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U.S. Sens. Bob Casey, D-Pa., left, and Pat Toomey, R-Pa., could play a significant role in resolving the UPMC-Highmark dispute.
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Can you hear them?: Bob Casey and Pat Toomey, your constituents are talking

Rebecca Droke/Post-Gazette

Can you hear them?: Bob Casey and Pat Toomey, your constituents are talking

Where there is a will there is a way but the senators don’t seem to have the will

It’s no wonder that nearly nothing seems to be happening in our nation’s capital when it comes to UPMC and the impending loss of access to the health care behemoth’s providers and facilities for thousands of Pennsylvanians who are Highmark insurance subscribers.

Our state’s two U.S. senators don’t seem to see the June 30 ending of the consent decree between UPMC and Highmark as their problem; Insurance is a state-level issue.

Which leads us to wonder: Are Sens. Bob Casey (a Democrat) and Pat Toomey (a Republican) deaf to the cries for help from their constituents who feel they are nothing more than collateral damage in a war being waged by UPMC to vanquish Highmark?

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The public’s cries have been heard by this editorial board: Their letters, emails and phone messages show they care and they care deeply.

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Mr. Toomey couldn’t make time — morning, noon or night over a couple of days — even to discuss the issue (though he did delegate staffers for that purpose. They said he was “very busy” with federal budget matters and his lack of availability to be interviewed doesn’t reflect lack of interest in the issue.)

Mr. Casey (flanked by a couple of staff members) carved out about a half-hour for a conference call but seemed to become perturbed when pressed to go beyond boilerplate comments in response to specific questions particular to the UPMC/​Highmark clash. “I think the people who are adversely affected should be taken care of ... I don’t give a damn about the process here. I want to make sure those people have the same kind of coverage on July 1 as June 28. That’s my opinion. As a federal legislator, I can’t stop an entity from doing something. We have limited power.”

That’s true. Their power is limited. It is also substantial.

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What can be done?

Both the senators have urged UPMC and Highmark to be transparent with the portion of the public that qualifies for Medicare or Medicaid (the poor, the elderly and the disabled). The legislators have penned letters to the local health care leaders and they’ve urged the Centers for Medicare and Medicaid Services (the oversight agency for such programs as Medicare advantage plans) to stay on top of the matter. Cross-network access ends for advantage plan subscribers on June 30.

In its efforts to market to senior citizens post-consent-decree, Highmark has said it would offer some “enhanced out-of-network” benefits. As a deterrent to anyone with a Highmark advantage plan, UPMC warned it would require up-front payment for anyone out-of-network.The senators rightly pointed out that this issue is specifically within their wheelhouse as Medicare and Medicaid insurance programs are federal and they are federal legislators. And it’s great they’re staying on top of that aspect of this mess. But they have the power to do much more.

1.) They could press the antitrust experts at the U.S. Department of Justice to take a fresh look at the health care landscape in Western Pennsylvania. A lot has changed since the DOJ looked in ​2012 at Highmark’s plans to purchase West Penn Allegheny Health System, which has morphed into the Allegheny Health Network, affiliated with Highmark.

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2.) UPMC’s medical research arm received more than $1 billion in federal funding from the National Institutes of Health in 2017 and 2018, according to unofficial estimates from the NIH funding data website. There are Highmark patients involved in UPMC clinical research who question their post-consent-decree fate. NIH funding should be used as leverage with UPMC to guarantee that Highmark subscribers will be allowed to participate in UPMC clinical trials now and in the future as if they were UPMC in-network subscribers. No exceptions. No lack of certainty. No ifs, ands or buts.

3.) The senators could come together as a bipartisan team to press UPMC to meet at the talking table with Highmark.

Do they have the will?

Where there is a will there is a way but the senators don’t seem to have the will.

Mr. Casey said, “The most important thing I can do is to be concerned with the federal programs and federal policy.” But the senator also has an obligation to represent, and protect, his constituents. All of them.

One of the senator’s staffers referenced the special allowances for cross-network access post-June 30: Childrens Hospital (until 2022) and certain medical conditions for which UPMC provides “unique services.” As to the rest of Highmark subscribers, the answer seemed to echo what UPMC has been saying: They’ve had five years to prepare for the divorce.

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In fact, one of Sen. Toomey’s staffers put it pretty plainly: “This dispute has been going on for some time. This brokered agreement, this divorce, is going to happen...” He steered the conversation back to the federal Medicare programs, like his corollaries in Mr. Casey’s office. “(It is) a dispute between two private organizations...”

Asked if Mr. Toomey is willing to jump in, the answer: “We’re very hesitant.”

Why? Because this is a local issue? Or because it is a tough and controversial issue with no political upside?

The UPMC/​Highmark dispute is not primarily a federal issue. That is true. It is mostly a Pennsylvania problem. That is true. But the senators’ constituents are Pennsylvanians. This, too, is true. And that should make this problem their problem.

The senators are either too removed from real life or real people to care, or too absorbed in their rarified political world to relate. Either way, this neutrality, and indifference, is a disgrace.

First Published: March 31, 2019, 10:00 a.m.

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Rebecca Droke/Post-Gazette
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