With a six-hour-long court hearing on the settlement agreement between Partners HealthCare System and the Attorney General’s office coming to a close, Martha Coakley rose from her seat in the gallery to address a clearly skeptical Superior Court Judge Janet Sanders.

All day long Sanders had been questioning the terms of the agreement and repeatedly hinted that she may put off a ruling until Coakley’s successor, Maura Healey, and Gov.-elect Charlie Baker take office in January. “What is the harm?” she asked Christopher Barry-Smith, an assistant attorney general and the lead attorney on the case.

Coakley rose from the first row in the gallery and approached the bench. “She is not the attorney general yet,” Coakley said of Healey. “I have a responsibility until January 20th to uphold my constitutional responsibility.”

Sanders explained her reasoning. “I just want her to say she is behind this and take the very public and political stance,” Sanders said. “I didn’t mean in any way to impugn your integrity.”

Coakley responded: “Well, you have done that.”

The exchange capped a tense hearing at which Sanders questioned the settlement agreement’s impact on health care competition and costs. Partners, by far the largest health care provider in the state, is seeking to acquire South Shore Hospital in Weymouth and the Hallmark Health hospitals in Melrose and Medford. Coakley, who says her agreement is supported by the US Justice Department, decided to seek concessions from Partners on pricing and market power rather than run the risk of challenging the mergers in court and losing. The settlement agreement has come under intense criticism from competitors and economists fearful the deal will only make Partners more powerful and lead to reduced competition.

Sanders, who has made no secret of her skepticism about the agreement, challenged lawyers from Coakley’s anti-trust division to justify why they opted to enter into an agreement that allows the state’s biggest provider to grow even more and spread its market footprint. She cited many of the criticisms raised by Partners’ competitors as.well as a report by the state Health Policy Commission.

“[The report] drastically shows that Partners rates are three times higher” than other hospitals, Sanders said. “There’s that reality. What will happen if the expansion is allowed to happen?”

Assistant Attorney General William Matlack said rate increases will be mitigated by the agreement’s 6 1/2-year price cap on all Partners operations as well as a provision allowing insurers to negotiate individual rates with portions of the hospital giant rather than having to accept one take-it-or-leave-it rate with the entire system. In addition, he said, there was the risk of losing a court challenge and being unable to extract any agreement at all. Even if a court challenge was successful, Matlack said, a victory would only derail the proposed acquisitions and would have no impact on Partners rates.

“The price cap prevents Partners from increasing its prices more than the rate of inflation for the next six and a half years,” Matlack said. “We win the litigation, Partners can still increase their prices for as much as they can get away with… The question, then, is what happens if we litigate and we lose. Previously, payers negotiating with Partners had to take all or nothing. Under the [settlement], payers can choose to take piecemeal if the prices are satisfactory or not.”

Sanders asked Andrea Murino, an attorney for a coalition of competing Boston hospitals, including Tufts Medical Center, Beth Israel Deaconess Medical Center, Atrius Health, and Lahey Health Systems, to join in the discussion. Murino said legal comparison to other antitrust cases involving Microsoft or the merger of Comcast and NBC-Universal were irrelevant.

“You’re talking about people who have to see doctors, who have to seek treatment,” said Murino. “You’re not talking about switching devices or switching a browser.”

When Sanders pondered what would prevent Partners from jacking up prices far beyond inflation once the price cap agreement lapsed, Murino said pointedly: “Nothing.”

Sanders said she was concerned that Partners could gain market power by using its deep pockets to offer discounts to insurers that competitors would be unable to match. Matlack said Partners price cuts would be “pro-competition,” but Murino said the opposite could happen. “There are instances where somebody discounts their prices so low it drives everyone else out of business,” she said.

Sanders also had questions about why the federal Justice Department, which is investigating possible antitrust issues with the merger, was not a party to the agreement. Matlack insisted the Justice Department was behind the settlement but did not want to put its name on anything should Sanders opt not to allow the decree to take hold.

“They prefer not to be a signatory to this settlement but they are fully supportive,” Matlack said. “I am authorized to tell you, if you approve this consent agreement, the Department of Justice will close its investigation.”

Sanders asked for details about how the 10-year agreement would be enforceable if she is no longer on the bench and the attorney general’s office has new occupants every four years.

“All those things are going to be coming on your desk so you’re not just the business law judge but the health care czar,” Murino said.

“I really don’t want to be the health care czar,” Sanders replied.

Bruce Sokler, Partners’ lead attorney, said many of the issues raised by competitors were red herrings, meant to obfuscate the proceedings as much as clarify the issues. “Some of these criticisms are like Goldilocks: too hot, too cold, not perfect,” he said.

But, as she did throughout the course of the hearing, Sanders repeatedly returned to wanting assurances that Healey and, to a lesser extent, Baker, who defeated Coakley in the race for governor, would be supportive of the agreement if she approved it. Sanders noted Baker is the former CEO of Harvard Pilgrim.

“There has to be an end to the process,” Sokler responded, noting the negotiations began in January and an agreement was filed with the court this summer. “The current administration still has two months to run. We don’t think the election should have any effect,” he said.

Sanders, who became defensive in her exchanges at the end, said she was unsure if Healey’s approval of the settlement would sway her one way or the other but insisted it was a necessary imprimatur.

“Surely, we should make sure the incoming attorney general is behind this,” she said. “The president changes and the policy of the government changes enormously. I have no idea what the incoming attorney general thinks about this but shouldn’t she have a chance to weigh in on this? This does have big ramifications for the health care industry going forward.”

Coakley, saying it was not her place to speak for Healey, said whenever someone takes over an office, it is their obligation, like it has been hers, to serve from beginning to end and enforce laws and policies that are in place until they are changed.

“We made no decisions other than what we believe was in the public interest,” she told Sanders. “We have been working with this for eight years. I’ve done [agreements] without fear or favor, without seeking anyone’s advice, perhaps to my own detriment…If you feel you don’t have enough information, that’s one thing. I know when I came in, [former attorney general] Tom Reilly was signing things right up to the final hours. It is a complicated issue but it is an important one and we need to get it resolved.”