Working Missourians can’t afford hidden hospital contract games

Every year, the trustees of our carpenters’ health and welfare fund sit down to figure out how much it will cost to keep our members and their families covered. And every year, the number goes up. Not because our members are getting sicker. Not because they’re using more care. It goes up because health care costs keep climbing, while hidden contract restrictions can tie our hands before a single hammer swings or a single patient walks through a hospital door.

For years, we assumed that was just how health care worked, a cost of doing business, like the price of lumber or diesel. But the more our fund’s advisors have dug into our claims data and the way provider networks operate, the clearer it’s become that the problem isn’t just what health care costs. It is whether health plans like ours are actually allowed to fight for a better deal. Contract provisions negotiated behind closed doors can restrict competition before our members ever get a bill.

These provisions go by names like anti steering, anti tiering, all or nothing, gag clauses, and most favored nation clauses. Most working people have never heard of them.

They should.

Big hospital systems can use anti steering and anti tiering clauses to stop an insurance provider like United Healthcare, Anthem, or Cigna from designing health benefit plans that incentivize our members to choose high quality, lower cost providers.

All or nothing provisions can go even further. They can effectively tell a health plan that if it wants access to one hospital, facility, or provider within a large health system, it has to contract with all of them.

Think about that.

If our health fund believes one facility delivers excellent care at a competitive price, we should be able to contract for that care. We should not have to purchase every other facility or service owned by the same system just to get it.

No contractor would accept being told that buying one piece of equipment means buying everything else the supplier sells. We should not accept that logic in health care either.

Our members negotiated for these health care dollars. Their employers contribute those dollars as part of their compensation. Trustees have a responsibility to use them wisely.

We should be allowed to shop for value.

Hospitals and health systems should absolutely be allowed to compete for our members’ business. When a hospital provides outstanding care at a fair price, we want our members using it.

But competition only works when both sides are actually allowed to compete.

When contract provisions prevent health plans from steering members toward better value, building meaningful provider tiers, or selectively contracting with the providers that best serve their members, they take negotiating tools away from the people paying the bill.

In a market that’s supposed to reward better quality and better value, that’s a rigged game. Working families and their union benefit funds are the ones who pay for it.

This isn’t a theoretical concern for organized labor. Just last month, the Cleveland Bakers and Teamsters Health and Welfare Fund filed suit against OhioHealth, alleging the hospital system used restrictive contract provisions, including anti steering and all or nothing requirements, to block insurers from offering lower cost plan options that could have saved that fund’s members real money.

That lawsuit follows on the heels of federal antitrust actions brought by the U.S. Department of Justice against OhioHealth and New York Presbyterian over similar restrictions. When the federal government and union trust funds are independently landing on the same conclusion, that these contract terms can squeeze out competition and drive up costs, Missouri labor should be paying close attention.

Because here’s the question working families in this state deserve an answer to:

Are Missouri health plans free to negotiate for the best combination of quality and cost?

Can we reward providers that deliver better value?

Can we direct our members toward a better option?

Can we contract with the facilities we want without being forced to purchase an entire health system?

Or are hidden contract restrictions taking those choices away?

We should not have to guess.

Our members build this state. They pour the concrete, frame the buildings, and show up to work every day trusting that the health benefits they’ve bargained for will actually be there when they need them, at a price their fund can sustain. That trust shouldn’t be undercut by contract language they’ll never see.

Missouri hospitals do essential work, especially in the rural communities where access is already stretched thin, and they deserve to be financially strong.

But strong hospitals and fair competition are not opposing goals.

Hospitals should compete based on the quality of their care, their outcomes, their service, and their price. Union health funds should be able to reward the providers that deliver the best value for their members.

That is not anti hospital.

That is competition.

As the legislature comes back in next session, organized labor in Missouri will be at the table.

Our ask should be simple.

Let hospitals compete. Let health plans compete. Let quality, service, outcomes, and price determine who earns the business.

And stop hidden contract restrictions from standing in the way.

Our members have paid enough for fine print they never got to read.