BOSTON, January 14, 2026 – Massachusetts residents will soon face fewer hurdles to accessing necessary medical care, as Governor Maura Healey announced new regulations effectively eliminating prior authorization requirements for a range of services, from emergency care to chronic disease management. This move aims to streamline healthcare access and reduce administrative burdens, but its impact on overall costs remains a point of contention.
Easing Access, But At What Cost?
Table of Contents
the new rules seek to simplify healthcare for patients, but experts disagree on whether they’ll drive up expenses.
- Governor Healey unveiled regulations eliminating prior authorizations for emergency, urgent, primary, and chronic care, and also certain therapies and prescriptions.
- A new health Care Affordability Working Group, led by Kate Walsh and Lisa Murray, will develop further proposals by June.
- While proponents say the changes will improve access, some analyses suggest they could increase healthcare spending by $600 to $1,500 per member annually.
- The regulations apply to most insurers in Massachusetts, but exclude self-insured employers.
“Health care is too difficult and too expensive for far too many people,” Healey said, framing the changes as “the most complete action in the country to make it faster, cheaper, and easier to get the care you need.” The proclamation comes as Healey seeks reelection this November and as Democrats nationwide emphasize affordability as a key campaign promise.
A Second Push for Affordability
This is the second major healthcare initiative Healey has announced in the past two weeks. Last week, she detailed a $250 million state trust fund designed to help residents cope with rising premiums in the Affordable Care Act marketplace. Healey has consistently prioritized affordability, building on a similar pledge.
blue Cross Blue Shield of Massachusetts already doesn’t require prior authorizations for inpatient acute care,urgent care,emergency care,or primary care.
In June, several insurers, including Blue Cross Blue Shield of Massachusetts and Point32Health, committed to reforms, including honoring existing prior authorizations for 90 days when patients change insurance plans.
A Debate Over Costs
While the administration argues that standardizing and restricting prior authorization will reduce administrative burdens and lower healthcare spending, others disagree.The council for Affordable Quality Healthcare, based in Washington, D.C., estimates that the healthcare industry spent $1.3 billion on administrative costs related to prior authorizations in 2023-a 30 percent increase from the previous year.
However, a 2023 report by Milliman, commissioned by the Massachusetts Association of Health Plans, suggested that eliminating prior authorizations could increase healthcare spending by $600 to $1,500 per member annually. Lora Pellegrini, CEO of the association, emphasized that prior authorization is “a core affordability safeguard that promotes evidence-based care.”
The potential benefits were powerfully illustrated at Healey’s news conference, where a patient named Melissa shared her experience struggling to access a critical drug for a serious autoimmune neurologic illness. She recounted how a three-month wait for insurance approval allowed her condition to deteriorate, causing permanent harm. “For a patient in the world of neurology…three months is like three years,” she said, questioning why she had to endure such a delay.
Dr. Paul Hattis, a senior fellow with the Lown Institute in Needham, acknowledged that prior authorizations won’t disappear entirely, and questioned the extent to which the changes will reduce spending or administrative burdens. However, he applauded the potential to simplify care for consumers.
The new working group is expected to deliver recommendations by June. Previous state task forces on healthcare issues have yielded limited results, but Hattis expressed optimism that the current affordability challenges will compel the Legislature to act. “The affordability challenges now are so great and getting greater that I don’t see how our Legislature can rationally sit by and do nothing,” he said.
