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The primary care system in Massachusetts is broken and getting worse, new state report says – The Boston Globe

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The primary care system in Massachusetts is broken and getting worse, new state report says – The Boston Globe


Primary care, the foundation of the state’s health care industry, is crumbling, and Massachusetts is running out of time to fix it, according to a report published Thursday by the state’s Health Policy Commission, which sounded the alarm on many ways the front door to the health care industry is broken.

Among the problems: high and growing rates of residents reporting difficulty accessing primary care; an aging and increasingly dissatisfied physician workforce; and an anemic pipeline of new clinicians.

“I worry when I look at some of this data that the state of primary care has crossed a line from which recovery will be very difficult, unless we take action soon,” the commission’s executive director, David Seltz, said in an interview.

The report sets the stage for the work of a new state-appointed primary care task force, created by a health care law signed earlier this month. The law outlines that the new 25-member group will consider issuing recommendations related to increasing recruitment and retention of the primary care workforce and establishing a target for how much insurers should spend on primary care.

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Such goals would put Massachusetts more in line with other states, including California, Oregon, Rhode Island, and Washington, which have set benchmarks for primary care spending. Seltz called such efforts an important way to rebalance the incentives of the market.

“This is an opportunity to shift the dialogue, to one of: ‘What can we do immediately to relieve this deep challenge?’” Seltz said.

While the findings set the stage for reform, they are perhaps not a surprise. Previous reports on primary care have been blaring the warning signal for years. Increasingly high portions of residents have said they had difficulty accessing health care. Analysis on health care spending has shown dwindling amounts of health care dollars going to primary care.

But the report lays out in stark terms just how dire the prognosis on primary care is.

Among the findings:

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  • Patients’ ability to access primary care is bad and getting worse. New patients must wait an average of 40 days in Boston, twice as long as the average of 15 other cities studied. Access to primary care worsened across the state in recent years, with such issues especially pronounced in lower-income communities.
  • A lack of primary care access means more reliance on emergency departments, which are more costly places to get care. In 2023, a whopping two-thirds of those who sought care in hospitals’ emergency departments said they were there because they couldn’t get an appointment in a doctor’s office or clinic.
  • Massachusetts has a lot of doctors — the highest total physicians per capita in the country. However the vast majority of those physicians are specialists. Compared to other states, Massachusetts has the fifth lowest share of primary care physicians.
  • The primary care workforce is aging, with an estimated half of primary care physicians over the age of 55.
  • The pipeline for new primary care doctors is dwindling, with only one in seven new Massachusetts physicians in 2021 going into primary care — among the lowest share in the country.

A primary driver of the current challenge is related to the low reimbursement rates primary care receives relative to other specialties and hospital services, the report states, a factor that disincentivizes both new graduates from entering the field and the health care industry from investing in it.

Beyond the low pay, primary care can be an exhausting job, requiring myriad billing and administrative tasks, increased documentation requirements, and visits too short to accommodate the core point of primary care — caring for the patient.

Dr. Alecia McGregor, a commissioner and an assistant professor at the Harvard T.H. Chan School of Public Health, noted the state is seeing evidence of that very burnout and corporatization of medicine, with both those complaints cited as key reasons primary care doctors at Mass General Brigham recently filed to unionize.

The state is currently making up for primary care physician shortages by leaning more on nurse practitioners and physician assistants, together known as “advanced practice providers.” However the share of even those providers working in primary care is dropping, in part because of the low pay.

“Relying on advanced practice providers to serve as (primary care providers) instead of physicians may not resolve challenges related to the availability of providers if we can’t improve job sustainability in the field of primary care,” said Sasha Albert, associate director of research and cost trends at the Health Policy Commission, during a presentation at Thursday’s commission meeting.

Beyond setting the stage for a new task force, Commissioner Tim Foley said the “scary” report emphasized the importance of the commission remaining focused on drivers of the recruitment and retention challenges.

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“It just highlights again our need to continue to focus on the workforce issues,” said Foley, who is also the head of union 1199SEIU, which represents health care workers. “We had the hearing on the impact of the workforce, and it hasn’t gotten any better. It’s probably gotten worse.”


Jessica Bartlett can be reached at jessica.bartlett@globe.com. Follow her @ByJessBartlett.





