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,Heather Stauffer's PPACA blog posts
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Keeping an eye on competition

By - Last modified: May 2, 2013 at 10:02 AM
Heather Stauffer
Heather Stauffer

The Pennsylvania Insurance Department's website doesn't say much about preserving competitive markets.

What it does say, in bullet points in the About section, is this:

• Monitor the financial solvency of insurance companies

• License insurance companies and producers/agents

• Review and approve insurance policy language and rates

• Coordinate the rehabilitation and liquidation of insolvent insurance companies

• Administer health insurance programs for eligible children

Nevertheless, preserving competitive markets is an important part of PID's job, and that's clear in its handling of the Highmark acquisition of West Penn Allegheny Health System. Why else take so long, and why else impose 37 conditions, including language like "firewall" and "most favored nation" on the deal?

I found Condition 19 especially interesting. In it, PID essentially says, "Hey, you threw out some figures on how the new integrated delivery network you're forming with WPAHS is supposed to benefit policyholders. We're going to make you report on your progress toward those benchmarks yearly, and if by the end of 2016 you're not hitting them, you need to file a detailed corrective plan showing how you intend to change that."

The first of those benchmarks is $3,000 lower premiums for a family of four by fiscal year 2016 (compared to what was expected without the network). That's real money, folks.

Do you think it will work? Which conditions do you like?

• • •

In a conference call after the announcements, Highmark president and CEO William Winkenwerder Jr. was asked about the conditions.

"We are comfortable that we will be able to well comply with all the conditions that have been outlined in the commissioner's order," he said. "Many of these conditions were things that we would have done in any event."

• • •

According to Winkenwerder, Highmark's system will rank as one of the biggest systems in the nation that integrate delivery and finance, with the largest being Kaiser Permanente.

• • •

In unrelated but truly horrifying news, a recent Kaiser Family Foundation poll showed that 42 percent of Americans are unaware that the Patient Protection and Affordable Care Act — aka PPACA, ACA, Affordable Care Act, health care reform and Obamacare — is still the law of the land.

I hope none of you are among them. Protesting and (nonviolent) fighting are one thing, but denial is quite another, and risky. It's big change, and it's coming, and your smart competitors are preparing for it. You should be, too.

• • •

Speaking of fighting, did you know that more than two years after the PPACA provision that made over-the-counter medications require a prescription before they're health-savings-account eligible, people are still trying to change it?

• • •

The former Susan P. Byrnes Health Education Center in York has rebranded, dropping the "Susan P." and simplifying its logo to a rainbow-colored heart.

The nonprofit is 18 years old and its mission is still to educate and inspire people of all ages to make healthy choices. Today it delivers dynamic health education programming to youth and adults on campus in high-tech teaching theaters, as outreach to schools, businesses and community groups, via webcasting and online at

Heather Stauffer covers Lancaster County, nonprofits and health care. Have a tip or question for her? Email her at You can also follow her on Twitter, @StaufferCPBJ.

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