ALREADY-THORNY PROBLEMS of skyrocketing health care costs and lackluster access to services will likely continue to worsen in the coming years as a result of federal policy changes, a series of experts said Wednesday, putting more pressure on Massachusetts to “exercise some courage.” 

Months after state watchdogs reported that health care spending once again blazed past the target for affordability, the Health Policy Commission convened the usual cavalcade of policymakers, analysts, providers, and insurers on Wednesday to survey the landscape and ponder steps Massachusetts can take. 

Speaker after speaker at the day-long cost trends hearing landed on a similar conclusion: The state’s long-standing health care problems will only grow more dire thanks to funding cuts and eligibility changes enacted by the Trump administration. 

Attorney General Andrea Campbell, who has repeatedly challenged the federal government in court, warned that “business as usual is not working” on the health care front. 

“It may mean we have to exercise some courage, be a little bit more bold, take a few more risks, revisit the benchmarks,” Campbell said. 

Elected officials will have their hands full charting a state response to the massive changes coming through the federal reconciliation package, a law supporters dubbed the One Big Beautiful Bill Act. 

About 300,000 Bay Staters are expected to lose coverage through MassHealth, the state Medicaid program, or the Massachusetts Health Connector marketplace over the next decade, according to state data cited by Blue Cross Blue Shield of Massachusetts Foundation president Audrey Shelto. 

Once the myriad provisions in the law fully take effect, Massachusetts will lose about $3.5 billion annually in federal health care funding — more than a quarter of the $12.3 billion the state receives from Washington today for health care, Shelto said. 

“The state is going to have to make some really, really hard decisions. This is not a number that they can make up,” Shelto said. “Some of the decisions are going to also have to be: Who gets covered? What do they get for coverage? What do providers get paid?” 

Under the new federal law, some lawfully present immigrants — about 2,500 in Massachusetts, according to Shelto — will lose eligibility for Medicaid and the Children’s Health Insurance Program. 

Many other potential enrollees will face work requirements to qualify for Medicaid and will need to prove that they remain eligible every six months, twice as often as current policy. Shelto said those two changes together are projected to “double the rate of uninsurance in Massachusetts.” 

She stressed that impacts will bleed out to all Bay Staters, not just those who might lose heavily subsidized health insurance. If funding cuts cause providers to stop offering services or to scale back staffing, Shelto said, “it’s not going to matter if you’re receiving MassHealth as your insurance or if you have Blue Cross Blue Shield or Point32 or anyone else — that place is not going to be available to you.” 

On top of those changes, more than 300,000 residents face higher premiums starting in 2026 for insurance they get through the Health Connector because of expiring federal tax credits. 

Democrats in Congress have been pushing to extend those subsidies beyond their end-of-year sunset, making the topic a central focus during the record-breaking government shutdown, but it appears unlikely they will be able to get enough Republicans on board. 

“We may be able to turn this crisis into an opportunity,” Shelto said of the combined federal impacts. “We may be bold enough to do things that we wouldn’t go near before because they were just too hard. But the urgency and the potential devastation here is just so imperative for us to really do that.” 

Deep fissures in the state’s health care system had been apparent long before passage of the reconciliation package or agreement on a deal to reopen the government without extension of the subsidies. 

Take the assessment Sen. Cindy Friedman, the Senate’s point person on health care, delivered in March, nearly four months before Trump signed the megalaw: “We hear about a system in crisis,” she said at the time. “We’re beyond that. It is now falling apart.” 

“We’re seeing all of these issues being exacerbated by the federal administration, not just because they’re seeking to take resources away, but [also because of] the chaos and the confusion,” Campbell told reporters Wednesday. “You don’t know at times what their policy is, or you’re learning it 24 hours before it’s supposed to take effect, and then we’re in court trying to protect Massachusetts residents.” 

Total health care spending in Massachusetts grew 8.6 percent from 2022 to 2023, far above the 3.6 percent benchmark that represents the state’s cost-containment goal, driven in part by higher spending on pharmaceuticals and specialty care. 

The trend has saddled many employers and households with higher costs, too. Premiums for small businesses will increase by an average of 11.5 percent in 2026. The Center for Health Information and Analysis said in March that more than two in five Massachusetts residents struggled to afford health care in some way over the past year. 

Neil Abramson, the owner of ECi consignment stores, said the squeeze is being felt in both directions. “Businesses like ours and our employees are spending more and getting less from their health care,” he added. 

Other attendees also warned of a dire state on the front lines.  

New England Medical Association president Dr. Ellana Stinson said she’s observing more and more patients unable to afford basic medications. Liliana Patino, senior director of community impact and development for Eliot Community Human Services, said community agencies are “overwhelmed” trying to translate complex policy changes into language that people can understand. And Dr. Katherine Gergen Barnett, the vice chair of primary care innovation and transformation at Boston Medical Center, said the ability to provide high-quality care faces “grave danger.” 

Gergen Barnett called on policymakers to devote significant attention and new resources toward primary care, an area where provider burnout and comparatively low investment are making it harder for residents to get appointments. 

In 2021, only about 8 percent of all commercial health care dollars in Massachusetts went to primary care. Some policymakers are beginning to coalesce around the idea of mandating a higher share of funding for primary care, which could draw resources away from other areas. 

For her part, Gergen Barnett suggested Massachusetts direct 10 percent to 12 percent of health care dollars toward primary care. 

“This is not business as usual,” she said. “Primary care and the health of Massachusetts depend on urgent action.”