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Healey shares plan to limit health insurance cost increases for Massachusetts residents

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Healey shares plan to limit health insurance cost increases for Massachusetts residents



Gov. Maura Healey said Thursday that the state is spending an additional $250 million to limit premium increases for residents who have insurance through the Massachusetts Health Connector.

After Congress let Affordable Care Act tax credits expire at the end of last year, more than 300,000 people in Massachusetts have been facing a potentially steep increase in their health care bills. 

The governor’s office said those enrolled in ConnectorCare who make below 400% of the of the federal poverty level, which is $62,600 for an individual or $128,600 for a family of four, will see “little to no premium increases.”

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Under the plan, Healey’s office said a 45-year-old couple with two kids in Fall River will see their monthly health insurance costs rise from $166 to $206. Without the new funding, the governor says they would be paying $452 a month.

“While President Trump continues to increase health care costs, we are taking the strongest action in the nation to address them and keep costs as low as possible for families,” Healey said in a statement. “Despite this increased state investment, far too many people will still see their premiums increase because of the White House.”  

The U.S. House of Representatives is set to approve a three-year extension of the health care tax credits. While it appears unlikely to pass the Senate, senators have talked about a compromise plan that could include a two-year extension with added reforms. President Trump hasn’t offered a specific health care plan, but said subsidies going to insurance companies should “go to the people” instead. 

The $250 million is coming from the Commonwealth Care Trust Fund, which gets its money from employer medical assistance contributions and financial penalties from residents who violate the state’s health care insurance mandate. 

Massachusetts residents can sign up for health insurance coverage or switch their Health Connector plans until Jan. 23 if they want to be covered by Feb. 1. 

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Minnesota childcare fraud allegations spark audit request in Massachusetts: ‘Serious risks’

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Minnesota childcare fraud allegations spark audit request in Massachusetts: ‘Serious risks’


Fraud allegations in Minnesota’s childcare system are prompting two Massachusetts Republican lawmakers to ask the Healey administration to conduct a “top-to-bottom audit” of a Bay State voucher program.

State Reps. Marc Lombardo, R-Billerica, and Nicholas Boldyga, R-Southwick, say they’re alarmed after seeing national reports of fraud in childcare subsidy programs, pointing specifically to widespread allegations in Minnesota.

Their concerns have prompted them to ask Gov. Maura Healey to direct Education Secretary Patrick Tutwiler to “urgently conduct” an audit and review of the Massachusetts Child Care Financial Assistance program to identify any potential fraud and vulnerabilities here.

Child Care Financial Assistance helps low-income families pay for childcare in Massachusetts.

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“While Massachusetts has not yet been directly implicated in the same manner, the similarities in program structure, relying on voucher reimbursements to providers for low-income families, raise legitimate questions about whether comparable fraud or waste could be occurring here undetected,” Lombardo and Boldyga wrote in a joint letter to Healey on Wednesday.

“Our Commonwealth invests hundreds of millions of dollars annually in this critical program to support working families and early education,” they added. “We owe it to Massachusetts taxpayers and the families who genuinely need this assistance to ensure every dollar is spent appropriately and reaches its intended purpose.”

The governor’s office did not immediately respond to a Herald request for comment on the letter.

Early Education and Care Commissioner Amy Kershaw has said that Massachusetts is not facing disruption to its $293 million share of federal childcare payments amid a nationwide freeze in response to the Minnesota fraud allegations.

Kershaw has also added that Child Care Financial Assistance is not being impacted, either. The state appropriates funds for the voucher program at the beginning of the fiscal year and then seeks federal reimbursement.

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This fiscal year’s funding totals about $1.087 billion for the program, which covered more than 66,000 children in fiscal year 2025, according to a December report from the Massachusetts Taxpayers Foundation.

“Obviously, we are incredibly concerned about families across the country and in Minnesota who may lose access to Child Care Financial Assistance based on acts by the federal government,” Kershaw told Bay State childcare stakeholders on Monday.

Before the new year, the federal Administration for Children and Families froze all funding to Minnesota. All 50 states must now provide additional verification before receiving more funds.

Minnesota Democrats accuse the Trump administration of playing politics and hurting families and children as a result.

This all comes after a video surfaced on YouTube alleging fraud in childcare in Somali communities in Minnesota, to which Kershaw has said none of the allegations have been proven.

