Opinion | Shaul: Missouri Employers Need More Choices to Control Health Care Costs

For Missouri grocers, the rising cost of health care isn’t an abstract policy debate. It’s a cost they deal with every month as they work to provide health insurance for their employees and their families.

Our members include independent grocers serving small towns as well as larger employers with hundreds of employees. Grocery stores operate on tight margins. When the cost of providing health insurance goes up, employers feel it—and employees and their families ultimately feel it too.

That’s why Missouri employers should pay attention to something happening behind the scenes in health care contracts.

Some contracts between hospitals and insurance companies contain provisions that limit an insurer’s ability to tell patients that another hospital or health care provider may offer the same service at a lower cost. They can also prevent insurers from designing health plans that make it less expensive for patients to choose providers that offer better value.

These are commonly called “anti-steering” and “anti-tiering” clauses.

Those aren’t terms most Missourians use around the dinner table. But the effect is fairly simple: they can limit choices that could save employers and their employees money.

Think about it in terms of a grocery store.

Imagine one supplier tells a grocer: “You can buy from my competitors, but you can’t encourage your stores to buy from them—even when they offer the same quality product at a better price.”

No grocer would consider that a healthy, competitive marketplace. Yet employers purchasing health insurance can find themselves paying the bill for a system where similar restrictions exist.

This isn’t just a concern being raised by Missouri employers.

The U.S. Department of Justice has challenged similar contract restrictions at major hospital systems in Ohio and New York, arguing that they limited competition and made it harder for employers, insurers and patients to benefit from lower-cost health care options. In Ohio, the case has already resulted in a proposed settlement that would prevent the hospital system from using contract terms that discourage health plans from directing patients toward more affordable options.

Missouri shouldn’t have to wait for a federal lawsuit to take a serious look at the same issue.

Hospitals are essential to Missouri communities, particularly in rural areas where maintaining access to quality health care is critical. This isn’t about diminishing the important role our hospitals play. It’s about making sure competition can work.

If one hospital or health care provider can deliver high-quality care for less money, employers and employees should be able to know that. And health plans should be able to give people incentives to choose that provider.

Last legislative session, Rep. Dane Diehl brought forward legislation addressing these types of restrictions in health care contracts. The issue deserves the General Assembly’s attention again this coming session.

I spent years serving in the Missouri House of Representatives, and I understand that health care policy is rarely simple. Hospitals have concerns. Insurance companies have concerns. Doctors and other providers have concerns.

But employers and employees have a seat at this table too—because they’re paying much of the bill.

For Missouri grocers, controlling health care costs isn’t about providing employees with less. It’s about making the dollars they spend on health benefits go further.

Our members compete every day. They negotiate with suppliers, compare prices and look for ways to provide better value to their customers. They should be able to expect those same basic principles of competition and transparency when purchasing health care.

And this issue extends far beyond grocery stores. Businesses across Missouri are trying to provide good health benefits while dealing with costs that continue to rise. When contracts prevent a health plan from helping employees find high-quality care at a better price, that’s a problem worth addressing.

Missouri can support strong hospitals while also supporting competition, transparency and choice.

As lawmakers return to Jefferson City, I hope they will take another serious look at Rep. Diehl’s proposal and listen to the employers and employees who are paying these costs.

Health care policy can be complicated. This issue doesn’t have to be.

When Missourians can get the same quality care for less, they should be allowed to know about it—and they should be allowed to choose it.