EndocrinologyPennsylvania Insurance Department Examinations To Focus On Health Insurance Competition
The Pennsylvania Insurance Department will conduct examinations of the state"s four Blue Cross and Blue Shield insurance companies, Blue Cross of Northeastern Pennsylvania, Capital BlueCross, Highmark, Inc. and Independence Blue Cross, to determine if any of them were engaged in anti-competitive or unfair trade practices in violation of the law, Insurance Commissioner Joel Ario announced today.
"When Highmark Blue Shield and Independence Blue Cross withdrew their consolidation proposal earlier this year, it was good news for consumers," said Commissioner Ario. "But it did not improve the anti-competitive dynamics that remain at play in Pennsylvania"s health insurance marketplace.
"The purpose of these four examinations is to determine whether there are any anti-competitive practices that violate current law and, if so, to take steps under the law to remedy the effects on competition," continued Ario. "If we discover competitive problems that do not violate current law, an outgrowth of this process could be recommendations for statutory changes to promote more competition in the Pennsylvania health insurance marketplace."
Ario said the examinations, which would be done on a company-by-company basis, would be wide-ranging in collecting data, analyzing agreements, and otherwise investigating competitive dynamics in the Pennsylvania marketplace.
"The consolidation review was forward-looking in determining whether the consolidation would lead to a better marketplace for consumers," said Ario. "These examinations have a different focus in determining whether the status quo gives consumers access to a healthy climate of competition. Competition is always important to consumers in reducing costs and increasing choices, and it will only become more important if Congress moves forward with federal health reform that is premised on competitive markets existing at the state level."
Among the issues to be explored are the following:
-- Whether the territorial restrictions in the Blues" licensing agreements are anti-competitive given the unique circumstances in Pennsylvania with competing Blue licenses in three of the state"s four regions, as well as evidence that Blue on Blue competition has benefited consumers and enhanced the Blue brand in the central region.
-- Whether there are other agreements among the Blues that impede rather than promote competition.
-- Whether the Blues use their market power to unfair and anti-competitive advantage in areas such as provider contracting and product tying.
-- Whether there are restrictions on data sharing and other market practices that impede the transparency necessary to a competitive marketplace.
"Our underlying goal is to promote competition, not to denigrate in any way the impressive accomplishments of the four Blues, each of which has played a critical role in providing health insurance and supporting civic causes," Ario said. "We reject the notion that enhanced competition is inconsistent with the future success of the Blues and their competitors."
The Insurance Department will begin the examinations this month, with the goal of completing them by early 2010. The department has retained the law firm of Hangley Aronchick Segal & Pudlin to serve as an examiner and expects to retain an expert economist in connection with the examinations. While the law governing examinations requires that confidential treatment be given to information and materials provided by the examination subjects during the course of the examinations, the law also provides that the results, in the form of final examination reports, be made public.
Pennsylvania Department of Insurance