Put patients first
Josh Shapiro applies needed pressure
The Highmark-UPMC split is now just months away. And the public is justly anxious. Some history: UPMC was the biggest health care system in the region. Highmark was the biggest insurance provider. Then, UPMC started its own insurance brand and Highmark countered by buying what is now Allegheny Health Network. Two conglomerates were born. And everyone — including many if not most doctors — had to pick sides. Now, the five-year decree that allowed us cross-network access is ending June 30. And there’s no way to avoid the repercussions.
For example, as of July 1, Highmark consumers will lose access to most UPMC doctors. That’s just one of many ways consumers are adversely affected by the pending divorce of these warring giants.
These two entities aren’t just the biggest employers and largest property owners in the region, they have an impact on the health of virtually every resident of Western Pennsylvania and beyond. When they take a step, the ground shakes. When they force health care consumers to pick one side or the other, they leave tens of thousands of people confused, scared and with far less access to the health care they deserve.
That’s why Pennsylvania Attorney General Josh Shapiro went to Commonwealth Court last week to pressure UPMC to change its approach to Highmark insurance members. He’s accusing UPMC of violating the state’s public charities law by restricting access to its doctors and medical facilities. He expressed frustration at UPMC’s unwillingness to bend. AHN is on board with working together, which is why Mr. Shapiro is going after UPMC.
The AG said he’s fighting for “open and affordable access” to UPMC services, UPMC’s acceptance of binding arbitration if an impasse is reached as negotiations proceed and protection against “excessive and unreasonable billing practices” that result in “unjust enrichment.”
All of this is reasonable. Indeed, it represents minimal decency. All of it should be acceptable to any mission-driven nonprofit that puts people first.
But UPMC, in particular, does not act like a mission-driven nonprofit that puts people first. Rather, UPMC has behaved like an avaricious, iron-fisted competitor — ruthless, arrogant and out of touch. It is hard to see, never mind sympathize with, ordinary folks from the clouds of the 64th floor of the U.S. Steel Tower.
So Mr. Shapiro has stepped into the ring — taking UPMC to task, and to court. Some say he is engaged in a David-and-Goliath battle, with Mr. Shapiro playing the part of David. Though he is the top prosecutor in the state, he is facing off against an entity worth billions, politically powerful and abundant in legal staff and resources.
But let’s remember who won the battle of David and Goliath. Mr. Shapiro is the last hope of health care consumers — otherwise known as sick people who need help.