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What Pennsylvanians Need to Know about AG Shapiro’s Actions on the UPMC-Highmark Dispute

February 8, 2019

Yesterday in Pittsburgh, PHAN was proud to stand with our consumer leaders and Attorney General Josh Shapiro in Pittsburgh as he announced several important legal actions his office is taking to modify the existing consent decree (a document governing the terms of the breakup between UPMC and Highmark, which is set to expire June 30, 2019), hold UPMC accountable to their charitable mandate, and protect patients’ access to care.

What does AG Shapiro’s announcement mean?

In order to protect patients, promote the public interest, and bring UPMC into compliance with Pennsylvania’s charity laws, AG Shapiro filed a petition in the Commonwealth Court to modify the existing consent decree.

If upheld by the courts (expecting that any decision may be appealed to the State Supreme Court), these changes would — with no expiration date: (1) Require both UPMC and Highmark’s Allegheny Health Network to offer open, affordable access to their doctors and hospitals through contracts with any willing insurer, and for UPMC and Highmark’s insurance plans to contract with any willing provider, (2) Set up “last-best-offer” arbitration to make sure contracts between health plans and hospitals can be reached within 90 days when there is a disagreement between the insurer and the provider over payment rates, and (3) Ensure each health system’s prices are fair and reflect their status as a non-profit charity, rather than unreasonable or excessive.

Under the existing consent decree, any party (the state, UPMC, or Highmark) can modify the terms to promote the public interest, which would take effect if all parties agreed. After years of negotiation, Highmark agreed to accept AG Shapiro’s modifications, UPMC did not, and that’s why he’s taking UPMC to court. He’s asked the Commonwealth Court to consider the evidence and issue a ruling before the consent decree expires in June.

What’s next?

The future is unknown until the courts have their say, but became much brighter for hundreds of thousands of families in Western PA who have waited, wondered, and worried for years about who would step up and fight for them.

It’s important to note the important bipartisan work led by Rep. Dan Frankel, newly-appointed chair of the House Health Committee, who in 2013-14 partnered with former Rep. Jim Christiana to offer legislation that would have enacted many of the patient protections contained in the Attorney General’s filing. Senator Jay Costa is seeking co-sponsorship for an updated version of this legislation. We’ll keep an eye on this legislation if it progresses.

The Attorney General has brought a strong case before the court, and his actions are a powerful example of the difference government — good government — can make. No matter what happens, we applaud his leadership and courage in taking on this fight, which is a matter of life and death for so many Pennsylvanians.

Until there’s a solution in place, we encourage anyone who has been affected by this split to file a formal complaint through the Attorney General’s Office, which you can do by calling (844) 743-2015 or visiting: