Governor Maura Healey got the most applause from the retailers in the room a year ago when she promised to tackle the high costs of health care.

This time around, at the 2025 annual meeting of the Retailers Association of Massachusetts last week, it was Sarah Iselin’s turn to make a similar pledge.

As chief executive of the state’s largest health insurer, the nonprofit Blue Cross Blue Shield of Massachusetts, Iselin has as much power to curb health care costs as the governor, if not more. And Iselin isn’t afraid to wield it. She put hospital systems on notice over the summer that as contracts come up, she would hold them to the medical inflation cap set by the state Health Policy Commission — 3.6 percent today.

Iselin, in a Q&A session with RAM president Jon Hurst, pointed to the first high-profile clash caused by this stance, over renewing a huge contract with the UMass Memorial Health system, affecting nearly 200,000 members. (The two sides reached an agreement on a new three-year contract earlier this month.)

“That [3.6 percent] benchmark, we’re taking it seriously,” Iselin said, speaking to the crowd of RAM members at Bentley University in Waltham. “We’re going to hold our unit prices to that benchmark, on average.”

Hospital operators, she said, generally argue the 3.6 percent benchmark is too low. Many hospital systems, including UMass Memorial, have been contending with skyrocketing labor costs since the COVID-19 pandemic, particularly with regard to hiring nurses.

“That is the tension we’re going to have to navigate,” Iselin told the crowd. “[But] we’re at a point where people can’t afford to pay more.”

She cited one report that showed Massachusetts ranked 48th in the country for health care costs paid for by employers.

“That’s not the direction you want to go in,” Iselin said. “The bad news is, honestly, as I look out over the next couple of years, I don’t see it slowing down.”

Hurst lamented that state lawmakers didn’t focus enough on costs when they first adopted the so-called Romneycare health care reforms in 2006. The cost control reforms that created the Health Policy Commission came later, in 2012.

Hurst said he was disappointed to see an employer representative missing from the HPC in favor of hospital and biotech industry reps, in a reorganization that took effect over the past summer.

“Are we really serious about dealing with health care costs in this state, or are we sweeping it under the rug?” Hurst asked Iselin.

She responded: “We’re serious about it.”

She ended on an encouraging note, saying she remains optimistic that policy makers can come up with a creative solution to the rising costs.

“Each of us will likely have to give something up, us as health plans included,” Iselin said. “The more we hear from those ultimately [paying] the bills, employers and consumers, the better choices we will make.”

This is an installment of our weekly Bold Types column about the movers and shakers on Boston’s business scene.

Jon Chesto can be reached at jon.chesto@globe.com. Follow him @jonchesto.