Holding the line

While public employee union leaders pitched their own plan to curb municipal health insurance costs yesterday, I was still wondering how the state had managed to limit premium increases for its employees in the fiscal year ahead to just that 2.4 percent.

The Group Insurance Commission manages health insurance for 185,000 subscribers and their families. Besides state workers, that includes employees of 20 municipalities that have joined the GIC since 2007.

The commission reported its new premium estimates at the end of last week.

Relatively small rate increases are good news for the state and for cities that contribute to plans managed by the commission. They also put pressure on municipal employee unions representing workers elsewhere. Any deal negotiated with other Massachusetts cities and towns to limit health premium hikes will surely be measured against those small rate increases available through the GIC.

But how did the commission actually manage to keep its rate increases to just 2.4 percent?

For starters, it’s important to remember that the expected premium change is an average spread out over hundred of thousands of insured workers and more than a dozen plans. Still, the 2.4 percent figure is real.

Dolores Mitchell, the commission’s executive director, says scale helped keep a lid on GIC rates. The state’s biggest insurance pool has plenty of negotiating power.

Another factor: The actual use of medical services by covered employees is not increasing. That’s been the case for awhile, and the commission expects usage to remain about flat in the year ahead, Mitchell says.

The other big factor keeping the GIC’s average rates down revolves around new “limited network’’ insurance plans that restrict access to more expensive hospitals and health care providers.

All state employees will be required to reenroll in a health insurance plan next month. Mitchell expects about 13 percent of employees will be covered by those limited plans when the reenrollment process ends in May.

What’s the appeal? The limited network policies can be as much as 20 percent cheaper, Mitchell claims. The commission is also offering the first three months of coverage free to employees who switch into one of those plans.

The commission is also going to place employees who fail to select a specific plan during reenrollment into one of the limited network policies. Mitchell expects that to be about 5 percent of employees.

The number of people who try limited network policies offered by the GIC and the number who stay with them may turn out to be very different over time. But those policies are a big reason state employee health rates are expected to remain under control in the year ahead.

Whom does the public blame for sky-high health insurance rates?

That would be almost everyone, according to a public opinion poll conducted for the Massachusetts Association of Health Plans, the trade association representing state health insurers.

But insurers themselves are near the front of the line for a slice of the blame pie, according to the private survey that came my way.

Drug companies were named as most responsible, followed by insurance companies, hospitals, and the state Legislature. The public itself was the eighth most culpable party identified in the poll.

Most of the people surveyed said they would favor rate caps on both hospitals and insurers as a way to limit the rising cost of health care.

The survey, of 400 Massachusetts residents, was conducted for the hospital association from Jan. 7 to 10.

The results, compared with those from a similar poll conducted in 2007, found people with a low opinion of insurance companies had increased to 64 percent from 47 percent. Those with a low opinion of Blue Cross Blue Shield of Massachusetts doubled to 26 percent in polling that was conducted before the recent controversy over compensation for former chief executive Cleve Killingsworth.

Teaching hospitals are often identified as a key source of rising health costs, but they scored highest on the poll’s reputation question. A total of 85 percent of those polled had a high opinion of teaching hospitals.

Steven Syre is a Globe columnist. He can be reached at syre@globe.com.

Correction: Because of a reporting error, this column incorrectly referred to the sponsor of a public opinion poll on health care issues. The sponsor, the Massachusetts Association of Health Plans, is a trade group representing health insurers.