Pa. House bills aimed at protecting consumer health care access, lawmakers say
By Brad Bumsted
Published: Wednesday, Oct. 2, 2013, 12:12 p.m.
HARRISBURG — Legislation to require hospitals to accept all insurance companies is aimed directly at the UPMC and Highmark Inc. dispute, but critics say the bills go far beyond the state's legitimate role in the health care marketplace.
The two bills “go well beyond any compelling interest by state government,” the Hospital & Healthsystem Association of Pennsylvania said in a statement. The legislation “would force a specific hospital and specific health plan to contract with each other,” the association said.
UPMC said no other state allows it. Highmark said the bills are needed to protect the community and preserve access to health care.
The two health care giants have fought bitterly since June 2011, when Highmark decided to enter the hospital business.
UPMC refused to renew contracts between them that expire next year because Highmark became a competitor with its Allegheny Health Network.
Rep. Dan Frankel, D-Squirrel Hill, and Rep. Jim Christiana, R-Beaver County, say their bills will protect patient access and choice in the health care marketplace.
“Hundreds of thousands of people are on the verge of being forced to find a new doctor or hospital because of the logo on their insurance card,” Christiana said.
The bills are similar to legislation introduced last session aimed at leveraging an agreement between Highmark and UPMC. Before the bills could become law, Gov. Tom Corbett intervened and provided a mediator. Highmark and UPMC agreed to continue in-network access to UPMC services through 2014.
Frankel, asked about again attempting to leverage an agreement, said a final plan for them to work together is “probably unlikely.” Both UPMC and Highmark provide health care services and insurance.
“I want a long-term solution,” Frankel said.
UPMC issued a statement, saying: “No state has ever enacted radical ‘any-willing-insurer' legislation that would require a hospital to give an in-network contract to whatever insurer wants one and on whatever terms the government or some outside party specifies. Such legislation would be regressive and anti-competitive and would create a new state bureaucracy of price controls to ‘arbitrate' shotgun marriages.”
If the parties cannot agree, the bill calls for a mandatory contract through binding arbitration, Christiana said. The hospital association said it unfairly forces only hospitals to abide by the arbitration.
Highmark spokesman Aaron Billger, arguing there is a need for the bill, said government action “is essential to protect the community, preserve provider choice, maintain continuity of care and manage growth of health care costs.”
Some lawmakers are wary of the state forcing competitors to work together.
“Where is that done elsewhere and who sets the rate?” said Rep. Eli Evankovich, R-Murrysville. “Is it government setting the rate?”
The sponsors said consumers' interests must take priority.
“Taxpayers helped fund these facilities. These institutions benefit from tax-exempt status,” said Christiana, who noted he usually doesn't favor government intervention.
The Insurance Federation of Pennsylvania said through its top executive that it wasn't surprised but was disappointed that the two drafted the legislation. “Highmark is again looking for the government to perpetuate its monopoly,” said Samuel Marshall, president and CEO of the federation.
Billger responded that the legislation “really encourages open competition.”
Whether the bills will gain traction isn't clear. House Majority Leader Mike Turzai, R-Bradford Woods, was noncommittal about whether the House will consider them.
“Now, we think that there is appropriate competition on the health care provider side and on the insurance side,” Turzai said.
The state has to step up, Christiana said.
“With today's rapidly changing health care marketplace, we must find ways to prevent hospitals and doctors from denying patients access to quality health care based on the insurance card in their wallets,” he said. “This legislation will go a long way in eliminating the ‘culture of fear' consumers have developed when health care giants discuss operational changes.”
Brad Bumsted is Trib Total Media's state Capitol reporter. Reach him at 717-787-1405 or email@example.com.
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