— Another deadline passed Monday night with little new to show from high-stakes negotiations affecting health care costs for hundreds of thousands of North Carolina state employees and teachers.

State Treasurer Dale Folwell is still pushing hospitals across the state to lower what they charge the State Health Plan and overhaul the way they set those payments.

Hospitals, with just a handful of exceptions, continue to resist the hit to their bottom line and the possibility that other insurance plans will try to follow the largest plan in the state in trading complex, opaque, company-by-company reimbursement contracts for payouts tied to what the federal government pays for health care.

Only five hospitals signed on by a midnight deadline, despite Folwell boosting the promised payments after a lower rate failed to bring hospitals around by his initial July 1 deadline.

More than 110 hospitals are included in the State Health Plan's current contracts, which serve some 470,000 state employees, teachers, retirees and their families. If the two sides don't strike some sort of agreement, nearly all of these facilities will be out-of-network for plan members, boosting out-of-pocket costs.

Folwell accused hospitals of "cartel-like" behavior Tuesday in a call with reporters, saying they're boycotting the State Health Plan. He has railed for months against rising prices and the industry's lack of transparency on how those prices are set.

Hospitals have complained of Folwell's intransigence and called on the General Assembly to pass legislation delaying his reforms, locking the status quo in place while reforms are studied. That measure has passed the House, but Senate President Pro Tem Phil Berger reiterated Tuesday that there are no plans to pass it in the Senate.

"It just puts off the point of decision for a year," said Berger, R-Rockingham. "I don't know that, 12 months from today, we'll be in any different position than we are now. ... There's a deal there to be had, they just need to move forward with getting there."

Folwell had previously said this latest negotiation effort was his final offer. After the second deadline passed Monday, he told reporters to "stay tuned" on what's next.

"We're not extending the deadline at this time," he said.

Folwell's plan would pay hospitals and other providers an average of 196 percent of what Medicare pays for procedures. That would save taxpayers, who fund the lion's share of the State Health Plan $166 million, the treasurer's office has said.

Plan members would save another $34 million. The total plan costs roughly $3.4 billion a year.

Hospitals have pitched other reforms in conversations with Folwell. A spokesman for UNC Health Care said Wednesday that its approach would be "comprehensive" and "result in a stable insurance platform for years to come." WakeMed spokeswoman Kristin Kelly said the hospital system believes "there is a better way to move forward."

"One that supports state employees by working to help lower health care costs and increasing pricing transparency while also guaranteeing accessible, quality care to all of the community’s residents," Kelly said in an email.

Folwell said the "value-based medicine" pitches that hospitals have advanced would only slow cost increases, not bring costs down or increase transparency.

But support for Folwell's position among a large segment of State Health Plan members appears to be eroding.

Mark Jewell, president of the North Carolina Association of Educators, sent the treasurer a letter Wednesday to express concern "about risking our members’ health as part of a political power struggle" and to seek more information for plan members, who must enroll this fall for 2020.

"We share your concern over the billing practices of hospitals and health systems which charge the SHP an excessive and unpredictable amount of money for the same procedures … and your vision for a more transparent and open health care marketplace and also agree that steps must be taken to save the SHP money wherever possible," Jewell wrote. "Unfortunately, both of these laudable goals are now in jeopardy as a result of the flawed ... strategy and implementation."

The Treasurer's Office has had more success recruiting individual doctors to the new arrangement, but the push has fallen fall short of the status quo.

Some 27,000 providers have signed on, out of roughly 61,000 statewide.

As for the hospitals, these are the five that have signed up, according to the Treasurer's Office:

Catawba Valley Medical Center

CaroMont Health in Gastonia

Martin General Hospital

Randolph Health

NC Specialty Hospital in Durham