The state's top health care official assured lawmakers Wednesday that the state is prepared to respond to the next turn in the Steward Health Care crisis, mentioning the potential for a bankruptcy filing, acknowledging that receivership has been discussed, and touching on efforts to pressure-test contingency plans designed to ensure uninterrupted access to patient care.

"Every day at 7:30, we have a stand-up call with leaders across government, external counsel, people across the health care system, other colleagues in other parts of government, to discuss what we know, what we've learned and how we're going to proceed," Health and Human Services Secretary Kate Walsh told the Senate Post Audit and Oversight Committee. "We also have expert advisors to guide us with respect to a national bankruptcy if that were to occur."

Citing threats to call loans and the potential for a bankruptcy filing, U.S. Sens. Elizabeth Warren and Edward Markey last week urged six private credit funds that hold Steward debt to offer loan modifications that they said could keep the system's hospitals afloat.

Noting Steward is the third-largest hospital operator in Massachusetts, employs 16,000 people and serves tens of thousands of patients here, the senators told the leaders of credit funds that "as one of the largest holders of Steward’s debt, you have the power to help keep those hospitals open and preserve access to care for communities in Massachusetts." They asked for a bevy of financial information to be delivered by Friday, citing "the fast approaching deadlines."

A union-backed coalition has been holding rallies outside Steward hospitals this week, citing fears about loan agreements that may expire early next week and calling on elected officials to take steps to prevent service reductions or hospital closures.

The Senate committee called its hearing in Taunton to explore health care access issues and provider challenges in southeastern Massachusetts, and Cape Cod and the Islands. While Walsh touched on that subject, she almost immediately zeroed in on what she called "the topic of the day, which is Steward."

A national company with 33 hospitals in seven states, including eight campuses in Massachusetts, the Dallas-based Steward is confronting financial problems tied in part to an expansion that it capitalized by selling land and buildings that host health care facilities and then leasing them back.

"This debt structure, and the concomitant lease payments that go along with that has made their hospitals less attractive to potential acquirers," Walsh, a former hospital executive herself, said. "People can't figure out what they're buying. [Steward has] signaled that they are looking to leave this market and so we're trying to figure out what happens next, and how we can help a safe and orderly transition of these assets to a different operator."

While acknowledging "there's much about this situation that we don't control" and that "people are understandably really worried," Walsh said the Healey administration's goals in navigating the crisis are protecting access to care and jobs, and making sure the health care needs of residents are met.

Steward's problems spilled more clearly into public view this year but are not new, and Walsh said state officials were wrestling with the situation last year.

"Over the last six months we've been working really hard," Walsh said. "I think we at the state are prepared to respond."

Steward operates St. Elizabeth's in Brighton, Carney Hospital in Dorchester, Good Samaritan Medical Center in Brockton, Holy Family Hospital in Methuen and Haverhill Hospital in Haverhill, Morton Hospital in Taunton, Nashoba Valley Medical Center in Ayer, Norwood Hospital, and St. Anne's in Fall River.

Walsh said Wednesday that "there's not a one-size answer, there's not a sweeping answer to 'What happens when if Stuart leaves our market?'"

"We still don't know exactly what's going to happen or when it's going to happen," Walsh said. "But we have a prepared, thoughtful, coordinated response. People from all aspects of the health care industry -- long-term care, behavioral health -- have been in the room with us as we've been sorting this out. We also know that the issues in Taunton are different than the issues in Methuen, and we're trying to craft our response to be tailored to the region."

Committee Chair Sen. Marc Pacheco recalled the events of 2000, when former Attorney General Tom Reilly and Insurance Commissioner Linda Ruthardt played key roles in a state receivership for Harvard Pilgrim Health Care, the large health insurance company that then reemerged under the leadership of Charlie Baker, who would later become governor.

"It wasn't a hospital. It wasn't other pieces of the health care system," Pacheco said. "But it was a certainly a significant component of your finance system. So I would just ask you to consider strategies around that when and if ... they may be needed to look at and I'm sure you're looking at everything."

The Senate committee has reached out to speak to Attorney General Andrea Campbell about what the attorney general's office is looking at in connection with Steward's Massachusetts operations, Pacheco said.

"There's a lot of responsibility that lies within the AG's office around all of this," he told Walsh. "So I just ask you as you are deliberating strategies, you might want to pull out a strategy that was used to be able to facilitate and expedite saving a piece of the complex health care system that we have."

Walsh told Pacheco she had "mentioned something like that" on the daily, early-morning calls and tried to assure him, saying "we have a lot of really smart people looking at the best way to carry our responsibility, which is taking care of patients, making sure people can support their families and making sure we don't miss this opportunity to reform the health care system in eastern Mass. You know, we're thinking of every creative way we can possibly do that."

"Every time I mentioned something like that," she told Pacheco after he surfaced a receivership option, "I inevitably use the wrong legal term and every lawyer unmutes and starts to tell me whether, you know, I call it bankruptcy for dummies."

State Public Health Commissioner Robbie Goldstein said the five regions where Steward operates are the focus in a "highly unusual and challenging moment in time." They are Boston, the southeast and Brockton area, the Merrimack Valley, central Massachusetts, and the South Coast.

"We don't know yet exactly what will happen with Steward Health Care, what form a transition will take or what it will look like," Goldstein said. "But one thing we can say with certainty is that such a major change will affect communities across eastern Massachusetts. And it will require coordination and collaboration with health care organizations in areas where Steward currently operates."

Goldstein has been heartened by the response from health care professionals at recent private meetings in Steward regions. "Without hesitation, they universally said they took seriously the responsibility for work together and to do what it takes to serve patients and communities," Goldstein said.

Meeting attendees have discussed topics like medical surge and patient capacity, transportation and mobile health options, insurance considerations, and access to maternity, emergency and urgent care, he said. Upcoming talks will focus on behavioral health, workforce, and issues affecting and academic programs and clinical rotation opportunities.