Governor’s Budget Address Promises to Strengthen ISMS-Initiated Legislation, Crack Down on Bad Insurance Practices

February 22, 2024

On Wednesday, Governor Pritzker delivered his annual State of the State and budget address to a joint session of the General Assembly. In his address, the governor announced key initiatives related to medicine for the $52.7 billion budget.

The governor intends on introducing “The Healthcare Consumer Access and Protection Act," which is designed to curb predatory insurance practices and address other health insurance issues. The Act would:

  • Strengthen the ISMS-initiated Prior Authorization Reform Act, which is designed to significantly reduce delays for patient care (applicable to state-regulated insurance plans). The governor said that insurance companies often try to boost profits by requiring patients to obtain permission before they receive care, which is often denied. Among the features of the Healthcare Consumer Access and Protection Act, Illinois would become the first state in the nation to ban prior authorization for in-patient adult and children’s mental healthcare. The legislation would also ensure that insurance plans publicly post all treatments that require prior authorization so that consumers can compare plans when they are shopping for coverage.
  • Bolster another ISMS-initiated law, the Network Adequacy and Transparency Act (NAT Act), which requires insurance companies to ensure that there are enough in-network doctors to treat patients when and where patients need healthcare. The governor’s proposal would target “ghost networks,” in which an in-network directory publishes physicians and specialists who in reality either aren’t accepting any new patients, aren’t in-network or don’t exist at all. In addition, insurance companies would be required to update their in-network directories to reflect the actual availability of physicians and healthcare professionals and penalize insurance companies when they do not comply.
  • Ban step therapy in Illinois and force insurance companies to use the same definitions of medical necessity that physicians use. As you already know, step therapy occurs when a patient is forced to try a less effective treatment and then have that fail before getting the actual quality care their doctors said they needed in the first place.
  • Prevent insurance companies from unfairly increasing rates for consumers. Last year, unchecked rate increases in the small group insurance market was banned and this year that same requirement will extend to large group insurance carriers.
  • Prohibit insurance companies from selling short term, limited duration insurance plans. These plans fail to meet even the minimum standards of the Affordable Care Act.

The governor highlighted other healthcare-related issues that he would like to address:

  • During the next four years, $4 billion of medical debt would be eliminated for more than 1 million Illinoisans through working with a national non-profit called RIP Medical Debt.
  • As Black women in Illinois are three times more likely to die from pregnancy-related causes than white women, the State of Illinois would work to reduce maternal mortality rates and eliminate racial disparities.
  • To ensure that the most basic human needs are met for asylum seekers arriving in Chicago and Cook County, the governor proposed a $181.7million investment to develop a cost effective and comprehensive response plan over the next 12 months.

In a statement issued to the media, ISMS thanked Governor Pritzker for joining our ongoing efforts to enact additional improvements to the Prior Authorization Reform Act and for his commitment to strengthen the protections afforded under the Network Adequacy and Transparency Act. Your ISMS will continue to work with the governor and state lawmakers to make sure the inhabitants of Illinois have access to the quality healthcare they deserve and that the administrative burdens on physicians are lessened so that more of their time can be spent on delivering patient care.

If you have questions, please contact ISMS Senior Vice President of State Legislative Affairs Erin O'Brien by email.

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