The state must act

Decisive action could preserve health care access

Pittsburghers should keep complaining about the coming divorce of Highmark and UPMC that will split the parties’ health care consumers into two camps, leaving each camp largely cut off from the other’s services.

Allegheny County Controller Chelsa Wagner last week unveiled a website, HealthcarePGH.com, where consumers can sign a petition demanding that Gov. Tom Wolf, state Attorney General Josh Shapiro and the Legislature do something to make sure each entity’s subscribers continue to receive in-network access to each other’s services after June 30. That’s when a consent decree — brokered in 2014 by Highmark, UPMC and state officials — is due to expire.

When the consent decree ends, more than hospital access will be at stake. Highmark subscribers will lose in-network access to many UPMC physicians, services and specialty care facilities, such as the UPMC Hillman Cancer Center, because UPMC no longer wants to contract with Highmark. Nor do UPMC’s health plans offer in-network access to Highmark’s affiliate, Allegheny Health Network.

There are some exceptions — UPMC Children’s Hospital will be innetwork for Highmark subscribers through June 2022, for example — but Pittsburghers by and large will be the collateral damage in the health care behemoths’ competition for market share.

Because Highmark and UPMC haven’t been able to reach a compromise, Ms. Wagner suggests that consumers put the heat on state officials, who could revoke the health care systems’ nonprofit status, launch an antitrust action or pass a law requiring better treatment of consumers.

Government’s main job is to keep people safe, so consumers have every right to expect that their elected officials would follow up the consent decree with something permanent. But so far, nothing.

What irony: Pittsburgh is home to two of the nation’s best health care systems, yet residents potentially can’t use the pioneering doctor or the award-winning hospital down the street without paying exorbitant out-of-network rates. Some simply won’t be able to afford it, and they may delay or forgo care.

UPMC and Highmark have suggested that consumers already have resigned itself to the split and made the health care choices they need to make to maintain insurance coverage.

But that’s just hot air from their marketing departments. Consumers are still struggling with the switch to new doctors and hospitals. If state officials hurry, they still might be able to preserve access to the care that Pittsburghers deserve.