On July 30, something happened in the Massachusetts House that primary care doctors like me have been waiting years to see: the House passed H.5618, the PC4YOU bill, with a unanimous vote. The Senate passed its own version back in June. For the first time in a long time, it feels like Beacon Hill is taking the primary care crisis seriously.
I run an independent family practice in Amherst and Northampton. I see the crisis this bill is meant to fix every single day — not as an abstraction, but as a waiting list. People calling frantically every day begging for a primary care provider. Colleagues retiring early or changing to concierge medicine (or esthetics or functional med or… ) because they have had enough. Medical students who come through our practice genuinely excited about primary care, and then, a few years later, choose a specialty instead — because they’ve seen what the job actually demands, and how little support comes with it.
State Rep. Greg Schwartz, a primary care physician himself, put it plainly in his floor speech before the vote: half of Massachusetts PCPs are 55 or older, and fewer than 20% of graduating medical students are choosing primary care and staying in it. Meanwhile, healthcare spending keeps climbing, but the share going to primary care keeps shrinking — down to just 6.7%, even though health policy experts have long said a functional system needs to spend closer to 15%. This bill would move us toward that target gradually, over 10 years, while also cutting the prior authorization red tape that eats up hours of every PCP’s week, funding population health and care management work that currently goes unpaid, and putting real money into workforce recruitment.
I’ve felt the workforce piece firsthand. In the past year we laid off 15 employees and had to cancel our Saturday urgent-care hours. Earlier this year, I reached out to my state senator about a recruitment earmark just to help keep our own practice open to new patients in an underserved part of the Valley. Not a week goes by that I don’t have a message from a patient who is angry about their medical bill or their lab bill or needing us to fight their insurance to obtain a medication that they literally need to function. Needless to say, this is not a good use of time for family physicians and cuts into the hours that could be spent in patient care.
This bill is what it looks like when that problem gets addressed structurally, for every practice in the state, instead of practice by practice. This didn’t happen overnight. It’s the product of many years of sustained lobbying for this specific bill, and two decades of advocacy for primary care reform in Massachusetts more broadly. Thousands of physicians, patients, and advocates called and wrote their legislators to get here. That work mattered, and it’s worth pausing to say so.
But the bill isn’t law yet, and this is the part I’d ask people not to tune out on. The House and Senate now have to reconcile two different versions of this legislation in a Conference Committee, with the goal of passing a final bill by the end of the year. That reconciliation process is exactly where good policy quietly gets hollowed out. Insurance companies did not spend the last seven years sitting on the sidelines, and they’re not going to start now. Expect pressure to add new bureaucratic hurdles, cut payments to primary care practices, and water down the provisions that actually move the needle: the increased share of healthcare dollars directed to primary and behavioral health, the removal of deductibles for seeing your own PCP, and the reduction in prior authorization requirements that currently stand between patients and timely care.
None of those provisions are decorative. They’re the substance of the bill. If they get negotiated away in conference committee, Massachusetts will have passed something that sounds like primary care reform without actually being one.
So, this is genuinely good news, and it deserves to be treated that way. But if you called or wrote your legislator to help get this bill through the House, the job isn’t finished. The next few months, as this moves through conference committee, are when it will actually be decided whether Massachusetts primary care gets the investment it needs — or whether this becomes one more bill that looked promising on the House floor and came out the other side gutted. I’d ask you to stay engaged through the end of this year. We got this far because people didn’t stop. We need that same pressure to see it through.
Dr. Katherine J. Atkinson lives in Haydenville.