The Lead

Top Pa. Senate Dem. moves to halt Highmark/UPMC divorce

By: - February 6, 2019 3:29 pm

The Pennsylvania Senate’s top Democrat is wading into the acrimonious — and seemingly endless — break up of two of the state’s largest healthcare providers.

Senate Minority Leader Jay Costa, D-Allegheny, is seeking co-sponsors for a bill that would require UMPC Health System and Highmark Inc. to either contract with each other for services or enter into mandatory arbitration if they can’t get a deal on their own.

In a statement, Costa’s office said the bill “addresses the issue of integrated delivery networks throughout the Commonwealth; however, this issue is particularly problematic in southwestern Pennsylvania given the ongoing dispute between UPMC and Highmark. While the two are currently operating under a consent decree, that order will expire in June of this year.”

Costa’s office cited two, compelling consumer protection arguments for the bill:

  • It requires “hospitals and physicians operating as part of an integrated delivery network to contract with all insurers, consumers will not be denied care, or worse abandoned mid-treatment, simply because they hold one type of insurance over another. All consumers should be afforded access to these vital hospital and physician services, regardless of which insurance card they carry.”
  • The bill “[eliminates] the ability of any dominant hospital system from demanding unreasonable rates for services from insurers, and in turn raising the overall cost of health care because they are the “must have” system in the area.”

Current state law doesn’t provide a mechanism to resolve contract disputes between so-called “integrated delivery networks,” whose ranks include such healthcare industry titans as UPMC, Allegheny Health Network, and Geisinger, Costa’s office said. Under the bill, if the providers can’t come up with an agreement of their own, they’d be forced into mandatory arbitration to settle their differences.

“Both parties need to come to the table, negotiate and cultivate a relationship that will allow the residents of Western Pennsylvania to get the care they need. It’s time to undo the damage caused by the divorce of these two companies. Disputes between enormous, profitable companies cannot get in the way of patients and their care,” Costa said in a statement. “Health care consumers should not have to worry about whether their insurance will be accepted when they’re sick, injured or simply seeking preventive care. Their only worry should be getting healthy. This legislation can relieve that stress and establish consistency for integrated delivery networks.”

Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our web site. Please see our republishing guidelines for use of photos and graphics.

John L. Micek

A three-decade veteran of the news business, John L. Micek is the Pennsylvania Capital-Star's former Editor-in-Chief.