Because they lack the bargaining power of a large company, small businesses have a tough time offering employee health insurance. Yet under the state's health reform law, many small operations -- those with 11 or more full-time equivalents -- are required to do so and contribute to the cost, or else pay a fine of up to $295 per employee per year

Getting everyone insured serves the public interest, but the law places a financial strain on small companies. So it was good to see movement on the issue when Gov. Deval Patrick announced recently that he plans to file two bills and develop purchasing cooperatives for small buyers.

The bills expand the powers of the state Division of Insurance in a way that might prove controversial.

One would give the Division of Insurance the power to review small-business premiums and reject the rates if the agency determines they are unreasonable. The second bill would expand the division's power to eliminate administrative costs it deems unnecessary.

Giving the state veto power over rates is nothing new. The Division of Insurance enjoys the same power for Medicare supplemental plans and for homeowners insurance purchased under the FAIR plan, which serves homeowners who are unable to get insurance in the open market.

But if the state artificially limits premiums for small businesses, insurers could try to make up the difference by raising rates for other customers.

In contrast, open-access purchasing cooperatives like the one Patrick proposed represent progress. Small businesses -- and individuals, too -- could join a cooperative to combine their purchasing power, thereby giving them a chance at lower rates.

The state's Health Connector was supposed to accomplish a similar goal; how the new cooperatives would be different remains to be flushed out.

Without question, customers have endured significant increases in recent years. Small businesses saw double-digit annual increases in health insurance, while coastal homeowners who were forced into the FAIR plan suffered large and sudden rate hikes.

The FAIR plan is a different animal in a number of ways, but for health insurance, comprehensive reform is what we need, not a piecemeal approach.