Last week, state senators in Pittsburgh heard more testimony on the coming separation of UPMC and Highmark. The time for talk, though, is over. Gov. Tom Corbett needs to act.
As just about everyone knows, most Highmark customers will lose their in-network access to most UPMC facilities beginning Jan. 1. This will be a tectonic shift for people in Western Pennsylvania.
Highmark, the region’s largest health care insurer, and UPMC, the largest health care provider, have had contracts for decades that provide easy entry for Highmark customers. The landscape changed, however, when Highmark jumped into the hospital business last year by acquiring the West Penn Allegheny Health System and relaunching it as the Allegheny Health Network.
UPMC took it as an opportunity to declare, essentially, that it will close its doors Jan. 1 to most Highmark policy holders. In the meantime, UPMC is steering them toward other insurance policies, including its own UPMC Health Plan, so they can maintain access to UPMC physicians and facilities. (Many Highmark customers can’t change plans, however, because their insurance is determined by their employer.)
Remarkably, UPMC calls this competition. Yet there is no competition when the currency of a potential customer — a Highmark insurance card — is rejected at the door. Says UPMC, “Your money is no longer good here,” thereby dictating competition strictly on UPMC’s terms.
Highmark, for its part, appears shocked — shocked! — that UPMC would get its back up over the insurance giant moving into the hospital field. Although the public should be grateful for Highmark’s rescue of the five-hospital Allegheny Health Network — which will save jobs and stave off a UPMC monopoly — the price comes in Highmark customers’ loss of UPMC services. That’s not right.
Next year, when the split occurs, many patients will lose their doctors. Care will be compromised. Harm will be done.
In Harrisburg, Democrats and Republicans in the House and Senate have responded with bills to require integrated health-care/health-insurance systems, such as UPMC and Highmark, to give access to any holder of a legitimate insurance policy. But Republican Senate leaders appear bent on quashing the idea. That leaves the people’s hopes in the hands of another Republican, Tom Corbett.
It was Mr. Corbett who was instrumental two years ago in getting UPMC and Highmark to extend their contract. It is Mr. Corbett who can and must bring them back to the table now to negotiate a way out of this mess.
Given the changing nature of health care and health insurance — the more direct competition regionally, the growing trend nationally of insurers narrowing their menu of health care providers and the overall desire to help more people afford coverage — a new arrangement between UPMC and Highmark in 2015 may look different from the present one. Call it a contract (Highmark’s preference) or a transition plan (UPMC’s), but semantics should not stand in the way of what is fair for the people whose premiums, payments, donations and state-sanctioned tax exemptions have built these thriving, essential institutions.
The next agreement may not be as open-ended for insurance customers, particularly in letting them choose from redundant facilities in the rival hospital networks. It could come, conceivably, with modest surcharges to let a customer keep a favorite physician. But it should not bar from UPMC or AHN a whole class of people simply because they carry the wrong insurance card.
There is no greater issue right now in the Pittsburgh region, and Pittsburgher Tom Corbett must get personally involved. He has a health department and an insurance department that can put the brakes on any company with business practices that do harm to the public. It’s time for the state to use its muscle.
It’s true that Mr. Corbett has other things on his plate — a state budget to balance and a re-election campaign to wage. But effective leaders also meet the unforeseen challenges that are thrust on them. UPMC-Highmark is a big one, and Tom Corbett’s moment is now.