Hopkins v. CareFirst: Can a referee please call the fight? | COMMENTARY [Baltimore Sun]

Imagine for a moment that you are 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.

It’s bad enough that this clash of the titans — Hopkins health care system is Maryland’s largest provider and CareFirst its largest insurer — revealed last month continues today with no clear sign of resolution. But here’s where it gets especially painful for the average Marylander. It’s open season over health insurance offerings for many employers, meaning you now have to make a decision about your coverage: Stay with CareFirst or switch to a potentially more expensive in-network insurer without even knowing if there might yet be some resolution. State employees, for example, have until Nov. 4 to choose their 2023 coverage, yet the deadline for the Hopkins-CareFirst negotiation is Dec. 5.

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 is maddening. First, both of these organizations are nonprofits that have pledged to act in the public interest. Second, both appear to believe they are acting in that capacity in this dispute. Hopkins wants a reimbursement rate that will allow their doctors and other providers to continue their work. Hopkins Health System President Kevin Sowers refers to this as a “sustainable” business model. But CareFirst executives have 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 is 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 plans to put pressure on them. But how exactly? 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. Maryland Insurance Commissioner Kathleen A. Birrane, a DLA Piper attorney who formerly served on the University of Maryland Medical System’s board of directors before her appointment just two years ago, isn’t speaking out.

Frankly, Hogan administration officials likely expect the matter to be resolved soon. They’re probably right. The two sides have too much at stake not to find common ground. But the damage the impasse has already done is significant. Marylanders are already making choices without a full knowledge of what is going to happen in the future. There are undoubtedly some, perhaps thousands, who are in ill-health and rely on a Hopkins provider for cancer treatment or chronic pain relief or any number of serious maladies. How much are they suffering now 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. 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.

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