BLOG: Supreme Court Ruling: Win for Seniors in Western Pennsylvania

By: Governor Tom Wolf

December 03, 2015

Pennsylvania has some of the best health care institutions in the entire county. These world class facilities are on the forefront of delivering quality services and developing new technologies that will lead to better outcomes for the commonwealth.

The success of our health care institutions should certainly make all Pennsylvanians proud. However, uncertainty and ongoing disputes between one of our largest providers and insurers has sometimes distracted from the good work our institutions do in taking care of our most vulnerable, especially seniors, our children and others who are sick.

Nowhere has this challenge been more acute than in Western Pennsylvania, where the divorce between UPMC and Highmark has led to unnecessary confusion for consumers.

Prior to the start of my administration, UPMC and Highmark reached a “comprehensive transition agreement” that would protect vulnerable populations. This agreement was memorialized in a consent decree signed off on by both institutions.

However, issues persisted, and the delivery of quality care took a backseat to bickering. This all came to a tipping-point back in February, when the Medicare Advantage contract between UPMC and Highmark was threatened to be terminated. This would have been extremely disruptive for 180,000 seniors, forcing many of them to find a new doctor or insurer.

Immediately, I made very clear that the decision to cancel Medicare Advantage for over 180,000 seniors was wrong, and I vowed to fight that decision by any means necessary, including through legal action. I swiftly took this issue to Commonwealth Court, and also asked that all other disputes, including defining “continuity of care,” and solving reimbursement issues, were addressed.

Recently, both UPMC and Highmark, through binding arbitration mandated by the court, finalized a compromise on every issue before these two world-class health care systems except for the canceling of the Medicare Advantage contract.

And just this week, the Supreme Court ruled that the Medicare Advantage contract had to remain in place, resulting in a huge victory for seniors across western Pennsylvania.

I am hopeful that with this decision we can move away from divisiveness and toward consensus on putting patients and consumers first in every circumstance. I know UPMC and Highmark share this goal and I look forward to working with them to achieve it.

I will always put the people of Pennsylvania first, and I will never hesitate to take action if it is warranted. From day one of my administration, I have worked tirelessly to protect the commonwealth’s most vulnerable citizens and my administration will always stand up to protect consumers and ensure all Pennsylvanians have access to quality health care.

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