The Pennsylvania Supreme Court has agreed to take up Attorney General Josh Shapiro’s case against health giant UPMC, setting the stage for a showdown next month in Harrisburg.
The high court is scheduled to meet next on May 14, 15 and 16.
Shapiro spokesman Joe Grace described the court’s willingness to take up the appeal quickly as “welcome news.”
“Through this appeal to the Supreme Court, our case will move forward and our efforts to protect Western Pennsylvanians’ access to affordable care will continue,” Grace said.
The attorney general seeks to delay this summer’s insurance network breakup between Downtown Pittsburgh- based rival health systems UPMC and Highmark, in hopes of ultimately enabling thousands of seniors, cancer patients and people with disabilities to maintain access to doctors within both systems.
Shapiro is racing against a 73-day clock until a 2014 state-brokered consent decree between the two rivals expires.
On Wednesday, Commonwealth Court Judge Robert Simpson ordered that Shapiro’s petition to modify the UPMC-Highmark decree be put on hold, or “stayed,” in light of the Supreme Court proceedings.
The Supreme Court is tasked with ruling on a narrow but critical dispute: whether Shapiro has the authority to change the June 30 expiration date of the consent decree.
UPMC spokesman Paul Wood said the Supreme Court’s decision to grant Shapiro’s right to appeal was “expected.”
“UPMC is confident the Supreme Court will affirm the Commonwealth Court’s April 3, 2019, ruling that the Consent Decrees end on June 30, 2019, which is based on the previous Supreme Court decision from last July,” Wood said in a statement.
Shapiro appealed to the Supreme Court an opinion issued earlier this month by Simpson that said the expiration date could not be changed or extended indefinitely. Simpson said his findings were in line with a Supreme Court ruling last summer, when Shapiro failed to convince the court to extend the consent decree until the end of 2020 for patients insured by Medicare Advantage plans, privately offered alternatives to traditional Medicare.
If Shapiro fails to win an extension this time, he’ll have weeks left before the decree expires, and efforts to force changes on UPMC through the agreement could be rendered effectively moot.
If Shapiro wins his appeal, he then wants to use the consent decree as a vehicle to seek new concessions and requirements by UPMC — including forcing it to contract with Highmark and any other interested provider or insurer “in perpetuity” and drop a controversial prepay rule for out-of-network patients. It also asks for other demands specific to UPMC, including that it replace a majority of its board.
UPMC has argued in court filings that Shapiro not only waited too long to extend the decree but has no authority to do so.
UPMC further has accused Shapiro of “political grandstanding” and siding with Highmark over the public interest.
Highmark spokesman Aaron Billger said it fully supports Shapiro’s efforts in the name of “preserving health care choice for all consumers.”
Shapiro said he took the latest legal action against UPMC after what his office described as two years of failed negotiations to reach an agreement.
He defends his right to intervene on behalf of public interest via his office’s charitable oversight role.