When I read that the state was mandating insurance companies to cover urgent care centers in Massachusetts, my blood started boiling. The Massachusetts Legislature can force insurance companies to pay for “doc-in-the-boxes” but not for primary care? Health care is at a crisis point in the commonwealth. In western Massachusetts, thousands of patients cannot find a primary care doctor, and practices are struggling to recruit physicians. The work is relentlessly hard and underpaid, which has only worsened since the pandemic due to increased insurance bureaucracy and drug shortages.

In our medical home in western Mass., we work with patients to control chronic diseases, detect and treat illnesses, and prevent diseases as much as possible. Good primary care eliminates the need for most urgent care clinics — we see patients when they are sick and treat them so that our patients rarely need to go to the emergency department. Countless studies have demonstrated that primary care improves health and decreases costs. Expanding urgent care is a band-aid approach to the dearth of primary care and undervalues the crucial role that primary care plays in our health care system.

In the wake of the Steward Health Care fiasco, I am struck by how no one has pointed out the obvious fact that even a wealthy company underwriting primary care in Massachusetts cannot financially survive.

So why are we not doing more to support the medical practices that bear the brunt of the work? Offices like ours are struggling to stay in business as our overhead costs have soared, yet insurance companies continue to pay what they did 10 years ago. High-deductible insurance programs are hurting both us and our patients. They intentionally discourage patients from seeing a doctor early in an illness or getting routine maintenance of their chronic diseases.

There are no studies showing improved outcomes with high-deductible health plans, yet most insurance companies in the commonwealth mandate thousands of dollars out of pocket per person per year for routine medical care, in addition to the exorbitant premiums that people pay.

Mass House Bill 1140 would mandate that insurance companies pay outpatient doctor bills and not have these visits go toward deductibles. A version of this bill has been in the State House for nearly five years with little traction. We have been repeatedly told, “We can’t tell the insurance companies what to do.” Clearly, Massachusetts legislators can fight back. The question is, why they are not doing more to save primary care?

Katherine J Atkinson, MD, Fellow of the American Academy of Family Physicians; assistant professor, Family and Community Medicine, UMass Chan School of Medicine; medical director, Atkinson Family Practice in Amherst.