GOV. HEALEY made two splashy health care policy announcements last week. The question now is whether there is steak behind the sizzle.

First, she asked the Division of Insurance to draft regulations barring commercial insurers from requiring prior authorization for prescriptions and care involving many routine and essential services. Second, she announced the creation of a 30-member Health Care Affordability Working Group, charged with developing “concrete proposals to reduce health system costs and ultimately make health care more affordable for patients, families, and employers.”

Eliminating prior authorization for routine care is, frankly, a no-brainer—and a path that some of our insurers already were on. The creation of a new Affordability Working Group potentially represents a much bigger development. Given the severity of the health care affordability crisis facing Massachusetts households, businesses, and the state budget itself, we should all hope this initiative leads to significant policy breakthroughs. But hope alone won’t get us there.

One way to assess the likelihood of success is to view the announcement through the lens of some skeptics. What follows is a composite of the arguments that I have heard since the announcement from some consumer advocates, health policy experts, and a few business and health care leaders. Most of them share my hope that the working group produces meaningful recommendations that lead to concrete action – but are worried that too often in these situations the status quo prevails.

The Political Skeptic

“Here goes Gov. Healey, kicking off an election year with a big announcement about health care affordability and access. It plays well politically, aligns neatly with national Democratic messaging, and allows her to say she’s taking action. But let’s be honest: Prior authorization isn’t disappearing. Plenty of patients will still face it, just now for a narrower set of services. And though the state Medicaid program now says it will also eliminate prior authorization for routine services, that still leaves state employees covered through the Group Insurance Commission without such relief.”

“As for the new affordability working group, we’ve seen this movie before. Even if it produces solid ideas, there’s no guarantee the Legislature will act. The state’s large and dominant hospital systems seem to always be able to thwart meaningful cost-containment legislation from moving forward. And until recently, health care hasn’t exactly been a signature issue for this governor—except when crisis forced her hand, as with the Steward collapse. If she’s serious, why not file legislation now and fight for it?”

The Cost Skeptic

“Getting insurers out of the exam room is a good thing. But let’s not oversell the savings. The scope of the prior authorization prohibition is limited, and health care utilization – and therefore costs — may even increase. Administrative savings will be modest since insurers and providers will still need staff for non-routine authorizations.

“And let’s not forget, people in self-insured employer plans—who make up the majority of privately insured residents—may still face these requirements. Employers, not insurers, set the rules there. So this reform may feel good, but it’s unlikely to bend the cost curve in a meaningful way.”

The Institutional Skeptic

“Why do we need a new health care affordability working group at all? We’ve had the state Health Policy Commission since 2012. Its staff has produced some of the most rigorous analyses in the country, documenting how Massachusetts—after early success—has now fallen back into unsustainable cost growth at the system, employer, and household levels.

“The problem isn’t a lack of diagnosis. It’s a lack of a clear prescription in the form of legislative action. The Health Policy Commission has made serious recommendations—on price growth, market power, and payment reform—but the Legislature has punted on nearly all of them. Other states have moved ahead with versions of these ideas — Maryland, Rhode Island, California, Oregon, Washington, and others. Massachusetts is now playing policy catch-up.

“And let’s not forget the Primary Care Task Force, created just last year. Legislative leaders involved in that effort have already signaled that its recommendations are likely to advance. If the new working group is going to add value, it must look beyond primary care and tackle tougher issues: health care provider price growth, hospital global budgets, pharmaceutical pricing, pharmacy benefit manager practices, site-neutral payments, and out-of-network billing.”

The Governance Skeptic

“Yes, it’s encouraging to see stronger employer representation on the working group. Employers are absorbing double-digit premium increases year after year. But the group is still dominated by traditional health care interests—providers, health care systems, and unions—whose financial stakes are deeply embedded in the status quo.

“That raises a real concern: Will this group be able to advance recommendations that meaningfully cut against the interests of those in the room—especially large hospital systems and biopharma companies that have repeatedly prevailed on Beacon Hill?

“There are also open questions about leadership. Working group co-chair Lisa Murray, the head of Citizens Bank of Massachusetts, may bring a strong commercial insurance affordability lens. But what about her co-chair, Kate Walsh? As former secretary of health and human services and, before that, a health system CEO, will she be guided by the fiscal realities she witnessed during recent bailouts of Medicaid and the Group Insurance Commission? Or by a health care provider mindset that has long treated revenue growth as the system’s primary survival strategy? And will her new role as a Blue Cross of Massachusetts Board member have any impact on her policy thinking and the guidance she gives to the working group?”

The Real Test

All of this complexity makes skepticism understandable. Massachusetts doesn’t suffer from a shortage of commissions, task forces, or data. What it lacks is follow-through—particularly when reforms threaten entrenched financial interests.

For now, the announcement of the new working group offers promise, not proof. Whether it delivers real affordability will depend less on process and far more on what happens if meaingful recommendations hit the Legislature.

If the group simply repackages well-known analyses or avoids taking on the important cost drivers, it will fail to move the needle. If it produces a focused set of politically difficult but economically necessary recommendations—and the governor uses her political capital to insist on action—this effort could mark a turning point.

Paul Hattis is a senior fellow at the Lown Institute. He co-hosts the monthly Health or Consequences episodes of The Codcast.