are outstanding bills, and in and of themselves would be historic, national stories,” Altman said of the House and Senate proposals. “This primary care bill that will pass in 2026 will be a national model for primary care legislation all over the country in the same way Romneycare was for Obamacare.”

The hard work is not done. While both branches are in alignment on some of the biggest general ideas, legislative negotiators will now need to hash out a host of specific details and find common ground on areas where the House and Senate diverged. They have the next five months to do so before the legislative term ends.

Doctors, patients, and advocates have been warning for years that the primary care system is teetering in a precarious position. Physicians are leaving the field more quickly than new practitioners are joining, and securing an appointment has become increasingly difficult. One survey published in June 2025 found that a patient in the Boston area needed to wait an average of 69 days to book a physical with a new provider, the longest among 15 cities studied.

Primary care receives comparatively little investment. In 2024, primary care accounted for only about 6.6 percent of spending by commercial insurers, down from an even 7 percent a year earlier.

Both the House and Senate bills would force that figure upward, requiring at least 15 percent of health care expenses in Massachusetts to go toward primary care. That embraces one of the central recommendations from a task force that studied primary care problems, which counted Altman among its members.

Under the House bill, regulators will monitor health care entities for their compliance with new primary care spending requirements. Those that fail to devote enough dollars toward primary care can be required to file a plan detailing how they will come into compliance, and if they still fall short, they might be subject to a performance improvement plan — one of the main levers the state can use currently if a hospital or other actor is contributing to excessive health care spending growth.

Embracing a higher primary care spending floor is a full turn for Beacon Hill. Former governor Charlie Baker twice filed legislation that sought to boost dollars going to primary care, but neither of his proposals ever received a vote in the House or Senate, and Baker later reflected that his idea “freaked everyone out.”

The move could generate tension. If lawmakers conclude they want to increase the share of health care money that goes toward primary care, but avoid increasing overall health care spending, that means other segments such as pharmaceuticals or specialists might receive less of the pie — or at least smaller growth in future years — than they would under the status quo.

The House bill also calls on insurers to offer new payment models to primary care providers. Instead of defaulting to the current fee-for-service approach, in which practitioners are paid for each separate service or test, plans would have to make available a flat per-member per-month payment. Supporters argue that will make it easier for doctors to provide more comprehensive care because they can respond to patient needs without incurring additional administrative work of billing for multiple, discrete services.

Jennifer Lemmerman, executive director of the Health Care for All group, said the bill “will help patients access more timely, affordable primary care and begin to address the deep concerns about primary care access we hear from patients” every day.

There are several noteworthy areas of difference between the House and Senate bills that legislative negotiators will need to navigate.

The House version, but not the Senate bill, would prohibit insurers from using AI-powered automated tools as the “sole basis” to decide not to cover a procedure or service; those rulings would instead need to come from licensed health care professionals.

Lora Pellegrini, the head of the Massachusetts Association of Health Plans, called those proposed requirements “unnecessary.”

“State law already requires that adverse utilization review determinations be made by appropriately licensed clinicians, and the Division of Insurance has established comprehensive standards governing insurers’ responsible use of artificial intelligence,” Pellegrini said in a statement.

Another House addition calls on insurance carriers and the middlemen known as pharmacy benefit managers to pass along the majority of savings from prescription drug rebates to patients by limiting what they pay.

House Speaker Ron Mariano said his chamber’s approach also recognizes that different types of hospitals face different economic realities. “We make allowances for the different situations that different hospitals are in. Some are financially a little better off than others,” Mariano told reporters Thursday before the vote. “We make it fairer.”

One of the biggest areas of divergence is the timeline. The Senate bill seeks to reach the 15 percent primary care spending target within three years, while the House’s would ramp up to that point over the course of a decade.

That longer timeline is Altman’s chief concern with the House bill.

“Family physicians and primary care physicians are retiring early. They’re leaving the profession altogether. They’re reducing their hours. They’re leaving for concierge care,” Altman said. “We can’t wait until 2036.”