I led efforts to increase primary care spending in Rhode Island. Here are the things Massachusetts must get right.

I led efforts to increase primary care spending in Rhode Island. Here are the things Massachusetts must get right.

July 26, 2026

By Christopher Koller

The passage by the Massachusetts Senate of S-3116 at the end of June marks a milestone in efforts to strengthen Massachusetts’s vital but fragile primary care sector. The bill’s detractors are now furrowing their brows and defending the status quo. Their arguments should not carry the day.

I know because I confronted and refuted those same arguments 15 years ago as Rhode Island’s health insurance commissioner when we started down the same path.

Primary care is essential to a high-performing health system. It is the only health care service where an increased supply results in longer lives and more equitable outcomes. Hospitals, specialists, and the pharmaceutical industry cannot say the same thing. Yet because of political power and explicit public policy, we have funneled more and more money into those services, resulting in an ever-weakening primary care system, in Massachusetts and the country.

The solution is clear but requires persistence. We must spend a greater portion of our health care dollar on primary care and pay for it in ways that allow primary care teams to improve access and coordination. This is exactly what S-3116 would do.

The bill would require increasing the share of health care spending directed to primary care from the current level of less than 7 percent to at least 15 percent. It would phase in this shift over three years, starting in 2028, and require that the change have no net impact on health care spending, insurance premium prices, or cost sharing paid by patients.

It recognizes that the current model of private rate negotiation between health insurers and providers advantages large systems, which use their size to negotiate high rates for their profitable medical services, leaving primary care clinicians with crumbs and patients without access.

Faced with the prospect of change, insurers and health care providers have started wringing their hands. Insurers raise the prospect of increased insurance premiums. Providers, seeing a threat to their revenues, point to increases in the number of uninsured resulting from Medicaid cuts stretching their budgets.

I have heard these arguments before, and they need to be recognized for what they are -- a defense by entities invested in the current ways of doing things. This is the status quo that created this mess.