SPRINGFIELD, Ill. (WAND) — Illinois House lawmakers passed a massive health insurance reform plan late Thursday night. Sponsors and Gov. JB Pritzker said it will help curb predatory insurance practices and protect consumers.

The Healthcare Protection Act could make Illinois the first state to ban prior authorization for in-patient adult and children's mental healthcare. This plan would also ban step therapy, or the fail first method, where insurers force people to receive less effective drug treatments before moving to options initially recommended by doctors.

"For far too long, insurance companies and not doctors have been free to determine what treatment options patients should have and how quickly they can receive it," Pritzker said. "With this bill, we're putting power back in the hands of doctors and patients."

Short-term limited duration plans, or junk insurance, that fail to cover basic treatments like maternal healthcare and pre-existing conditions would also be banned under the legislation.

"House Bill 5395 requires prior approval from the Department of Insurance before large group plans can increase rates and require premiums to align with the actual cost of providing care," said Rep. Anna Moeller (D-Elgin).

34 other states already conduct large group insurance rate review. However, Rep. Ryan Spain (R-Peoria) said he is concerned that the Department of Insurance may not be able to keep up with the mandated review process. Spain asked if the agency will require more budget funding to increase staff headcount.

"This is a major expansion. What is the additional capacity building that will be necessary for DOI on this," Spain asked. "I appreciate the opportunity to discuss this important and meaningful piece of legislation. I think that this bill is making important strides and I intend to support it tonight. I also think that there's further work to do."

The measure could also require insurance companies to ensure their provider networks are adequate to serve the healthcare needs of patients. Insurers would need to go through 90-day internal audits to see if their provider directories reflect actual availability.

Advocates from Protect Our Care IL said the bill will make healthcare more affordable to over 1.7 million people who have large group insurance plans and anyone in the state's health insurance marketplace.

"This legislation will profoundly impact Illinoisans living with multiple sclerosis, removing barriers to care and banning predatory insurance practices," said Corbin McGhee from the National MS Society. "Every Illinoisan deserves access to their medications, as well as access to high-quality, comprehensive healthcare." 

Still, Rep. CD Davidsmeyer (R-Jacksonville) said he is concerned the vast majority of Illinoisans would not benefit from this proposal since they have ERISA plans. Moeller agreed that Illinois is not allowed to change self-funded plans because they are protected by the federal government. Although, Moeller stressed this should be a message for Congress to act.

"I hope that the federal government looks at what we're doing here in Illinois and adopts the reforms on the national level," Moeller said. "This is a call to our fellow states and the federal government to take a look at what we're doing to expand these reforms."

House Bill 5395 passed out of the House on a 81-25 vote with two representatives voting present. The legislation now moves to the Senate for further consideration. Sponsors and leaders from the Pritzker administration said they are prepared to continue negotiations with advocates and industry leaders in order to get the bill passed out of the Senate in the coming weeks.

Copyright 2024. WAND TV. All rights reserved.