Report on the Contract Dispute Between UnitedHealthcare and Ascension Wisconsin and its Implications for Sustainable Development Goals

Executive Summary

A contract negotiation impasse between UnitedHealthcare and Ascension Wisconsin poses a significant threat to public health access and affordability, directly challenging the achievement of several United Nations Sustainable Development Goals (SDGs). This report analyzes the dispute through the lens of SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 17 (Partnerships for the Goals), examining the potential consequences for Wisconsin residents if a resolution is not reached by the September 30 deadline.

Analysis of Impact on SDG 3: Good Health and Well-being

Threats to Universal Health Coverage (Target 3.8)

The core of the dispute jeopardizes the principle of universal access to quality and affordable healthcare. Should Ascension Wisconsin be removed from UnitedHealthcare’s network, a significant portion of the population will face immediate barriers to care, undermining progress toward SDG 3.

• Disruption of Care: Patients may be forced to switch established healthcare providers, interrupting continuity of care, which is crucial for managing chronic conditions and maintaining overall well-being.
• Financial Barriers: Seeking care at out-of-network Ascension facilities would result in substantially higher out-of-pocket costs, creating a financial barrier that directly contravenes the goal of affordable healthcare for all.
• Reduced Access: The removal of a major health system like Ascension from a major insurer’s network effectively reduces the availability of accessible healthcare services for thousands of individuals and families.

Economic Tensions and Alignment with SDGs 1, 8, and 10

Conflicting Financial Pressures and Social Responsibility

The positions of both organizations highlight the tension between economic sustainability and the broader goal of equitable health access. This conflict has direct implications for poverty, economic stability, and inequality.

1. Ascension Wisconsin’s Position: The health system argues for “fair and market-relevant reimbursement” to address rising operational costs. This stance aligns with SDG 8 (Decent Work and Economic Growth) by seeking to maintain financial viability and operational capacity. However, if these costs are passed on without consideration for affordability, it could negatively impact SDG 1 (No Poverty) and SDG 3.
2. UnitedHealthcare’s Position: The insurer warns that Ascension’s demands are “unsustainable price hikes” that would increase costs for members and employers. This position aims to protect against rising healthcare costs that can contribute to financial hardship (SDG 1) and strain employer resources (SDG 8).

Impact on SDG 10: Reduced Inequalities

The potential termination of the contract would disproportionately affect vulnerable populations, thereby exacerbating existing health and economic inequalities.

• Vulnerable Groups: Members enrolled in Medicaid and Medicare Advantage plans would be particularly affected, limiting their choice of providers and potentially disrupting access to necessary medical services.
• Widening Health Disparities: Reduced access and increased costs for certain populations can lead to poorer health outcomes, widening the gap in health equity, a key target of SDG 10.

A Challenge to SDG 17: Partnerships for the Goals

Breakdown in Institutional Collaboration

The dispute represents a significant failure in the partnership between two key institutions responsible for the public’s health. Achieving SDG 3 is contingent upon effective collaboration between payers and providers.

• The ongoing negotiations are a critical test of the ability of major healthcare stakeholders to work together for the common good.
• A successful resolution, similar to the one reached between the parent companies in Florida, would reaffirm the commitment to partnership.
• Failure to agree would signal a prioritization of corporate financial interests over the collaborative spirit required to build a sustainable and equitable healthcare system for the community.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The entire article revolves around access to healthcare services, which is a cornerstone of SDG 3. The dispute between UnitedHealthcare and Ascension Wisconsin directly threatens the ability of patients to receive continuous and affordable care from their chosen providers. The article states that if an agreement isn’t reached, it “could mean hard choices for patients, like whether to switch doctors,” which impacts their well-being.
2. SDG 10: Reduced Inequalities
   • The article specifies that the potential contract termination affects members of various plans, including “Medicaid and Medicare Advantage health plans.” These programs serve low-income individuals and the elderly, respectively. A disruption in their in-network access could disproportionately affect these vulnerable populations, who may have fewer resources to find new doctors or pay higher out-of-pocket costs, thus exacerbating health inequalities.
3. SDG 17: Partnerships for the Goals
   • The conflict described is a breakdown in a critical partnership between a major health insurer (UnitedHealthcare) and a major healthcare provider (Ascension Wisconsin). The article highlights the negotiation process, stating, “Insurance companies periodically negotiate prices for health care services with hospitals and other health care providers in their network.” The success or failure of this partnership directly impacts the delivery of healthcare, making it relevant to SDG 17, which promotes effective public-private partnerships.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • This target is central to the article. The dispute directly impacts “access to quality essential health-care services” by potentially removing Ascension’s hospitals and doctors from the network. The issue of “financial risk protection” is also prominent, as UnitedHealthcare warns that Ascension’s demands could lead to “higher premiums and out-of-pocket costs” for patients, making healthcare less affordable.
2. Target 10.4: Adopt policies, especially fiscal, wage and social protection policies, and progressively achieve greater equality.
   • The negotiation over payment rates and insurance premiums is a form of fiscal and social protection policy-making within the private sector that has public consequences. The article notes that the dispute affects Medicaid and Medicare Advantage members, linking the outcome to social protection systems. The failure to reach a “sustainable contract” that balances costs for insurers, providers, and patients affects the equality of access to care.
3. Target 17.17: Encourage and promote effective public, public-private and civil society partnerships, building on the experience and resourcing strategies of partnerships.
   • The article is a case study of the challenges within a crucial private-sector partnership that serves the public good. The negotiation between UnitedHealthcare and Ascension is an attempt to create a sustainable and effective partnership. The statement, “Hopefully both sides in the negotiations will keep the interests of patients in mind and they will reach an agreement,” underscores the need for this partnership to be effective for the benefit of society.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicators for Target 3.8 (Universal Health Coverage)
   • Coverage of essential health services (Indicator 3.8.1): This is implied by the number of patients who could lose in-network access. The article mentions that patients “began receiving letters this month letting them know of the potential change” and identifying the “Ascension-affiliated doctors whom they have seen and would no longer be in-network.” The number of affected patients serves as a direct measure of service coverage disruption.
   • Household expenditures on health (Indicator 3.8.2): The article explicitly mentions factors that measure this indicator. UnitedHealthcare warns that price increases “could lead to higher premiums and out-of-pocket costs.” Measuring the change in these costs for affected members would be a direct indicator of financial risk and the affordability of care.
2. Indicators for Target 10.4 (Reduced Inequalities)
   • Access to healthcare for vulnerable groups: An implied indicator is the number or proportion of Medicaid and Medicare Advantage members who would be forced to switch doctors or face higher costs compared to those on employer-sponsored plans. The article identifies these specific groups, allowing for a measurement of the disproportionate impact on the elderly and low-income populations.
3. Indicators for Target 17.17 (Partnerships)
   • Status of contract agreements: A clear, though qualitative, indicator is the outcome of the negotiation. The article states that the “current contract ends Sept. 30” and a new agreement is needed. Whether a “new multi-year contract” is signed (as was the case in Florida) or the partnership is terminated serves as a direct indicator of the partnership’s effectiveness and sustainability.

SDGs, Targets, and Indicators Table

Source: jsonline.com