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Local Lawmaker Proposing Bill To Compel UPMC, Highmark To Play Nice

Matt Rourke
AP Images

State Sen. Jay Costa, a Democrat from Forest Hills, is proposing legislation to require Pittsburgh’s two largest health care systems to accept each others’ insurance policies. 

If that fails, the bill would force Highmark and UPMC into mandatory arbitration.

In 2012, UPMC sought to stop accepting Highmark insurance after the latter acquired hospitals in the Allegheny Health Network. A 2014 consent decree required each health care system to provide in-network services to the patients who carried insurance cards issued by each other.

That decree expires on June 30, and many in Western Pennsylvania stand to lose access.

With the deadline quickly approaching, it might seem late in the game for a legislative solution. But Costa said that before the November election, there wasn't the political will to pass such legislation.

“There’s a change in the composition of the Senate and the House,” he said. And for some incoming legislators, resolving the healthcare dispute "is something they’ve campaigned on. They want to see it come to fruition.”

Even the threat of legislation, Costa added, might force the two nonprofits to compromise.

“There’s a public charity mission that they have that they need to fulfill,” he said. “I think it’s providing quality care and allowing people to have access.”

The pending split is drawing attention from several elected officials. Pennsylvania Attorney General Josh Shapiro has also been investigating patient complaints. Allegheny County Controller Chelsa Wagner has been holding town hall meetings for people to "share their experiences and concerns."

UPMC said its split with Highmark has created more healthcare services and competition. Highmark did not immediately respond to a request for comment.

WESA receives funding from UPMC and Highmark.

Sarah Boden covers health and science for 90.5 WESA. Before coming to Pittsburgh in November 2017, she was a reporter for Iowa Public Radio where she covered a range of issues, including the 2016 Iowa Caucuses.