“I guess our question is why are small businesses seeing increases that are twice the rate of medical inflation? We believe the answer is that small businesses are treated as second-class citizens,” Jon B. Hurst, president of the Retailers Association of Massachusetts, said to Telegram.com.

Large companies have more leverage to negotiate lower costs, and rates for smaller groups depend more on factors such as age, community and industry, which can drive up premiums. Insurance plans will often charge small groups a higher base premium, despite providing the same coverage.

Insurers contend that they are raising premiums because doctors, hospitals and other medical providers are charging more. But the Massachusetts Association of Hospitals told the Telegram.com that “insurers can charge small businesses as much as 76 percent more in premiums than they charge their ‘big business’ counterparts,” while adding “billions of dollars to healthcare costs through their billing and claims requirements.”

Massachusetts Gov. Deval Patrick ordered health insurers to file their rates for small groups so the insurance commissioner can review them, said the Telegram.com article. Another piece of legislation would allow small businesses to form groups and purchase insurance together.