Opinion: Using vulnerable Virginians as bargaining chips must stop

Bon Secours Mercy Health (BSMH) has deployed a deeply concerning new tactic in
its recent negotiations with Anthem Blue Cross and Blue Shield.
In short: BSMH terminated its provider contracts relating to Anthem’s Medicare
Advantage and Medicaid members in an effort to raise prices for people who have
health coverage through their employer or the Affordable Care Act (ACA).

As a result, on Aug. 1 about 11,000 Virginians with Anthem Medicare Advantage
coverage lost access to affordable health care services at BSMH. If a resolution can’t
be reached, Anthem Medicaid members will lose access on Oct. 1. This is already
disrupting care for many of the most vulnerable people in our community. Anthem has
been working diligently to ensure treatment continuity for people with certain serious
and complex conditions. But BSMH’s decision means that most with Anthem
Medicare Advantage coverage will be forced to find alternative care.
It’s important to understand how we got to this point.
BSMH and Anthem agreed to contracts for Anthem’s Medicaid, Medicare Advantage,
employer-sponsored and Affordable Care Act health plan members which provided
Anthem members with in-network health care access until Jan. 1, 2025.

Just one year into the agreement, BSMH wanted to raise prices for Anthem members
with employer-sponsored and ACA health plans. It demanded increases more than
three times the current hospital inflation rate and the annual increases agreed to in the
current contract. Notably, it did not ask for more money for care received by Medicaid
members.
In an attempt to force these price hikes, BSMH told Anthem that it would stop
accepting Medicare Advantage and Medicaid members unless Anthem agreed to
these higher employer-based and ACA prices. Thus, using these vulnerable
populations as leverage to force increased payments from employers and individuals.
BSMH has been disingenuous about why this is happening. Recently, it issued a
press release describing this situation as “incredibly disheartening.” But BSMH chose
to become out of network for Anthem Medicare Advantage members. This was not a
given “next step” in the process. Despite our requests to rescind its termination and
rejoin discussions to find a reasonable solution, BSMH chose to terminate the
provider contracts relating to Anthem’s Medicare Advantage and Medicaid members
in the middle of the agreements.
This impacts our community.

People covered by Medicare Advantage and Medicaid are particularly sensitive to
medical care disruptions. Changing doctors and finding transportation, among other
factors, present difficult barriers to care — leading to missed appointments, skipped
screenings and unmanaged chronic conditions. Putting these vulnerable groups in
jeopardy to seek higher prices from other patients is as baffling as it is distressing for
our community.
Anthem has been committed to preserving access, repeatedly requesting that BSMH
continue serving Medicare Advantage members while working toward a resolution.
But BSMH terminated coverage for more than 11,000 Virginia Medicare Advantage
members on Aug. 1. Starting Oct. 1, it plans to terminate Anthem coverage for almost
40,000 Medicaid members. And Virginia is not the only state it is manipulating with
these tactics.
While negotiations between hospitals and health plans are an ordinary part of our
health care system, BSMH’s decision to break a contract for one group of members to
demand price increases from an entirely different group of members is anything but
ordinary. And sadly, it’s now part of a BSMH pattern of putting vulnerable patients at
risk to increase its profits.
Our ask is simple: that BSMH stop using vulnerable populations as bargaining chips
and work together to reach an agreement.

Now more than ever, hospitals and health plans must collaborate to put Virginians’
best interests first. I remain committed to that course so that our families and
neighbors continue to have access to high-quality, affordable health care.