The nonprofit insurers in Massachusetts, a leader in health reform, reported falling operating incomes in the first quarter, primarily because of increasing pressure to keep premium costs low. "We have taken an aggressive and responsible approach to pricing because we recognize that we're in economic times where our purchasers need that," Eric Schultz, chief executive of Harvard Pilgrim Health Care, told The Boston Globe. Although Blue Cross Blue Shield's net income rose to $29.8 million from $20 million, it also reported a $4.7 million loss from operations in the first quarter. Net income for Harvard Pilgrim plummeted to $3.4 million from $29.4 million, while its operating income fell to $400,000 from $24.2 million a year earlier. Tufts Health Plan reported a $5.1 million first-quarter net income, compared to last year's $9.8 million. Its operating loss increased from $4.2 million last year to $7.1 million. Article