Butler Memorial Hospital and Highmark appear to be in something of a high-stakes poker game, each organization waiting for the other side to blink over reimbursement rates. But in the meantime, county residents and employers have to worry about the outcome of the negotiations between the hospital and the dominant health insurance company in the region in terms of future health care costs.

Most people acknowledge that BMH's recent record as a profitable hospital is a good thing, considering the significant financial pressures on health care providers around the nation. But if the hospital presses for significantly higher reimbursements from Highmark, the community will likely be paying higher health insurance premiums. And that will impact employers and their employees across Butler County and beyond.

In what Highmark says is a highly unusual move, the hospital filed formal notification of its intent to cancel its contract with Highmark. Representatives from the hospital claim this was a necessary first step in order to clear the way for a new contract with higher reimbursement rates to the hospital. Yet Highmark notes that other hospitals that also are renegotiating new reimbusement contracts have not announced plans to cancel their existing contracts.

As with any business negotiation, not much is known by people outside those directly involved in talks. And most people express confidence, privately at least, that an agreement will eventually be reached.

Still, the uncertainty is disturbing. Some county employers who received an informational warning letter from Highmark are fearful that higher reimbursements will mean higher health insurance premiums.That will hurt company profits and, in many cases, require higher contributions from employees.

Highmark claims that BMH's current demands for reimbursements, if agreed to by the insurer, would make Butler's hospital the most highly paid hospital in the region — higher than even the specialty care hospitals in Pittsburgh. Hospital officials claim to be acting as "advocates to patients who use Highmark."

Whatever happens, it seems clear that employers will be paying more to provide their employees with health care coverage through Highmark. And continually increasing health care costs are, in most cases, no longer borne solely by the employer — most employees contribute to their health insurance. So, increased costs resulting from significantly higher reimbursement rates to Butler Memorial Hospital will likely be felt by thousands of people across Butler County as well as many businesses.

Whether or not the financial needs associated with building a new hospital or investing in major renovations at the current site are driving the tough stance being taken by BMH is not known. In fact, not much is publicly known about the hospital's plans in general.

Many in the community continue to wait for a public discussion of the review by Astorino Co. of the two-campus proposal (called Plan C) floated by hospital officials several months ago. At this point, due to lack of two-way communication with the public, we have only speculation and rumor regarding the hospital's plans for the future.

The uncertainty over the BMH-Highmark dispute has many businesses in the hospital's service area worried and also serves as a reminder of the rest of the uncertainty surrounding the hospital.

For now, the community can only wait and see how the hospital handles both the standoff with Highmark and the announcement of its plans for a new facility — and wonder about the associated costs.