MASSACHUSETTS’S NEW SECRETARY of health and human services has long had equity on his mind, even if national pressures now discourage using social justice language to describe it.  

“The way I think of health equity is the capacity of the system to spend more resources and more money on those who need it the most,” Dr. Kiame Mahaniah said on the latest episode of The Codcast.  

“Even though ‘Trump 2’ tries to stay away from the word equity, when they talk about rural health, they’re talking about equity. When they’re talking about substance use disorder, they’re talking about equity,” he said. “When they’re talking about bringing in a digital infrastructure and rural areas, that’s digital equity. They’re using different words, but the concepts – that the more pain that you’re in, the more services you should receive – I think those are right. Those are accepted concepts. And I don’t see us veering away from that in Massachusetts.” 

This week, on the monthly Health or Consequences episode of The Codcast, John McDonough of the Harvard TH Chan School of Public Health and Paul Hattis of the Lown Institute spoke with Mahaniah as part of CommonWealth Beacon’s health care access month and its special “Critical Condition” coverage. 

Mahaniah served as undersecretary of health for most of Health and Human Services Secretary Kate Walsh’s tenure. Upon Walsh’s departure for personal reasons in July, Gov. Maura Healey appointed Mahaniah as a permanent replacement.  

Massachusetts was already dealing with system stressors before the second Trump administration began, Hattis and Mahaniah noted. That included the primary care crisis, provider burnout, and difficulty for certain regions and populations to reliably access the health care they need.  

“As the improvement engineers say, your system is designed to get the results that it’s getting,” he said. The current system is complex and built on “a financing system that is not favoring primary care,” he said. 

Massachusetts, rather than a fee-for-service model, could consider payment systems that force a certain amount of primary care spending or work on a pre-paid prospective model. 

But when it comes to ensuring access to medical care like vaccines facing federal complications, the state is in a difficult position. While the Healey administration is crafting a process for recommending vaccines separate from the federal government’s position, there will likely still be issues securing those vaccines at an affordable rate, Mahaniah said. 

“I think the harder part is what’s going to happen to the purchasing and the distribution of these vaccines, because that was really coordinated by the CDC, and it was predicated on the CDC covering the vaccines from its own committee,” he said.  

The federal government was able to purchase tens of millions of doses for a negotiated rate that even a collaboration of states just cannot match, he said. “Will that whole infrastructure go away – meaning the ability to order vaccines and distribute them? … We really do worry about the purchase, the distribution, and then of course, the impact that it could have on health coverage.” 

On the podcast, McDonough, Hattis, and Mahaniah discuss looming Medicaid cuts (5:30), the primary care crisis (19:15), and how to make sure the vulnerable can still access health services (26:30).