Rivalries like the Montagues and the Capulets, the Hatfields and the McCoys and the Sharks and the Jets can be exciting and entertaining when they are on stage or screen, but not so much when you and your family’s health care is at stake.
The real-life discord between health care leviathans UPMC and Highmark has caused quite a few fingernails to be bitten down to their nubs in Western Pennsylvania in recent weeks, as the expiration of a five-year consent decree that assured Highmark customers would have in-network access to UPMC hospitals and doctors loomed on Sunday. If the consent decree had been allowed to expire, patients with Highmark insurance would have either had to pony up for care up front, or switch to doctors and hospitals that were in-network. This would have been especially disruptive for elderly patients, or those dealing with chronic or acute conditions.
Attorney General Josh Shapiro had gone to Commonwealth Court to try to extend the consent decree, but a judge ruled earlier this month that it could not be kept artificially alive. But, with just a week left before the consent decree was due to end, Shapiro and Gov. Tom Wolf announced in Pittsburgh on Monday that a new, 10-year agreement had been reached between UPMC and Highmark, which will maintain the status quo until 2029.
Shapiro said “intense dialogue” brought the deal to fruition, and the “historical, global deal will give patients a decade of stable care – protecting workers, seniors, cancer patients, (and) children.”
The roots of the dispute go back to 2011, when Highmark and the West Penn Allegheny Health System joined forces. UPMC countered that Highmark was piecing together a competing hospital system, so it would no longer contract with the insurer, and the battle was on. The 10-year agreement that’s been reached represents a lengthy ceasefire, but not a permanent peace. Monroeville resident Vicki Arnett put it well when she told Greensburg’s Tribune-Review, “Can UPMC and Highmark guarantee after 10 years that they can work together still? How are they going to work together after being such bitter enemies?”
That’s a good question. And it underscores the urgency for the two sides to start bargaining soon to come up with an agreement that will be both lasting and durable. Sure, 10 years seems like a long time from now, but consider that it was just 10 years ago that Barack Obama assumed the presidency, the Pittsburgh Steelers defeated the Arizona Cardinals in the Super Bowl and Michael Jackson died. Doesn’t seem that long ago, does it? Ten years can race by in a flash. No one wants to be racing against a deadline again in June 2029.
It’s widely assumed that Shapiro will be a candidate for governor or U.S. senator when 2022 rolls around. If he can pull a rabbit out of his hat by then and nudge UPMC and Highmark toward lasting concord, that would be a tremendous boost to whatever campaign he embarks upon.