On December 18, 2013, the Pennsylvania House Health Committee held a hearing on Pennsylvania House Bills 1621 and 1622, two bills that would require that any health provider in the state that operates as part of an integrated delivery system (i.e., a health system that also has its own health plan, as many larger systems do) contract with “any willing insurer” desiring to contract with the provider. The legislation, the first of its kind in the country, is essentially the reverse of the “any willing provider” legislation that has been enacted in over 30 states over the last several decades that require health insurers to accept every provider meeting its credentialing requirements into its provider network.
As explained by the bill’s sponsors, Representatives Jim Christiana (R) and Dan Frankel (D), the legislation was initially designed to force the University of Pittsburgh Medical Center (a larger Western Pennsylvania provider) to contract with Highmark Blue Cross, after UPMC announced last year that it intended to terminate its “in network” status with Highmark at the end of 2014. However, the bill’s sponsors have stated that their legislation is not intended solely to address this dispute, nor is it limited to these parties, and they claim that “if we want to pursue the best quality, highest value health care,” we must have “full patient access and complete competition in the insurance market as well as the provider market.”
At the hearing on December 18, 2013, UPMC representatives opposed the bills, maintaining that forcing parties to contract against their will would have anticompetitive effects and stifle innovation – claims that health insurers have made, typically without success, when opposing “any willing provider” legislation in other states. Highmark representatives, on the other hand, supported the proposed legislation at the hearing, and others – including a representative from a benefits management company – suggested that the bills should be expanded to cover all providers, not just those in integrated systems.
Since the hearing, UPMC and Highmark announced that they had settled a long running antitrust lawsuit between them, leaving open the possibility that the settlement might lead to a voluntary resumption of the parties’ contractual relationship. Nevertheless, this development may not necessarily derail the proposed legislation, particularly given the sponsors’ statements that the issue is bigger than just the UPMC/Highmark dispute. The Pennsylvania legislature reconvened on January 7, 2014 for further proceedings. Stay tuned.