AG Shapiro thanks patients face-to-face for fueling UPMC-Highmark truce
A week after rival health giants UPMC and Highmark struck a 10-year deal to preserve access for most Western Pennsylvanians, state Attorney General Josh Shapiro returned to Pittsburgh to meet with some of the patients who stand to benefit.
“I can say, unequivocally, you made a real difference,” said Shapiro to a few dozen people from across the region and health care consumer advocates gathered in Pittsburgh. “People said it couldn’t be done. You proved them wrong, and I’m grateful for that.”
The informal meeting was part victory party, part informal question-and-answer session.
“I found my inspiration and I found my drive when I’d be walking down the street here in Pittsburgh and someone would just stop me and say to me, ‘I’m really frustrated by this whole health care situation. Can you do something about it?’ ” Shapiro said about why he spent so much time and resources on the issue.
‘You really heard us’
“You saved my life, really,” Evie Bodick of Springdale told Shapiro. Bodick has Highmark insurance and thought she’d have to say goodbye to several UPMC doctors she credits with helping her get through cancer and other ailments. “And it is so refreshing that a politician actually listened to the little people because you don’t find that often. You really heard us … I can’t thank you enough.”
The Pennsylvania Health Access Network advocacy group and a representative from Allegheny County Controller Chelsa Wagner’s office presented Shapiro with more than a dozen handwritten postcards with photos and words of thanks.
“I realize you’re thanking me. I came today to thank you,” Shapiro told the group of patients. “It was your voices that were fueling me every step of the way to get this done.”
Last week, just six days before UPMC and Highmark insurance networks were scheduled to split after months of heated litigation, Shapiro lauded the leaders of UPMC and Highmark for inking an agreement to preserve access to both health systems for most patients across a 29-county region.
Shapiro described the negotiations leading up to the contract as “eight days of really intense conversations back and forth, which ultimately led to this breakthrough, 10-year deal.”
Some patients ‘still shut out’
The 10-year contract is broad in that it applies not only to Medicare-eligible and cancer patients but to patients of every age and those on individual as well as employer-based plans — as long as they are enrolled in so-called “broad-based” plans, or plans that include at least partial benefits to other networks. Highmark also agreed not to charge patients more for care received at UPMC facilities than they do for care within Highmark’s Allegheny Health Network.
But, also under the new contract, UPMC and Highmark agreed they each have the right to continue rolling out narrow or exclusive network plans that specifically exclude the other.
Narrow-network plans such as Highmark’s fast-growing Medicare Advantage Community Blue $0 monthly premium HMO plan will not be guaranteed access to UPMC. Similar narrow-network plans exist in commercial, non-Medicare markets, too.
Some employers, including teachers unions, have chosen narrow-network plan offerings because they tend to cost less.
“But, in exchange for that cheaper price, you’re accepting smaller choice, in terms of your doctor and hospitals,” said Erin Ninehouser of the Pennsylvania Health Access Network.
An estimated 1.2 million or so patients will be able to access both UPMC and Highmark’s Allegheny Health Network under the contract.
Another 300,000 or so people will not.
Beth McCracken of Pittsburgh’s Brookline neighborhood, who is among those who no longer have to leave her doctors, asked Shapiro what he and other state officials are doing “to make sure they’re holding up their commitments.”
The Department of Insurance and other regulators will be monitoring the execution of the agreement and specific health plan options, Shapiro said.
Ninehouser said it’s now up to state lawmakers to prioritize legislation with bipartisan support that would help more patients and extend protections statewide, such as a bill to require nonprofit health systems to contract with any interested insurer. That requirement was one of Shapiro’s initial goals.
“There’s still a lot of work to do, but we’re very grateful for the Attorney General and his leadership in taking on this fight,” Ninehouser said. “He’s a really good example of what we hope all elected officials will do.”
Shapiro reiterated that though he has dropped litigation against UPMC, his office will continue to oversee and investigate all purely public charities.
Natasha Lindstrom is a Tribune-Review staff writer. You can contact Natasha at 412-380-8514, [email protected] or via Twitter .