Physicians get Senate's ear on plan mergers

A proposed Pennsylvania deal prompts the Senate Judiciary Committee to have organized medicine and others speak out on what health plan consolidation has wrought.

By Jonathan G. Bethely, AMNews staff. Oct. 2, 2006.

For years, physicians have complained that health plan mergers create an imbalance, as dominant plans can act with near impunity and tell comparatively smaller medical practices to like it or lump it when it comes to contract negotiations.

In September, for the first time, physicians got a public audience in Washington, D.C., to air their concerns about health plan market dominance, thanks to a powerful Pennsylvania senator who recently heard an earful about a possible merger in his home state.

The Senate Judiciary Committee's hearing, "Examining Competition in Group Health Care," isn't expected to put an immediate halt to any mergers under discussion. That includes a deal being talked about between two powerful nonprofit plans in Pennsylvania, home of the committee's chair, Republican Sen. Arlen Specter. Nor does it signal that the Justice Dept. might be re-examining past deals, as it has with hospitals, to see if they still pass antitrust muster.

But having on-the-record statements from physician representatives -- and insurer representatives -- is expected to guide the department the next time a merger crosses its desk. "The Dept. of Justice pays attention to hearings," said Specter spokeswoman Courtney Boone.

"We've been seeking hearings for quite some time," said AMA Board of Trustees Chair-elect Edward L. Langston, MD, RPh, who testified at the Sept. 6 proceedings.

"The concentration of insurance companies has been a major concern of ours," said Dr. Langston, a family physician from Lafayette, Ind.