Massachusetts Governor Maura Healey has announced a comprehensive plan to make healthcare more affordable and accessible to residents. The plan includes updated insurance regulations that will eliminate prior authorization requirements for emergency and urgent care services, primary care, chronic care, occupational and physical therapy, and certain prescription drugs. Prior authorization is a process where healthcare providers must obtain approval from insurance companies before providing certain services or treatments. The new regulations will also require insurers to respond to urgent requests within 24 hours and ensure that patients’ care is not disrupted when they switch insurance plans.
Healey also announced the creation of a new working group, the Health Care Affordability Working Group, which will be led by former Health and Human Services secretary Kate Walsh and Lisa Murray, Massachusetts state president at Citizens Bank. The group will develop proposals to make healthcare more affordable and will include representatives from state agencies, trade groups, and business organizations.
The changes are expected to make a meaningful difference to some patients, particularly those with chronic conditions who often face delays and disruptions in their care due to prior authorization requirements. For example, a patient with diabetes will no longer need prior authorization for services and devices associated with their condition. The regulations will apply to all insurers that do business in Massachusetts, but will not apply to self-insured employers that pay healthcare claims directly.
The announcement is part of Healey’s broader effort to address the high cost of living in Massachusetts and make healthcare more affordable. Healey has made affordability a key issue in her reelection campaign and has signed a tax relief package and a sweeping housing law aimed at addressing the state’s high cost of living.
While some analysts have raised concerns that eliminating prior authorization requirements could lead to increased healthcare spending, Healey’s administration argues that the changes will improve access to care and reduce administrative burdens on healthcare providers. The Council for Affordable Quality Healthcare estimates that the healthcare industry spent $1.3 billion on administrative costs related to prior authorizations in 2023, a 30% increase from the previous year.
The new regulations have the potential to bring about meaningful change to patients who are often caught in the middle of bureaucratic delays and disruptions. One patient, who was diagnosed with a serious autoimmune neurologic illness, described waiting three months for insurance approvals and suffering permanent damage to her body and functioning during the wait. Healey’s announcement has been welcomed by healthcare advocates, who argue that the changes will improve access to care and reduce administrative burdens on healthcare providers. However, some analysts have raised concerns about the potential impact on healthcare spending and the effectiveness of the new working group in bringing about real change.