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Fábregas: Insurers’ feud helps enrollees

The health insurance heat is on. Way on.

Starting Saturday, people who don’t get health insurance at work can shop for coverage on the year-old, online marketplaces of by the federal health care law.

Before you roll your eyes, there’s a big reason why this year’s Obamacare enrollment will differ significantly from last year’s disastrous rollout: prices.

Bargain hunters in Western Pennsylvania will encounter some sizzling deals, thanks to the gift that keeps on giving: the Highmark-UPMC feud.

In what appears to be a bold move to stick it to its rival, UPMC Health Plan dropped prices for most of its plans — some by as much as 41 percent. Highmark’s prices are up compared with last year’s, but the insurer previously offered some pretty reasonably priced plans.

UPMC’s plans are cheaper, but they were priced higher last year. And the price difference between UPMC and Highmark plans could be less than $10 in some cases.

That’s not the point. In case you miss the significance of this price war, let’s make it clear. The lower prices — and thus the benefit to consumers — arrive courtesy of that pesky contract that UPMC and Highmark will toss out the window in December. We’ve all agonized about the lack of a pact, yet the payoff is golden. Some folks might get affordable health care.

No UPMC-Highmark pact in 2015 means Highmark will do anything to get people into Allegheny Health Network, the resurging hospital system that gives UPMC executives headaches. UPMC wants people to go anywhere but Allegheny Health.

That might explain why UPMC’s prices on the exchange are among the lowest in the country for silver plans, the most popular type. If Highmark wants to prevent an exodus of customers, it might have to produce some markdowns.

When the online exchanges went live last year, UPMC accused Highmark of lowballing its prices on the exchange, which were as much as 40 percent less expensive than its competitors. But we love a bargain in Western Pennsylvania, and the low prices allowed Highmark to snag more than 130,000 people on the exchange. By contrast, UPMC Health Plan signed up just under 5,000 people.

Is it any wonder that UPMC is lowering prices to be more competitive? You didn’t think money-hungry UPMC was going to sit idly and watch Highmark gobble up every possible customer?

As with pretty much any good deal, you get what you pay for. The low prices are generally attached to networks with limited hospitals and doctors. You might just have access to one hospital network, not both. Smart consumers should look beyond the enticing TV ads and make sure they understand what they get for their money.

They should realize that a limited hospital network is not a gloom-and-doom scenario. Unless they’re in the middle of cancer care or other specialized treatment, it’s conceivable that someone can find a capable doctor at either hospital system. So access to quality care is becoming a stale argument. Or does a great doctor who works at UPMC suddenly become a bad doctor if he or she is hired by Allegheny Health? Please.

Competition is finally forcing these often vilified organizations to lower prices. They can fight all they want, but if the bickering translates into a better deal for Joe Consumer, it’s hard to argue with that.

Luis Fábregas is Trib Total Media’s medical editor. Reach him at 412-320-7998 or [email protected].


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