Illinois House passes Healthcare Protection Act, sends monumental plan to Pritzker

SPRINGFIELD, Ill. (WAND) — The Illinois House passed the Healthcare Protection Act Saturday to help curb predatory insurance practices and protect consumers.

Gov. JB Pritzker’s monumental plan could make Illinois the first state to ban prior authorization for in-patient adult and children’s mental healthcare. The legislation also bans step therapy, or the fail first method, where insurers force people to receive less effective treatment before moving to options initially recommended by doctors.

“For far too long, insurance companies, 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.”

The measure requires prior approval from the Department of Insurance before large group insurance plans can increase rates and states premiums must align with the actual cost of providing care as well.

“I’ve heard powerful stories from doctors, patients and colleagues about how the Healthcare Protection Act would save lives and lower costs for millions of Illinoisans,” said Sen. Robert Peters (D-Chicago). “As my wife and I start on our journey to build a family through IVF and fertility treatments, this issue has been personal for me. I couldn’t be more proud to carry this legislation through the Senate.”

The measure could also crack down on ghost networks by forcing insurance companies to follow strict network adequacy and transparency standards. The proposal states that insurers would need to complete internal audits every 90 days to ensure their directories reflect the healthcare available to patients in those networks.

“I hope that the federal government looks at what we’re doing here in Illinois and adopts the reforms on the national level,” said Rep. Anna Moeller (D-Elgin). “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.”

This legislation passed out of the House on a 83-23 vote. House Bill 5395 previously passed out of the Senate on a 45-14 vote.

The Illinois Life & Health Insurance Council applauded the willingness of the governor’s office and sponsors to compromise on the bill. However, the organization also said the plan could lead to higher consumer costs.

ILHIC President Laura Minzer said banning the use of step therapy and restricting prior authorization limit the tools insurance companies have to control costs. She noted that these changes could lead to higher insurance premiums as the cost of medical care continues to outpace cost increases for other goods and services.

“We hope to make more progress during the implementation phase,” Minzer said. “What the ongoing discussions in the House and Senate have amplified is the indispensable role insurance companies lay in the affordability of healthcare. It is not an exaggeration to say that insurance companies make healthcare possible.”