Employers and insurers press to lower benchmark; advocates urge keeping 3.6% and investing in primary care

Three stakeholder groups told the Health Policy Commission hearing they want different policy responses to the CHIA data: business representatives and health plans urged a lower benchmark and stronger accountability tools; consumer advocates urged keeping the benchmark at 3.6% and directing investments to primary care and access.

Eileen McEnany, president of the Employer Coalition on Health, told the hearing: “If we want to reduce the cost of health care, we must first reduce the cost benchmark and impose different penalties for non‑compliance.” McEnany said employers face double‑digit increases in premiums and cited employer surveys and recent rate actions; she argued a lower benchmark would “signal that we are finally serious about getting healthcare cost under control” and would force stakeholders to find savings without prescribing how to achieve them.

The Massachusetts Association of Health Plans (MAHP) testified similarly. MAHP President and CEO Laura Pellegrini said health plans are experiencing losses driven by rising pharmacy and hospital outpatient costs and asked lawmakers for tools and accountability across providers and the pharmaceutical sector. “Without cost constraints on providers and the pharmaceutical industry, health plans cannot make health care more affordable for your constituents,” she told the committee, and she urged a moratorium on new benefit mandates that would increase premiums.

Advocates framed the choice differently. Alex Sheff of Health Care for All said CHIA’s report and household survey data show costs are already forcing families to skip care and take on medical debt; she said her group recommends keeping the benchmark at 3.6% “to keep the benchmark current at its 3.6% level moving forward” and using the HPC’s tools to rein in price variation while investing in primary care and workforce. Sheff highlighted health equity disparities in affordability and access, noting Black and Hispanic residents reported higher incidence of unmet need.

Several advocacy and policy witnesses asked for targeted actions: stronger controls on prescription drug prices and PBM oversight (the new session law requires PBM licensure and creates a pharmacy policy office at HPC), sector‑specific targets (for example, increasing the share of spending on primary care), improved prior‑authorization processes and more data transparency on provider price variation. Health Care for All emphasized that primary care accounts for a shrinking share of spending and that building capacity (including residency slots) and paying primary care differently are necessary to improve access and reduce downstream high‑cost care.

The hearing made clear the political tension: employer and insurer representatives said stronger limits and accountability are necessary and pressed for a lower benchmark, while consumer advocates warned that lowering the benchmark could be counterproductive without concrete tools to lower prices and protect access. The HPC and lawmakers signaled interest in several policy levers already enacted in recent legislation — including PBM licensure and pharmacy reporting — while acknowledging additional steps may be required if spending stays above the benchmark.