MANY PEOPLE TRYING to get health care services covered in Massachusetts are hitting an insurance wall. About one in five claims were rejected in 2024, according to a new report. The state says it’s addressing the issue with new regulations aimed at reducing administrative burden and improving patient access to care.

To unspool this and other health insurance issues, John McDonough of the Harvard TH Chan School of Public Health and Paul Hattis of the Lown Institute are joined on the monthly Health or Consequences episode of The Codcast by Michael Caljouw, the state commissioner of insurance.

In his first week as commissioner in 2024, Caljouw launched a series of listening conversations across the insurance marketplace. One issue that quickly arose, he said, was prior authorization — where medical providers must get approval from an insurer for coverage of a medical service or treatment.

Massachusetts had never really examined market practices around prior authorization, Caljouw said, and a new market-wide look at the extent of prior authorization and variation in its use found “substantial differences” in how and when insurance companies required it.

Gov. Maura Healey announced in mid-January that the Division of Insurance would be rolling out new regulations limiting the use of prior authorization for certain types of care. A public hearing is scheduled for February 19 on the proposed rules.

“The regulation should be seen as the first step to addressing many of the challenges that exist within the health care system,” Caljouw said. “And I should note that the insurance companies have taken a significant step with their commitment to this reform. I think it’ll be important to see that same level of commitment to reform across all stakeholders, because there’s other examples of administrative waste and administrative inefficiencies that will need to be taken so that we can adopt a better way of doing business at a time when we need to really be looking at everything.”

On the episode, Hattis, McDonough, and Caljouw discuss new regulations for insurers (5:15), concerns about the stability and solvency of the Massachusetts health insurance system (11:00), and insurer consolidation (17:15).