Proposed insurance law gets backlash

After a town hall meeting downtown Thursday to tout a proposed state law that would require “integrated delivery networks” like UPMC and Highmark to accept all insurance plans at their hospitals, a woman in attendance expressed her belief that the law is necessary to ensure access for Highmark subscribers to UPMC Altoona.

UPMC already has promised repeatedly that it hopes to ensure Highmark subscribers in-network access to Altoona after 2014 because it’s a sole community hospital – despite UPMC’s plan not to re-up with Highmark in the hospital-competitive Pittsburgh area.

Also, a UPMC Altoona spokesman recently confirmed for the first time that UPMC also intended to include in-network access for Highmark subscribers in this area to higher-level care at UPMC’s hospitals in Pittsburgh.

Those assurances aren’t good enough, said State Rep. Jim Christiana, R-Beaver, one of two prime sponsors of the bill, who ran the town hall meeting, along with co-sponsors John McGinnis, R-Blair and Mike Fleck, R-Huntingdon.

They may be true, but it shouldn’t be up to hospital executives to make those kinds of decisions, Christiana said.

His bill would ensure that universal health plan access to integrated delivery system hospitals and doctors – those owned by organizations that run both hospitals and insurance plans – would become a health care consumer’s right in Pennsylvania.

About 150 attendees seemed to agree, based on their questions, assertions and applause. He’s a conservative advocate of free markets, Christiana said.

“[But] we’re in uncharted territory,” he stated.

And a government check is needed on the new integrated delivery systems – specifically UPMC, because of its stance, he said.

It’s a bipartisan cause, he said, explaining that both liberals who favor the Affordable Care Act and conservatives like him that oppose it have united against UPMC’s declared intention not to renew its Highmark contract.

UPMC has said it doesn’t plan to renew the Highmark contract for hospital-competitive areas of southwest Pennsylvania because it believes Highmark – which wants to re-up with UPMC – plans to use UPMC’s “world-class” hospitals and doctors as bait to retain and lure insurance subscribers, only to “steer” them to its own hospital and doctor system, Allegheny Health Network.

Highmark will put UPMC hospitals in its most expensive “tier” of available facilities…” then heap increased co-pays, higher deductibles, and all kinds of other extra charges on patients who would prefer to use UPMC,” UPMC states in a Jan. 5 ad in the Pittsburgh Post-Gazette.

UPMC doesn’t want cooperation, but out-and-out competition between the two networks in hospital-competitive areas.

In the same ad, UPMC called proposed state government intervention “intrusion and control” that would “stifle competition and choice, while raising costs.”

The intention is just the opposite, according to the lawmakers.

Clearly, there are advantages to hospital consolidation, including better facilities, McGinnis said.

But when hospital systems are one with insurance plans, it threatens to create a reprise of “the company town,” he said.

“You never want competition to go away,” he said.

When the reporter suggested that the UPMC philosophy meshed with the Affordable Care Act’s support of integrated delivery, with cradle-to-grave, comprehensive coverage, better tracking of care needed and care given, for better efficiency, lower costs and better outcomes, Christiana objected.

Competing integrated delivery systems each have their strong points as providers, he said.

Limiting insurance plan holders to one would shut out UPMC subscribers from Allegheny’s burn center, or Highmark subscribers from UPMC’s women’s hospital, he said. It would also encourage unnecessary duplication of facilities, he said.

Should Allegheny need to build a children’s hospital to match UPMC’s? he asked rhetorically.

Moreover, nonprofit hospital systems like UPMC have no right to exclude consumers who have helped supply the community resources to build them by paying insurance and through millions of dollars worth of tax exemptions, Christiana said, echoing Highmark.

Christiana thinks there are enough lawmakers who will be ultimately willing to vote for the bill to pass it.

But he seemed less certain it would get enough sponsorship support to make it to a vote. UPMC has been putting pressure on lawmakers in the Pittsburgh area, he said.

That is shameful, according to meeting attendee Frank Rosenhoover, chairman of the county Democratic Committee.

The key is for residents to put their own pressure on reluctant lawmakers, Christiana said.

The bill will need to succeed by June because after that lawmakers will be concerned about the next election and even more reluctant, predicted Christiana, who conceded that he has gotten campaign contributions from Highmark, but who said his position was not influenced by those.

“UPMC is trying to take a knee and run out the clock,” he said.

“How much money can UPMC have that can make legislators not stand up?” asked Pastor Paul Johnson, who has Highmark, but who has had two successful kidney transplants at UPMC. “How in the world can they leave us in June and not pass this?”

It’s a “sad commentary,” Rosenhoover said.

It’s “high stakes poker,” Christiana said.