Hopkins v. CareFirst: A resolution has been reached, but not before significant damage was done | COMMENTARY [Baltimore Sun]

Baltimore Sun (MD)

Imagine for a moment that you were one of the several hundred thousand Marylanders who gets their health insurance coverage from CareFirst BlueCross BlueShield and you received a letter from Johns Hopkins Medicine informing you that your longtime provider may no longer accept your coverage because the two entities have thus far failed to reach a deal on certain payments.

This clash of the titans — Hopkins health care system is Maryland’s largest provider, and CareFirst its largest insurer — was finally resolved Wednesday, when the two entities reached a new, multi-year contract. But they failed to do so before open season in health insurance offerings began for many employers, putting some people in the uncomfortable position of making a decision about their coverage without knowing if there might yet be some resolution.

As William Shakespeare once wrote, “As flies to wanton boys, are we to the gods. They kill us for their sport.”

Let us count the ways this was maddening. First, both of these organizations are nonprofits that have pledged to act in the public interest. Second, both appear to believe they were acting in that capacity in this dispute. Hopkins wanted a reimbursement rate that would allow their doctors and other providers to continue their work; Hopkins Health System President Kevin Sowers refered to this as a “sustainable” business model. But CareFirst executives had a similar rallying cry: They want to keep a lid on rising insurance premiums. If, for example, they don’t use their market position to keep down rates, what’s to keep health care from eventually becoming unaffordable? What happens if employees choose lesser coverage or none at all?

But third is this: Where was the government oversight?

Last week, Gov. Larry Hogan urged the two parties to get their act together and reach an agreement as soon as possible. He also told reporters in Annapolis that he planned to put pressure on them. But using the regulatory functions of state government to put pressure on the private sector hasn’t exactly been a Hogan trademark during his two terms in office.

Even now that the two sides have resolved the matter, the damage the impasse caused is significant. Marylanders made choices without a full knowledge of what is going to happen in the future. There were undoubtedly some, perhaps thousands, who were in ill-health and relying on a Hopkins provider for cancer treatment or chronic pain relief or any number of serious maladies. How much did they suffer over the uncertainty of what this means for their care and their family’s finances?

Here’s what we’d like to see — a more aggressive response from state government than mere hand-wringing and tsk-tsking in this kind of scenario. And it can start with the incoming Maryland General Assembly and governor launching a full-blown investigation this January into how this ridiculous standoff happened in the first place and what regulatory reforms might be required to make sure it never happens again. That might include making the Maryland Insurance Administration process for reviewing insurance rates a lot more transparent, with far greater public involvement than it gets today. How about we open the books a little wider on both CareFirst and on Hopkins? Let’s hear them justify medical costs as well as insurance rates. And after that, it would be nice to hear some testimony on why both nonprofits pay their top leaders millions of dollars each year. Maybe there’s some waste to be trimmed.

Make no mistake, this needs to be a painful procedure done without benefit of anesthesia. Both these institutions have done much good for Baltimore. But with this fiasco, they are demonstrating they can inflict some harm, too. Let’s give them (and other insurers and health systems) a strong incentive not to attempt this game of chicken again.

Baltimore Sun editorial writers offer opinions and analysis on news and issues relevant to readers. They operate separately from the newsroom.