News & Events

Playing hardball with hospitals

THE FAILURE of the state’s insurers to hold down reimbursements to doctors and hospitals is a chief reason behind skyrocketing increases in health costs. The insurers’ effort now to strike harder bargains with hospitals is overdue but welcome.

The state left the insurers with no other option when it recently rejected many of the rate hikes that the insurance companies had submitted for the small-business pool, which is overseen by the state. Held to 2009 rates for these customers, the insurers cannot afford to continue the business-as-usual reimbursement hikes expected by doctors and hospitals.

Of course, hospitals with marquee names can threaten to pull out of an insurer’s network if they are denied the increases they seek. In the past, such a pull-out was enough to bring an insurer to heel, for fear that big employers would look elsewhere for their workers’ coverage if a network did not include a Mass. General Hospital or Children’s. But employers themselves are increasingly fed up with premium increases and may be more willing to accept a provider network that includes some but not all Boston teaching hospitals.

The state Senate’s health-cost bill would require insurers to offer lower-cost plans with limited networks of providers. The bill includes other useful measures for holding down premiums but has been put on a backburner in the House, unfortunately. That is one more reason the insurers have to play hardball with the providers — and earn their slice of the premium dollar