Local Lawmakers Seek Legislative Solution to UPMC-Highmark Stalemate

Hoping to break the stalemate between health care conglomerates UPMC and Highmark, state lawmakers held a legislative hearing and Capitol news conference Tuesday to discuss legislation they hope will ensure access to care for 3 million Western Pennsylvanians.

"People are worried they will lose access to UPMC’s 2,700 doctors and 20 hospitals because these two businesses can’t—or won’t—come to an agreement.," said Rep. Tony DeLuca (D-Penn Hills), Democratic chairman of the House Insurance Committee. "Even if people can still access those doctors, they may not be able to afford to pay the high fees that will occur when those doctors are out of their insurance network.”

At DeLuca’s request, the House Insurance Committee is holding a series of public hearings to gather information on ways to get everyone back to the table and to seriously discuss the issues. The committee heard from UPMC and Highmark, as well as the state Insurance and Health departments. A Wednesday hearing includes testimony from the Attorney General’s Office.

Following the initial hearing in Pittsburgh, DeLuca said he would look into whether legislative action could force the health care entities to continue their contract.

Last week, he introduced House Bill 32 with more than 60 bipartisan co-sponsors. The bill would strengthen the authority of the state insurance commissioner to step into contract disputes between a hospital and an insurer.

It also would make it possible for the commissioner to use his powers for both terminating contracts and expiring contracts, and if he determines such an end to a contract would not be in the best interest of residents, he could require the contract to continue for another term.

“People’s lives are dependent on their health care remaining accessible and affordable to them. We need everyone to come back to the table and remember the reason they got involved in health care at the start – to help people – and to do no harm,” DeLuca said.

Earlier this month, House Democratic Caucus Chairman Dan Frankel (D-Squirrel Hill) introduced House Bill 1910 with more than 70 bipartisan co-sponsors. The legislation would require binding arbitration for UPMC specialty hospitals. It also would ensure that specialty hospitals and services won’t be effectively closed to Western Pennsylvanians who need them due to the dispute between UPMC and Highmark.

Frankel's bill is intended to preserve patients' access to Magee-Womens Hospital, Western Psychiatric, Hillman Cancer Center and the entire cancer center network, which are all part of UPMC. It also extends protections for access to Children’s Hospital.

“The community is asking UPMC to re-enter contract negotiations with Highmark,” said Frankel. “While we can’t lock both parties in a room, we can assert our vested interest in the unique specialty care services of UPMC. By making certain that this specialized care is available to all Western Pennsylvanians, we put patients first, and put their minds at ease.”

House Democratic Leader Frank Dermody (D-Oakmont) said concern about the UPMC-Highmark dispute transcends partisan lines.

“Of all the concerns people have in life, health care is one thing that they need to be reliable and predictable,” said Dermody. “The unwillingness of UPMC’s CEO and board of directors to continue talking is causing problems already for employers who must make long-range decisions about health insurance coverage, and for workers and retirees who face uncertainty and higher costs. It threatens to cause a regional health care crisis.”

Senate Democratic Leader Jay Costa, (D-Forest Hills), pointed out that both Senate and House leadership reached out to Highmark and UPMC back in July to urge them to come to an acceptable resolution.

"In addition to hearings held by both the House and the Senate, we have strongly urged both of these entities to do the right thing," said Costa. "They need to get back to the table and start showing everyone that the people of Western Pennsylvania whom they serve are a priority for them. We intend to pursue every option available to us as elected officials to make sure that happens."