Legislation Quick Search
10/01/2022 08:34 PM
Pennsylvania House of Representatives
Home / House Co-Sponsorship Memoranda

House Co-Sponsorship Memoranda

Subscribe to PaLegis Notifications

Subscribe to receive notifications of new Co-Sponsorship Memos circulated

By Member | By Date | Keyword Search

House of Representatives
Session of 2019 - 2020 Regular Session


Posted: March 6, 2019 04:32 PM
From: Representative Dan Frankel and Rep. Garth D. Everett, Rep. Anthony M. DeLuca
To: All House members
Subject: Expanding Fair Access to Hospital Care
In the near future we plan to introduce two pieces of legislation which will address hospital systems which also own or are affiliated with a health insurance company or product, known as Integrated Delivery Networks (IDN).

Hospitals that own their own insurance companies are in the unique situation of paying themselves for health care delivery. That means they can use their own hospital systems as leverage to create unfair competition and, worse, terrible problems for sick and vulnerable Pennsylvanians.

For example, a hospital system could charge its own health plan $30,000 for a hip replacement, and charge Aetna, Cigna or other outside insurance companies $45,000. They can make their insurance products less expensive to consumers because other insurance companies must pay more for the same services. These contracts are private; consumers never know they are paying more. As we’ve seen, these IDNS - joint hospital and insurance companies - can even make it impossible for consumers who choose their competitors insurance plan to get care at all.

Hospitals and medical providers that are considered purely public charities should not be able to deny care in order to get the competitive advantage. They should not be able to subsidize their own insurance plans – selling them cheaper – by having their hospital system charge their competitors more than they charge themselves.
These practices harm patients, many of whom have no control over their insurance plan. But it also harms businesses that provide insurance for employees in Pennsylvania and outside of the region. Our legislation prevents this practice by requiring IDNs to fairly contract with all insurance companies.

This legislation is identical to House Bills 1621 and 1622 from the 2013-2014 session which were originally introduced to address the UPMC/Highmark issue in Western Pennsylvania. As these IDNs grow by purchasing independent hospitals around the state, protecting access to healthcare and creating a fair healthcare marketplace for Pennsylvanians seeking treatment is essential.

The Attorney General recently filed a lawsuit based on the Pennsylvania Constitution’s provision for “Purely Public Charities” requiring that UPMC provide patient access and negotiate fairly. Our legislation goes one step further – it avoids the long legal battles and confusion by clarifying the law for all healthcare providers that also sell their own insurance – to make sure patients don’t get caught in the middle.

Please join us by cosponsoring these important pieces of legislation.

Document #1

Introduced as HB1211

Description: The first bill creates a system for fair contracting with hospital systems that are part of integrated delivery networks.

Document #2

Introduced as HB1213

Description: The second bill creates a system for fair contracting with provider networks employed by integrated delivery networks.