Following on the heels of a very strident clash over the state budget this year, Gov. Ed Rendell has laid out a rather extensive agenda of issues he would like the General Assembly to consider this fall. Many of the governor's proposals deal with health care, and I am heartened he has expressed an interest in ensuring that Pennsylvanians have access to affordable health insurance coverage.

However, it is distressing he did not include the passage of legislation requiring state oversight of the pending merger of Highmark and Independence Blue Cross (IBC) as part of his agenda. This merger involves the potential joining of the largest health care insurance company in Western Pennsylvania with that of the largest insurer in Southeastern Pennsylvania — which could have a dramatic impact on both access to, and affordability of, health care insurance for millions of our citizens.

In my view, any of the governor's health care proposals are dwarfed when compared to the enormity and far-reaching influence that a new mega-blue insurer would have on health care in Pennsylvania for years to come. Therefore, we must make sure the commonwealth has the ability to thoroughly and appropriately review this proposed merger.

All told, the four Blues (Highmark, IBC, Capitol and Northeast) account for more than 62 percent of Pennsylvania's health insurance market. By comparison, the two top private health insurers in the state (Coventry Corp. and Aetna) have about 12 percent of the market.

I don't think we are being alarmists when we raise concerns that this merger would create a single, multibillion dollar, mega-entity that could crush what little competition remains in Pennsylvania's health care insurance market by creating a near-monopoly. There should be real concerns that costs will skyrocket, quality of care will decrease and the workforce will be stuck with the bill.

If there is only one option for consumers to consider, and only one entity to reimburse doctors and hospitals for services, increased costs and decreased quality are real possibilities.

Highmark and IBC have contended the merger will result in $1 billion in savings and, according to Highmark, "bring benefits to Pennsylvania citizens, physicians and other providers and the communities in which we operate." If so, there must be iron-clad assurances that those savings and the win-win-win situation Highmark claims will result from the merger will occur not only in the short-term, but the long-term as well.

The Blues must also not lose sight of their primary mission — the reason why they were created and why they receive special tax treatment. This merger must not undercut the social mission obligation Highmark and IBC have — an obligation that is part of their being excused from premium taxes and affords them other advantages under Pennsylvania law.

Most importantly, we must ensure those savings do not come at the cost of consumers' accessibility to essential health care — and to the doctors, hospitals, pharmacists and others who provide that care. If such assurances cannot be made, then I do not believe there is any reason to approve such a merger.

The Blues have stated this merger is in the best interests of Pennsylvanians, so we need to make sure they stick to their word. This should be an easy commitment to keep.

Unfortunately, under current law, the Commonwealth is limited in making sure such assurances stick. This proposed merger, which involves multibillions of dollars and potentially impacts the lives and well-being of hundreds of thousands of Pennsylvanians, is currently outside the purview of the state Department of Insurance and the General Assembly.

Today, the Insurance Department is empowered only to review proposed mergers of for-profit health insurance providers. The Highmark-IBC deal, because it involves two nonprofit organizations, is not subject to the same scrutiny. But we are working to change that. In fact, the Senate has approved oversight legislation on three separate occasions — and as recently as June 30 — only to see the bills sit idle in the House of Representatives because the governor has threatened a veto if it reaches his desk.

The Senate has shown that we want this oversight and I honestly believe a majority of the House membership wants to pass legislation that provides the essential regulatory review of the proposed Highmark and IBC merger.

The oversight proposed in this legislation is indeed extraordinary — but so is this proposed merger.

The call for more oversight of this unprecedented consolidation should not be a partisan issue. Both Republicans and Democrats in the General Assembly realize this proposed consolidation will, because of its size and impact on all Pennsylvanians, mean more in terms of the quality and affordability of health insurance than any piece of legislation we could enact, including those recommended by the governor. For the General Assembly not to have a meaningful voice in the review of this consolidation would be irresponsible.

Beyond empowering the Department of Insurance to regulate the proposed merger, our legislation calls for the creation of a Public Interest Review Board comprised of representatives from the Auditor General's office, the administration, the General Assembly, and policyholders or providers of the 'Blues.' This board would present recommendations to the department and provide information that will enable citizens to gain a better understanding of this merger's far-reaching consequences.

The legislation also calls for an accounting by the Blues of all spending on social mission and advertising. Those insured by the Blues have a right to know what advertising and community initiatives their premium dollars are subsidizing.

Finally, the legislation would require assurances that the merger — if it occurs — will result in sustained benefits for policyholders. In my mind, that is the key question to ask, and have answered: "Is this merger in the best interests of everyday Pennsylvanians who are struggling to maintain adequate health care coverage?"

I hope that we can resolve our differences and enact the oversight provision this fall. If the existing gap in the Department of Insurance's regulatory authority is allowed to persist, the department will remain unable to protect the interests of the Blue plans' policyholders in ruling on corporate transactions or review of any pending transactions involving the parent Blue plans for anti-competitive effect.

Many people don't realize that the nonprofit Blues have invested hundreds of millions of premium dollars in other for-profit subsidiaries across the state and the nation. Fortunately, the Insurance Department does have oversight over these for-profit subsidiaries and is accepting comments from the public regarding their proposed merger which is part of the two nonprofit parent companies' merger proposal.

The Department of Insurance needs to hear from Pennsylvanians who are as concerned as I am about the consequences this merger could have on long-term cost and availability of health insurance.

State Sen. Don White represents the 41st district and serves as chairman of the Senate Banking and Insurance Committee.