Pritzker’s healthcare insurance reforms pass State Senate
SPRINGFIELD, Ill. (WCIA) — A series of proposals changing the state’s health insurance laws are one step closer to becoming law.
The Senate passed two bills: the Healthcare Protection Act and one that would end short-term insurance plans.
The reforms are one of Gov. J.B. Pritzker’s (D-Illinois) top legislative priorities, which he first highlighted at his State of the State address in February.
“I think there’s broad agreement that this is something really good for the people of Illinois,” Pritzker said at an unrelated event early Thursday. “It’ll lower people’s healthcare costs and increase the likelihood that people get the healthcare that they deserve.”
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The bill makes step therapy, where an insurance company only covers a less expensive treatment rather than the treatment a doctor prescribes to their patient until it’s proven to not work for the patient, illegal for insurance providers.
The bill also bans insurance companies from requiring prior authorization for mental health treatments, which is a requirement from health insurance companies that the patient get the permission of their provider for a treatment their doctor already prescribed.
“I think the idea is that when they’re in that moment of crisis, the 72-hour period, that we provide them with the best treatment possible that that hospital may be able to provide, preferably of course to be able to have a mental health professional there, but no matter what it’s about the security of that patient,” State Sen. Robert Peters (D-Chicago), the bill’s Senate sponsor, said during floor debate on the proposal Thursday night.
Insurance companies were neutral on this proposal and it picked up some Republican votes. Still, opponents are concerned about the plans more than $50 million price tag.
“We keep adding more and more of these costs,” State Sen. Dave Syverson (R-Cherry Valley), said. “This is one more that’s going to be bore solely by working families.”
The Senate also passed a bill banning short-term insurance plans or what has been referred to as junk insurance plans. These are insurance plans people can opt into if they don’t get coverage through their job.
But these plans don’t always cover pre-existing conditions. Because of that, the bill’s sponsor, State Sen. Laura Fine (D-Glenview), said these plans can end up costing people lots of money.
“I have had people reach out to me who thought they had coverage when they had these short-term, limited duration plans only to find out that they were not covered,” Fine said. “Their prescription drugs were not covered, their emergency services were not covered, and it ended up costing them a whole lot more.”
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Insurance companies oppose this provision, and lawmakers who voted against this say short-term insurance plans offer people coverage at a lower cost than other plans.
“It’s an alternative,” Syverson said. “It’s one other option that people have. Yes, it’s limited in coverage, but it’s a low cost way for families who cannot afford the ACA or cannot afford a COBRA but they want to have some kind of protection and some kind of coverage.”
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Finally, the bill addresses network adequacy. In 2022, WCIA published a series investigating Blue Cross Blue Shield’s ghost networks in Central Illinois. The Illinois Department of Insurance has fined Blue Cross Blue Shield of Illinois twice in 2023 for not following the Network Adequacy and Transparency Act.
The bill previously passed the Illinois House along party lines.
Lt. Governor Juliana Stratton’s birth equity initiative also passed. It’s meant to make care more accessible to people across Illinois, and close racial gaps in maternal mortality.
“Today, Illinois takes a major step forward towards improving maternal outcomes in Illinois with the passage of the Birth Equity Initiative (HB5142) through the Senate,” Stratton said in a statement after the measure passed. “This bill empowers Illinois women to make holistic choices for their birth experience, which is especially important for Black mothers who face unacceptably high rates of complications and mortality.”
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