Randy Vulakovich

HARRISBURG — A contract between Highmark and UPMC will expire at the end of this year, and the two sides appear unwilling to settle their differences before that deadline.

However, a bill introduced by two state senators would force the two health care entities to work together by forbidding them from barring anyone based on the type of insurance they carry.

Sens. Randy Vulakovich, R-40th, and Jay Costa, D-43rd, announced their two bills Monday that address the dispute that’s affected millions of patients in Western Pennsylvania. Vulakovich’s district includes southern Butler County.

If no agreement is reached by the end of this year, people with Highmark health insurance could be denied access to all UPMC facilities or be forced to pay higher out-of-network costs for their care.

One bill would amend the Health Care Facilities Act by requiring hospitals to contract with “any willing insurer,” according to the language of the bill. However, only hospitals that are deemed “integrated delivery networks” would be covered under the law.

As stated in the bill, such a network is defined as an entity that offers both hospital and physician services while simultaneously providing health insurance. Both UPMC and Highmark fit that definition.

A second bill, called the Patient Access and Consumer Choice Act, would force hospital-paid physicians to contract with any willing insurer.

There is language in both bills that states if no contract can be reached between two entities, a binding arbitration hearing would “impose” the terms of the contract.

The bills also would prohibit health networks from charging unaffordable rates.

Vulakovich said that it’s an “extremely urgent” matter that must be resolved before the end of this year.

The problem, he said, is that there aren’t any laws that govern integrated delivery networks or how they’re structured. That leniency has allowed companies like UPMC “free reign to do whatever they wanted to do,” which in turn produced a single, dominant health care giant in the region.

That kind of market dominance isn’t good for consumers, the state senator added.

“We have something new here that at the very least needs to be addressed,” Vulakovich said. “How big can they get? If you have one dominant health care system, how can you have competition?

“That’s what we have here, and we can’t have just one dominant system in Western Pennsylvania. There has to be some competition there.”

Paul Wood, a spokesman for UPMC, said that the proposed bills are a case of “arbitrary and unnecessary government intervention” on the part of Vulakovich and Costa.

“The Senate leadership has already weighed in on this and said they’re not moving any legislation with respect to intervening in the UPMC/Highmark dispute,” Wood said.

Wood called the bill a “non-starter” and said there is “absolutely no support for it in a single hospital or insurer” in Pennsylvania.

Both bills have been referred to the Senate Banking and Insurance Committee.