'Any willing payer'
The impending merger of Highmark, the Pittsburgh-based Blue Cross insurer, and Blue Cross of Northeastern Pennsylvania is part of a broad trend of consolidation of insurers and health care providers.
Northeast Pennsylvania already has experienced the provider part of the trend, as most of the region's formerly independent community hospitals have merged into systems operated by Geisinger or Community Health Systems.
The hospital mergers generally have been good for the region, financially stabilizing struggling small hospitals, producing scores of millions of dollars in new infrastructure investments, and expanding the level of locally available care.
So far in this region the consolidations have expanded, rather than diminished access to care. But an unresolved dispute in Western Pennsylvania resulting from provider/insurer consolidations threatens to severely diminish patient access to high-quality care. It calls for legislation to preclude that possibility statewide.
Highmark, the huge insurer that is about to consume BC NEPA, acquired the West Allegheny County Health Care System, a competitor of the prestigious and huge University of Pittsburgh Medical Center system. UPMC, reacting to Highmark's emergence as a competing provider, plans to forgo an insurance contract with Highmark. That would make UPMC an out-of-network provider for the largest insurer in the region and the state.
Several bills have been introduced in the state Legislature, generally referred to as "any willing payer," that would require any hospital or hospital-affiliated medical group to accept any valid health care insurance.
The state hospital industry opposes it because it claims it would give too much market power to Highmark.
But the issue for lawmakers should be guaranteed patient access to the highest quality care. The possible benefits of hospital consolidations should not be denied to patients who need them because of commercial disputes. Lawmakers should establish "any willing payer."