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House passes Pritzker-backed bill cracking down on step therapy, prior authorization, junk insurance with bipartisan support

Friday, Apr 19, 2024 - Posted by Isabel Miller

* WGEM

The House passed the Healthcare Protection Act by an 81-25 margin, with two members voting “present.” Several Republicans joined all Democrats in voting for the bill.

It overhauls parts of the health insurance industry in Illinois.

The bill would ban so-called “step therapy.” This is when an insurance company requires a patient to try and fail alternative medications before covering medications their doctor recommends. […]

“One of the major changes that we’re making with this bill is ensuring that when someone is having an acute mental-health crisis that they can’t be turned away from in-patient care in a hospital because of arbitrary insurance rules,” said state Rep. Anna Moeller, D-Elgin, the bill’s sponsor.

* Governor Pritzker…

Today, Governor JB Pritzker joined legislators, doctors, patients, and stakeholders in Springfield to celebrate the passage of HB5395, also known as the Healthcare Protection Act (HPA), in Illinois’ House of Representatives. The bill, first proposed by Governor Pritzker in his FY25 Budget Address, aims to put power back into the hands of patients by banning step therapy, banning prior authorization for crisis mental health care, improving network adequacy, banning junk insurance plans, and ending unchecked rate increases for large group insurance companies.

“I’m pleased that dedicated advocates and legislators have made further progress in passing the Healthcare Protection Act, a bill that will curb predatory insurance practices and empower both doctors and patients,” said Governor JB Pritzker. “I want to especially thank the HPA’S lead sponsors, Senator Robert Peters and Representative Anna Moeller, two outstanding partners in the longtime fight for health insurance reform. Both you and your cosponsors are doing important work to advocate for Illinois families, and I’m proud to have you fighting alongside me.”

The Governor was also joined by the bill’s chief sponsors, Representative Anna Moeller and Senator Robert Peters, alongside various cosponsors working to promote the sweeping health insurance reforms. Acting Director Ann Gillespie also attended on behalf of the Department of Insurance.

“The Department will hold insurers accountable for unfair business practices that undermine Illinoisans, requiring them to jump through hoops just to access the health care services that they pay for each month,” said IDOI Acting Director Ann Gillespie. “Protecting Illinois insurance consumers is our priority, and we stand ready to enforce the Healthcare Protection Act.”

The Healthcare Protection Act targets three primary issues with the healthcare insurance industry: utilization management, network adequacy, and rate review.

Utilization Management

The first goal of HPA is to eliminate harmful utilization management practices, which force consumers to wait for permission (also known as prior authorization) from their insurance providers before receiving doctor-recommended treatments. Often, utilization management causes patients to be denied care deemed medically necessary or delay the process and create barriers to care. Another example of utilization management is “step therapy”, which requires patients to try other less effective treatment options before their insurance company will approve access to the original prescribed treatment from healthcare providers.

To address unfair utilization management practices, HPA will:

    - require insurance companies to adopt the same definitions of medical necessity as doctors,
    - require insurance companies to post all treatments that require prior authorization to help consumers make informed decisions while shopping for plans,
    - ban “step therapy” processes in Illinois, and
    - ban prior authorization for in-patient adult and children’s mental health care (becoming the first state in the nation to do so).

Additionally, with the passage of HPA, Illinois will join twelve other states in banning “junk insurance” plans, or Short Term Limited Duration plans, which are dangerous and misleading to consumers: junk insurance plans do not have to comply with the basic standards of the Affordable Care Act, such as coverage for preexisting conditions.

Network Adequacy

The second goal of HPA is to improve network adequacy and standards for transparency across Illinois. The bill implements stricter standards for insurance companies as they update their in-network care directories, which must now reflect actual availability. To ensure consumers can find care where and when they need it, companies will be required to indicate whether or not doctors and specialists are currently accepting new patients. Companies will also be required to remove healthcare professionals who are not in-network anymore or no longer practicing in a timely fashion. If these standards are unmet, companies will face potential penalties.

Rate Review

The final initiative of the Healthcare Protection Act eliminates unchecked rate increases in fully-insured large group insurance carriers. This follows similar action in June 2023, when Governor Pritzker signed HB 579, ending unfair rate hikes in the fully-insured individual and small group insurance market. Now, large-group providers will be required to do the same, protecting Illinois consumers further.

* House Sponsor Rep. Anna Moeller…

Illinois families will have access to better and more affordable health care coverage under a new measure backed by state Rep. Anna Moeller, D-Elgin, aiming to reduce costs and hold big insurance companies accountable.

“The fact of the matter is that healthcare has for far too long centered the needs of large, multi-billion dollar corporations versus those of working families and underserved communities,” Moeller said. “This legislation makes sure that health plans don’t get between a patient and their doctor when they are making life altering decisions, or requires that patients try alternatives to the prescribed medication, because it’s cheaper for the insurance company. These practices are not conducive to protecting people. Rather, they’ve protected profits. I am proud to join so many of my colleagues, including Governor Pritzker, to pass these landmark reforms and safeguard the health and wellbeing of Illinois communities.”

Moeller introduced House Bill 5395, which delivers a series of major reforms to make health care coverage better and more affordable. The new Health Care Protection Act would create a rate review process requiring insurance companies to justify premium increases, and empowering state watchdogs to reject unwarranted hikes that simply pad profits. Additionally, the measure curbs practices insurance companies use to deny access to medically necessary treatments, procedures, and prescription medications; instead, doctors and patients would be empowered to make important medical decisions—not insurance companies. The bill also stops insurance companies from selling inadequate short-term healthcare plans that provide little or no coverage.

* More…

    * WAND | Insurance Reform: Illinois House passes Healthcare Protection Act: “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.

    * Center Square | Illinois House passes ‘Healthcare Protection Act’ some warn increases taxpayer costs: “One of the major changes that we’re making with this bill is ensuring that when someone is having an acute mental health crisis, that they can’t be turned away from inpatient care at the hospital because of arbitrary insurance rules,” said state Rep. Anna Moeller, D-Elgin.

       

7 Comments
  1. - George Ryan Reynolds - Friday, Apr 19, 24 @ 12:06 pm:

    This is so important to address. Well done.

    “One of the major changes that we’re making with this bill is ensuring that when someone is having an acute mental-health crisis that they can’t be turned away from in-patient care in a hospital because of arbitrary insurance rules.”


  2. - Flyin'Elvis'-Utah Chapter - Friday, Apr 19, 24 @ 12:27 pm:

    I’ve voted for the man twice and have yet to have a regret.

    In this era of fringe candidates, Pritzker remains an oasis of sanity and normalcy.


  3. - halving_fun - Friday, Apr 19, 24 @ 12:41 pm:

    Happy that Springfield worked
    Rare win for Illinoisans


  4. - Cubs in '16 - Friday, Apr 19, 24 @ 12:45 pm:

    25 Republican reps voted against this legislation and they wonder why they’re still the superminority.


  5. - Former Downstater - Friday, Apr 19, 24 @ 12:59 pm:

    Why does Center Square bother to have reporters? Their takes are so predictable, couldn’t they just use AI to generate their articles?


  6. - Flapdoodle - Friday, Apr 19, 24 @ 1:06 pm:

    ==25 Republican reps voted against this legislation and they wonder why they’re still the superminority.==

    In the GOP’s world, things work the other way around so what they really wonder is how the voters can be so out of touch them. After all, when you’re far right, you’re right. /s


  7. - MadiM - Friday, Apr 19, 24 @ 1:20 pm:

    Now for the home and auto insurance industry. Let’s reform how they handle premium increases.


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