BOSTON (SHNS) - "The Steward hangover — if you think it's gone, it's not." At an event held by MASSterList and the State House News Service, Massachusetts Health & Hospital Association President and CEO Steve Walsh concurred on Wednesday with the suggestion by another industry leader that the state could see more hospital closures unless dramatic structural changes are adopted. A panel of hospital, health insurance and community care leaders agreed that while there's a heightened awareness of the vulnerabilities in the state's health care system post-Steward, structural failures will persist if broad action isn't taken.  Massachusetts Health Policy Commission Executive Director David Seltz opened the discussion at the MCLE Conference Center in downtown Boston by dubbing the past year a "cold reality" and concluding that the state "need[s] to update our laws to protect against potentially predatory actors," and to ensure compliance among all industry actors.  Seltz's context included much larger industry challenges than just Steward alone, per the HPC's October cost trends report. The report found structural financial issues across hospitals statewide — only 25 of 58 hospitals reported positive operating margins in the past year, according to Seltz — and that Massachusetts has the second-highest family health insurance premiums in the country. He said the cost of care is creating widening disparities and health outcomes, with a disproportionate impact on people of color and those with fewer resources. Sitting on the panel portion of the event were John Fernandez, President and CEO of Brown University Health (formerly Lifespan), and Dr. Abha Agrawal, President and CEO of Lawrence General Hospital. Rhode Island-based Brown now operates formerly Steward-owned St. Anne's Hospital in Fall River and Morton Hospital in Taunton, while Lawrence General took over Holy Family's campuses in Methuen and Haverhill from Steward. Both executives touched on the compressed timeline and financial responsibilities involved in taking over a Steward facility — Fernandez said Brown wouldn't have purchased the two facilities if it hadn't been "financially beneficial to the system as a whole." Agrawal said that without state aid, Lawrence General likely wouldn't have been able to purchase the property, adding that the conditions of the facility's medical equipment and physical infrastructure had been "absolutely worse" than she anticipated.  While the system might have exacerbated problems, Steward didn't cause the state's health care workforce issues and cost barriers. In the state's acute care hospitals alone, there are around 11,000 personnel vacancies — down from 19,000 earlier this year — according to Walsh, though the workforce burden lands on all care sectors, including primary, urgent and behavioral health care. Could the state's health care workforce issue be restored with incentives like free tuition for people going into the industry? It's an idea, according to NeighborHealth CEO Greg Wilmot. Leader of the largest community-based primary care health system in Massachusetts, Wilmot also said investing in community health centers as a vehicle to stabilize the "safety net system" is one piece needed to address the industry’s cracked infrastructure. Wilmot said one in six Bay State residents receive care at a community health center.  A conversation around equity on Wednesday centered on Medicaid and Medicare prices. President and CEO of the Massachusetts Association of Health Plans, Lora Pellegrini, said in her decades in the insurance industry she hasn’t seen the ecosystem “this bad,” naming a pullback in Medicare rates and inflation following Covid as potential contributing factors. Some panelists suggested that looking at the reimbursement issue through a lens of equity, fixing low Medicaid rates and not continuing to enable "cross-subsidization" would be a step in the right direction when beginning to attempt to bridge gaps of health-driven social needs and disparities.  Hospital officials and Pellegrini had differences in opinion about whether prior authorizations should remain in the industry. Where Pellegrini said getting rid of them would increase patient prices, fellow panelists suggested removing the need for prior insurer approval for certain services and prescriptions would impact patients beneficially. As for how the Legislature could play a role in rebuilding and repairing the fractured system, industry leaders suggested addressing workplace violence, creating more authority for the Health Policy Commission and reining in pharmaceutical prices.