The state Senate Banking and Insurance Committee apparently was listening when it held public hearings on the proposed merger of health insurance giants Highmark and Independence Blue Cross (IBC). Last week, Sen. Don White, R-41st, issued the committee's recommendation that the state Insurance Department reject the proposed merger.

Now that the state Senate has offered its recommendation, based largely on the impact of diminished competition, it will be interesting to see if the state Insurance Department also will listen to the will of the people, as well as the majority of doctors and hospitals in the state, by prohibiting the merger.

Most of the public testimony has opposed the merger. The state's hospitals and doctors are against the merger, arguing that allowing these two giant health insurance companies to merge would only increase their near-monopoly power to control pricing and reimbursements.

At the most basic level, it was hard to see any arguments in support of the merger because a Highmark-IBC combination would mean less chance of competition in the future, and would result in a single insurance company controlling about 65 percent of the market in Pennsylvania.

If competition generally leads to lower prices, then how can the merger of Highmark, the dominant health insurer in Western Pennsylvania, and IBC, the dominant health insurance company in the Philadelphia region, be good for consumers? Almost nobody, other than the executives and public relations departments at Highmark and Independence Blue Cross, thinks it will be.

While the majority of public comment on the proposed merger has been in opposition, there still is a chance that the merger could be approved. If so, it will not be because of benefits to the public, but rather because of the economic and political clout of Highmark and IBC.

The two non-profit companies, which have a combined $5 billion in reserves, have offered to provide funding of about $1 billion to help fund some of Gov. Ed Rendell's health initiatives — if the merger is approved.

Despite the conclusion by the state Senate Banking and Insurance Committee that the merger should not be approved, the final decision, by law, rests with the state insurance commissioner, a position appointed by the governor.

Reacting to the prospect of the merger, the Legislature in 2008 passed Act 62, which required the Senate Banking and Insurance Committee to hold public hearings and make recommendations to the state insurance commissioner.

Although Act 62 did not shift the decision-making power, it did, at least, provide plenty of opportunity for debate and public testimony. The overwhelming evidence heard during the public comment period suggests the merger would not benefit health care consumers, or doctors or hospitals.

In addition to recommending a rejection of the merger, the committee made suggestions for strict provisions and increased transparency to protect consumers, in the event that the insurance commissioner decides to go against the Senate committee's recommendation and approves the merger.

The lack of competition in the health insurance market is a problem in Pennsylvania, with Highmark and IBC operating as two separate companies. Highmark and IBC have little competition to force them to lower rates. And they so dominate the market that they can essentially dictate reimbursement terms with hospitals and physician practices across much of the state.

A merged Highmark-IBC would only diminish the prospect of future competition and would give doctors and hospitals fewer options.

Another fear expressed by opponents of the merger is that a combination of the Highmark and IBC would be a first step toward conversion to a for-profit corporation. And that step is seen as a precursor to a buyout by a national for-profit health insurance company, which would likely enrich top executives of Highmark and IBCwhile causing further economic harm to patients, doctors and hospitals across the state.

Months of debate and public testimony have revealed several very good reasons to reject the Highmark-IBC merger. It's encouraging that White's committee has sided with patients, doctors and hospitals.

It is not expected to be known until late January if state Insurance Commissioner Joel Ario will decide to back patients, doctors and hospitals — or the corporate interests of Highmark and IBC.