SPRINGFIELD, Ill. (WAND) — State lawmakers are in the early process of discussing Gov. JB Pritzker's massive plan to tackle predatory insurance practices.
The Health Care Protection Act could help Illinoisans by banning step therapy, which forces people to receive less effective treatment before moving to treatment initially recommended by doctors.
"Consumers are tired of being denied, delayed, and treated just like they're another number that needs to be managed," said Rep. Anna Moeller (D-Elgin). "I applaud the governor for his leadership and look forward to working with him and the Democratic majorities in the legislature who understand affordable, accessible care is a basic human right - even if it doesn't always fit the corporate mindset of care management.
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This proposal could also make Illinois the first state in the nation to ban prior authorization for in-patient adult and children's mental healthcare. This means people in a mental health crisis could receive immediate care without waiting for permission from their insurance company.
"Our patients need to be able to focus on their care, and their recovery and getting better," said Clay Ciha, President of Amita Health Alexian Brothers Behavioral Hospital. "They don't need to be worried about whether or not their insurance is going to cover their care."
The legislation would also require insurance companies to post all treatments that require prior authorization so patients can compare health plans when they look for insurance coverage.
Sponsors and advocates explained Wednesday that the measure could also crack down on ghost networks by forcing insurance companies to follow strict network adequacy and transparency standards. House Bill 5395 states that insurers would need to complete internal audits every 90 days to ensue their directories reflect the healthcare available to patients in those networks.
"Our bill requires that insurance companies update their in-network directories of doctors to reflect the actual availability of healthcare," Pritzker said. "If they don't, there will be steep penalties."
Gov. JB Pritzker talks about his Healthcare Protection Act during a press conference in Springfield on March 13, 2024.
Pritzker hopes to prohibit short term limited duration insurance plans, or junk insurance through this plan. The Illinois Department of Insurance would be required to approve any rate hikes on consumers and prevent premiums from being out of line with the actual cost of providing coverage as well.
"As the state's regulator of insurance companies, we will continue to protect Illinois insurance consumers and demand that they receive the coverage they pay for and deserve," said IDOI Director Dana Popish Severinghaus.
Although, the Illinois Life & Health Insurance Council opposes the current bill language. President Laura Minzer told lawmakers and advocates Wednesday that the legislation could lead to higher insurance costs and reduced access to medical care. Although, Minzer is confident the Illinois Life & Health Insurance Council can work with lawmakers to avoid those consequences and successfully improve access to affordable healthcare.
"Insurance companies play a critical role in affordability of healthcare," Minzer said. "In fact, with the costs associated with medical care, it is not an exaggeration to say that insurance companies make healthcare possible."
The House Human Services Committee plans to vote on the proposal next week.
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