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Bills Forcing Highmark and UPMC to Open Networks Introduced

Confusion continues to swirl around the coming split of Highmark and UPMC, and a pair of western Pennsylvania state representatives is hoping to calm the fears of many in the region.

Reps. Jim Christiana (R-Beaver) and Dan Frankel (D-Allegheny) this week introduced a pair of bills (HB 1621 and HB 1622) that would force all not-for-profit health care insurers and health care providers to open their services to all insurance holders, not just their own.

“We want to ensure that all people, no matter what color their insurance card is, have access to all hospitals and their physicians,” Frankel said.

Frankel admits that dealing with he state’s insurance rules and charity laws can “make your eyes glaze over” but he said it is legislation that must be passed because integrated systems like Highmark/Allegheny Health Network and UPMC will only become more prevalent in the future.

“We need to get out in front of it,” Frankel said. “It's not necessarily a bad thing, but ultimately government has a roll in terms of regulating it and making sure it is not an obstacle to true competition in the this country.”

Geisinger Health system in Pennsylvania would also fall under this bill, and Thomas Jefferson Health System in Philadelphia is reportedly working toward a similarly integrated system.  However, Frankel stressed that the measures would not cover for-profit entities that might move into the state in the future. 

Frankel is not sure forcing for-profit companies to open coverage to all insurance holders would be within the state’s control. 

“But the difference is that you are dealing with a nonprofit that receives enormous benefits from government,” Frankel said, pointing out that purely public charities like UPMC and Highmark receive tax breaks and enjoy the ability to take charitable donations, opening them to “a very different standard than for-profit companies.”

While the bills could take the worry out of many insurance holders in Western Pennsylvania who fear they will lose access to their doctors in 2015, Frankel said it is also an effort to control the rising cost of healthcare. 

“The only tool we have to control that is competition among providers and that is really what the debate is about here between UPMC and Highmark,” Frankel said.

Lawmakers from this side of the state have been debating the schism between UPMC and Highmark for years, but those in the center of the state and Philadelphia have in most cases failed to weigh in on the subject. 

Frankel said while there is no “elevator speech” he can use to get those elected officials up to speed, he thinks the two bills will get traction in the House and will eventually be approved.