Three ways for Massachusetts to lead post ‘Big Beautiful’ bill.
We can point the way forward during dark times.
by Amie Shei
“Again and again in American history, we seem to be at our very best when things are at their very worst,” write Ezra Klein and Derek Thompson in their book Abundance. The recent passage of the misnomered One Big Beautiful Bill Act of 2025 marks a low point, yet it presents an opportunity for Massachusetts to lead through crisis, much as we did 250 years ago in leading our fledgling country’s fight for independence. Here are three ways our Commonwealth can be a beacon of hope and progress in this moment.
First, we must act boldly and collectively. The loss of federal funding for Medicaid, SNAP, scientific and medical research, transportation infrastructure, and more will have far-reaching effects that could foster a scarcity mindset and competition for limited resources. Alternatively, we could collaborate in service of the collective good, just as we did during the COVID-19 pandemic when competitor institutions came together to share data and personal protective equipment, and people helped strangers schedule vaccine appointments at all hours of the night. Though that collective spirit has since dissipated, it lurks beneath the surface and can be summoned with some intentional effort.
We must avoid piecemeal approaches that force community-based organizations to compete against each other for funding to fill gaps as our social safety net is weakened by the Trump legislation.
Such a fragmented approach is neither efficient nor sustainable. Instead, state government, nonprofits, philanthropy, and businesses must proactively collaborate and strategize on the daunting but essential task of building resiliency and upward mobility so that fewer residents need to rely on the social safety net and charity in the future.
Though we have a responsibility to ensure that no one falls through the cracks in this moment, we have an even greater responsibility to ensure that our system is not so rife with inequities and gaps for people to fall through, and it will take bold collective action to achieve that.
Second, we must allocate our resources where we can achieve the greatest return on investment (ROI). Not all spending yields the same ROI, and we must take a data-driven approach to deploy resources efficiently, effectively, and equitably to mitigate the negative impacts of the sweeping tax and spending bill. Medicaid and SNAP are critical to beneficiaries and to the organizations receiving funding through these programs, but they do not address the root causes of poverty that lead people to need these programs. Cliff effects make it difficult to achieve upward mobility and economic self-sufficiency, as higher earnings can result in fewer benefits, leaving one worse off.
Preventing negative health impacts during these fraught times requires more than just increased investments in health care. Currently, much of our health-related spending is directed towards expensive medical treatments and emergency department visits, which have a relatively small impact on population health, rather than prevention, primary care, and upstream social determinants of health like housing, food, and transportation that have a far greater impact.
Insurers and providers are directing more resources toward these social determinants in unprecedented ways to address patients’ basic needs. Though well-intended, each isolated effort adds yet another administrative layer to our complex Rube Goldberg system and further increases our health care spending.
Massachusetts is already among the places with the highest per capita health care spending in the world. Spending more may seem like a heroic way to demonstrate how much we value health, but true courage comes in recognizing that our current system is broken and in leading a system redesign that prioritizes investments in primary care and social determinants.
Such a system redesign will require significant political will and cross-sector collaboration to achieve a better allocation of resources in service of population health. It will not be easy, but we have overcome seemingly intractable challenges in the past.
Massachusetts has led the nation with the lowest rate of uninsured through our ethos of shared responsibility. Yet, Massachusetts has ranked among the top quarter of states with the greatest share of the population enrolled in Medicaid and SNAP, which is a reflection of state-level eligibility differences and also the need.
Imagine if we could reduce the share of residents who rely on safety net programs not through draconian cuts and new administrative hurdles but through collective action that builds opportunity and resiliency and through smart investments with high ROI. If we can achieve that, our Commonwealth will move much closer to a state of common health.
Third, we must leverage technology to mitigate administrative burden and negative impacts. Recognizing that unnecessary business regulations can hinder economic development, the Healey-Driscoll administration launched the Massachusetts Means Business initiative and the Business Front Door platform to streamline business support.
The administration should similarly provide familieswith a “front door” and navigator support, as unnecessary public program rules and regulations can hinder personal development and upward mobility. The least-advantaged families should not bear the burden of navigating a complex, patchwork system of supports and overcoming administrative hurdles. The application process for Medicaid consists of dozens of pages of detailed questions and required documentation, while the enrollment process for employer-sponsored health insurance usually entails one page of basic information.
The newly enacted federal legislation imposes more frequent eligibility redetermination and work requirements for Medicaid and SNAP, which increases the likelihood of churn or loss of coverage for those who remain eligible. Technology can play an important role in mitigating negative impacts, a role that could be especially impactful given the state’s executive branch hiring freeze.
AI-powered tools now facilitate immunization compliance and employment verification. Such tools can surely be adapted, with the necessary guardrails and data protections in place, to make it easier for eligible residents to enroll in needed programs and to stay enrolled. There may be no better place to develop and implement these new technological advances than Massachusetts, a global leader in education and innovation.
With crisis comes opportunity, and this is our focusing moment. These three strategies would be worth exploring even without new federal legislation, but they are critical in this new reality. We need not wait for the law’s implementation or the storm of negative impacts to get to work. Let us rise to our very best and lead the way.
Amie Shei is president and CEO of The Health Foundation of Central Massachusetts, a health conversion foundation based in Worcester. She is a member of the board of directors of MassINC, the nonprofit civic organization that publishes CommonWealth Beacon.