Health contract battle resumes
The latest attempt by lawmakers in Harrisburg to address patients' concerns that they will lose affordable access to UPMC hospitals and doctors at the end of next year took center stage on Wednesday.
Supporters and critics of two bills that would force UPMC to contract with Highmark Inc., the state's biggest health insurer, argued during a House Health Committee hearing about how best to spur competition in the health industry and slow the trend of rapidly rising costs.
UPMC, Western Pennsylvania's largest hospital network, contended that allowing the contract to expire as scheduled would force it and Highmark to compete vigorously for insurance subscribers and patients — leading to greater innovation and lower prices.
Highmark countered that requiring hospital systems to accept all insurance plans will better stimulate competition by establishing a level playing field on which insurers can battle on price — and force hospitals to lower costs.
Caught in the middle are millions of patients in Western Pennsylvania — and billions of dollars in health-related revenue that come with them — who may be forced to pick a side in 12 months or sooner.
“The ramifications of the split between UPMC and Highmark are serious,” said Rep. Dan Frankel, a Squirrel Hill Democrat who sponsored the bills with Beaver County Republican Rep. Jim Christiana.
“This is not about helping Highmark. ... This is about helping our patients and our communities,” Frankel said.
In the past three years, a variety of legislative proposals have been introduced in response to UPMC's plan not to renew a contract after Highmark announced in 2011 that it would buy UPMC's chief rival, West Penn Allegheny Health System, and convert itself into a direct competitor for insurance and medical services.
In 2012, the House passed a bill that would have increased the state insurance commissioner's power to extend contracts between insurers and hospitals. The nearly unanimous support for that measure was widely credited with pushing UPMC to enter talks with Highmark, mediated by Gov. Tom Corbett, that produced an 18-month extension in the contract.
With 12 months remaining until the extension expires, the issue is again gaining traction.
“We want Pennsylvania citizens to understand that this issue is bigger than partisan politics,” Christiana said.
UPMC, along with trade groups representing the state's hospitals and for-profit insurance industry, argued that Frankel and Christiana's bills would unfairly tip the balance of power in contract negotiations to large insurers such as Highmark, as well as erode the burgeoning competition Highmark is facing from three national carriers in Pittsburgh.
“In three short years, the region has moved from one of the least competitive markets — with one dominant insurer and one increasingly preferred provider — to one of the most competitive,” said Tom McGough, UPMC's chief legal officer.
Because of that competition, every patient in Western Pennsylvania will have the option of in-network access to UPMC hospitals and doctors when the health system's contract with Highmark Inc. expires, McGough said.
Medicare and Medicaid beneficiaries aren't affected by the contract ending. Individuals who purchase their own insurance through a federal government website can choose from a range of insurance plans that include UPMC as an in-network provider. And employers are increasingly offering their workers options to Highmark insurance that guarantee less-costly access to the largest network of hospitals and doctors in the region, he said.
“Clearly, anyone who wants access to UPMC can get it,” he said.
Highmark CEO William Winkenwerder said the bills have his company's backing “because we believe it preserves people's ability to choose” any insurer and all hospitals and doctors, rather than just specific systems.
“In my opinion, the guiding purpose of this legislation is to do what's right and what's fair for Pennsylvania consumers ... making sure they're not forced to abandon” the doctors and hospitals they prefer.
Alex Nixon is a staff writer for Trib Total Media. He can be reached at 412-320-7928 or email@example.com.
Add Alex Nixon to your Google+ circles.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- CMU showcases its lengthy list of fledgling companies at venture event
- Volkswagen executive Horn sidesteps blame in emissions scandal
- Other segments nudge Alcoa to slim profit
- Energy efficiency goes mainstream with help of regulations, demand
- Finding balance key to PNC Capital Markets chief’s success
- EDMC to lay off 115 more faculty and staff at Art Institute campuses
- ATI expects quarterly loss of $142M
- Consol raises $101 million in coal asset sales
- Sluggish wage growth may sap retail spending during winter holidays
- Last-minute China worries derailed Fed’s rate hike plans, minutes reveal