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The Massachusetts early education and care commissioner noted how there have been similar videos posted in Massachusetts and other states like Ohio, California and Washington.

In their letter to Healey, Lombardo and Boldyga also highlighted how the U.S. Department of Health and Human Services has responded to the Minnesota allegations by closing loopholes that allowed payments without verifying attendance.

“These developments highlight serious risks in subsidized child care systems across the country,” the Republican lawmakers wrote, “including the potential for misappropriation of taxpayer funds on a massive scale.”

Lawmakers across the country are seeking similar reviews as Lombardo and Boldyga. In Michigan, State Senate Minority Leader Aric Nesbitt, a Republican, has asked for an audit of a state program that aims to help low-income families afford childcare there.

The Massachusetts audit would zero in on verifying that voucher payments to providers are based on documented child attendance records; cross-checking to detect potential “ghost children” or overbilling; and on-site inspections of voucher-receiving providers to confirm they are operating legitimate childcare programs, among other objectives.

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“Such a thorough review would not only safeguard public funds,” Lombardo and Boldyga wrote, “but also strengthen confidence in a program that is vital to thousands of Massachusetts families.”

The Associated Press and Herald wire services contributed to this report.



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Massachusetts police officer struck and killed in line of duty; department mourns

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Massachusetts police officer struck and killed in line of duty; department mourns


A Massachusetts police department is mourning the death of one of its own after an officer was struck and killed while attempting to assist a broken-down driver on a highway.

The Uxbridge Police Department has hung black bunting above its main entrance as it receives condolences from across the Bay State following the incident early Wednesday morning.

The crash unfolded at about 12:45 a.m., when the officer was trying to help a motorist in the northbound lanes of Route 146, a main artery in the Worcester County town that borders Rhode Island.

Authorities identified the fallen officer on Wednesday afternoon as Stephen Laporta, 43, of Uxbridge. The Massachusetts State Police is investigating the crash.

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“This is a devastating loss for our department and our community,” Police Chief Marc Montminy said in a statement. “Our thoughts and prayers are with the officer’s family, loved ones, and fellow officers during this incredibly difficult time.”

Gov. Maura Healey has ordered flags to be flown at half-staff at all state buildings in honor of LaPorta.

“I am heartbroken over the news of Officer Stephen LaPorta’s passing,” the governor said in a statement Wednesday afternoon. “He knew he was headed into a dangerous situation when he responded to the scene of a multi-vehicle crash, but like all of our officers do day in and day out, he put the public’s safety first – and he tragically made the ultimate sacrifice.”

Authorities closed Route 146 for hours after the crash, with investigators working the scene. The icy, frozen road reopened around 10 a.m.

Uxbridge First Holy Night, a community organization, offered its condolences to the department via social media, saying the loss is also felt “across our entire town.”

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“Our officers are more than public servants — they are neighbors, friends, parents, children, and family,” the group stated. “When one of our own falls, we all grieve together.”

“Uxbridge is a close-knit community,” it added, “and in moments like this, we lean on one another. May we surround this family and our police department with compassion, strength, and support in the days ahead.”

Police departments from across the region sent cruisers to participate in a procession that accompanied a vehicle carrying LaPorta’s body to a medical examiner’s office before daybreak.

The Boston Police Patrolmen’s Association described the officer as a “fallen hero” and the death as “heartbreaking news.”

“Another police officer killed in the line of duty. This time in Uxbridge,” the association stated in a social media post. “The officer was involved in a motor vehicle crash while attempting to assist a motorist on Rte. 146 early this morning. Our thoughts and prayers are with the officer’s family and the entire Uxbridge Police Department during this incredibly difficult time.”

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State Rep. Mike Soter, whose Central Massachusetts district includes Uxbridge, said his “heart sank” when learning of the death.

“This is so close to home,” he said in a Facebook post. “May GOD watch over this officer’s family and his fellow officers today as they need our strength as a community. May the officer’s memory be eternal always!”

In June 2024, the Uxbridge Police Department celebrated LaPorta’s promotion to full-time patrolman.

“He may seem familiar to you all because Ofc. LaPorta has already been actively serving our wonderful town as a full-time Dispatcher and working part-time patrol shifts,” the department stated in a Facebook post. “He has put in the work to switch his role up and come to the patrol side full time! Let’s give him a warm congrats Uxy!”

Uxbridge Police Department (Herald file photo)
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