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chief medical officer for Avera, said only 21 percent of the doctors available in Avera's network are Avera doctors.

But to Sen. Tim Begalka, there are no good guys in the health care industry.

Sanford and Avera each offer their own health insurance plans.

Converse Blue And White

Converse Blue And White

"When you say there are no bad guys, to me, I think you're all bad guys," he said. He blamed hospitals, insurance companies and others in the industry for driving up costs.

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That prompted an angry response from Sen. Mark Johnston to Begalka. Both are Republicans, but Johnston works for Sanford.

"Health care systems are not the bad guy here," Jacobs said.

Health insurance plan prompts testy debate

The "willful provider" bill has split the health community and is bitterly opposed by insurance companies and the hospital systems in South Dakota. In addition, an undercurrent of anti Sanford and anti Avera McKennan sentiment seems to be driving the debate, as lawmakers who support the effort worry that the hospitals are consolidating and forcing consumers to use one system or the other.

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The measure would enable doctors Converse High Tops

One of the most contentious issues left in the Legislature would require health Converse Blue And White insurance plans to pay for the services of out of network providers, which supporters say will allow patients to keep their current doctor even if their insurance changes.

But this effort, which cleared the House and now only awaits a final vote in the Senate, has moved further into the process, in part because of an economic study produced by University of Shoes Converse

"I want to stress Sanford is not the bad guy, OK?" Holien said near the end of the hearing. "There is no bad guy. This is business. This is capitalism, OK? I wish I had enough money to name stadiums after me, quite frankly."

"What have you done the last 30 years? It's gone up and up and up."

Tad Jacobs, Converse Gray And Black

South Dakota economics professor Mike Allgrunn.

Mike Shaw, representing the South Dakota Association of Specialty Care Providers, accused the hospital systems of using their insurance plans to deprive them of choice.

to see patients in different insurance networks and then bill the patient's network for the amount in network doctors can bill. Similar measures were unsuccessfully introduced in 2004 and in the 1990s.

But Allgrunn's analysis is not shared by the insurance industry, hospitals or others. They argue that insurance companies rely on negotiating discount deals with networks of health providers. If patients can go outside those networks, the cost to insurance companies and, thus, consumers will rise, they say.

The toughest questions, however, came about the hospital systems and the evolving nature of health care. Doctors testified that patients were forced to find new doctors when insurance changed. The hearing also reopened the rift between the nonprofit hospitals and physician owned specialty hospitals. The nonprofits successfully lobbied Congress during the Affordable Care Act to include a provision that makes it virtually impossible for physician owned hospitals to expand, so there is bad blood between the two.

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Converse Blue And White

"You know, it's amazing sitting here listening to this," Johnston said. "And we're a body of decorum, and when we have people saying negative things directly about one organization or the other, I want to turn to the trash can and regurgitate, because we're better than that."

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"I found there is no evidence that it will increase costs, and there is some evidence it will decrease costs," Allgrunn testified.

During the grueling, two and a half hour hearing, Sen. Ried Holien, a Watertown Republican who is chairman of the Senate Commerce and Energy Committee, repeatedly had to warn those testifying not to be negative.

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Converse Blue And White

Converse Blue And White

At a hearing on the issue last week, references were made to the amount of money the nonprofit hospitals make and Sanford's investment in sporting facilities in Sioux Falls.

"They're taking money out of one pocket and putting it in another," he said.

Lorin Pankratz, a lobbyist for Sanford, said the hospital systems make up only 21 percent of the market and aren't monopolies.

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