Denise McDonough is president of Anthem Blue Cross and Blue Shield in Maine.

Every Mainer can likely agree that health care is becoming less affordable. Where we sometimes disagree is on the solutions — and some proposals risk making the problem worse, not better. This is the case with an op-ed published here in December (“Health insurance companies should pay a price for abandoning Maine”), which proposed kicking insurers out of the state when they push back on health care prices from large health systems.

Here’s the reality: Anthem does not threaten to remove health care systems in Maine from our network in order to get fair prices for our customers; it is consistently the opposite that happens.

Large health systems here and across the U.S. routinely try to gain leverage in negotiations by publicly threatening that they will leave our network unless we agree to exorbitant price increases they are demanding. That type of behavior puts their patients — our members — in the middle of these negotiations, often months before an existing contract is set to expire.

When a health care system demands excessive increases and uses the threat of leaving our network as leverage, we do what Maine employers and families expect us to do: we push back on price increases that are unrealistic. That is our responsibility. Health care inflation already outpaces overall inflation year after year, and without intervention, the cost of coverage will become unaffordable.

Why do large health systems have so much leverage in negotiations to begin with? One reason is because health insurers must maintain adequate networks so that their members can access the services they need. Health care systems know this and use it to their advantage, especially when there is little competition in specific areas.

We cannot address affordability unless all stakeholders in the system are at the table.

It’s not enough for hospitals to provide care; they must also do everything in their power to ensure the care is affordable. Here’s one example — charges for knee surgery. It’s common that hospitals charge two to four times more for these surgeries than non-hospital independent providers charge. Why? Because they can.

Employers — especially small businesses — are already struggling to maintain coverage for their employees. Families are juggling health care, housing and grocery costs that continue to rise. We need guardrails that protect consumers, not policies that would remove the only remaining counterbalance in the system — our ability to negotiate on behalf of the people we serve.

Maine’s health care landscape is shaped by consolidation. Over the years, mergers have reduced the number of health systems to just a few, each with significant market power. When a market becomes this concentrated, even well-intentioned systems end up with outsized leverage. That leverage directly affects what Mainers pay for care and for insurance. Without meaningful reform in this area, costs will continue to climb — no matter who your insurer is.

In Maine, our Certificate of Need laws can create high barriers to entry for potential new participants. We all want more competition and more choices, but it is extremely difficult for new entrants to establish themselves, particularly when existing systems use the existing process to thwart competition. Any policy discussion about affordability must account for this reality and encourage the development of alternative sites of care that can provide high-quality services at a lower cost to patients.

At Anthem, our approach is simple: we work proactively and collaboratively with hospital systems across the state. Maine’s hospitals and clinicians are essential partners in serving our communities. But partnership does not mean writing a blank check. It means coming to the table with shared goals — improving quality, expanding access, supporting rural care and keeping coverage affordable.

Again, all players in the health care system must work together to make care more affordable. Absent that collaboration, health care costs will continue to increase at rates much higher than inflation.

Instead of punitive proposals that would reduce choice and drive costs even higher, Maine needs solutions rooted in balance, transparency and shared accountability. Let’s focus on addressing consolidation, strengthening competition and supporting partnerships that put patients first.

Mainers deserve this. And we can achieve it — but only if we work together on real challenges, not distractions.