The Push for Health Insurance Reform Had a Big Day in Springfield!

March 14, 2024

On Wednesday, Governor Pritzker held a press conference to introduce the Healthcare Protection Act (House Bill 5395), which he first proposed at his annual State of the State and budget address last month. The governor said that this legislation is designed to curb predatory insurance practices and return the power back to patients and their doctors – where it belongs.

The governor outlined the three components of the bill. The first part focuses on utilization management and would:

• Ban step therapy entirely in Illinois for fully insured plans
   
• Ban prior authorization specifically for in-patient hospital settings for adult and children’s mental healthcare. That means patients in a mental health crisis can get the care they need without jumping through hoops designed to deny coverage. The governor said these decisions should not be made by an insurance employee with no medical background.


• Prohibit insurance companies from selling short term, limited duration insurance plans (also known as junk insurance) that fails to even meet the minimum standards of the Affordable Care Act.

The second part of the proposal covers network adequacy, specifically “ghost networks,” which are in-network directories with doctors and specialists who are not actually accepting any new patients, are not in-network or don’t even exist at all. The bill would:

• Require insurance companies to update their in-network directories to reflect the actual availability of the healthcare professionals and, if they do not, be slapped with steep penalties.

The third part of the legislation cracks down on insurance companies that unfairly jack up rates on consumers and would:

• Ban unchecked rate increases in the larger group insurance market; last year this requirement was put in place for the small group insurance carriers.

At the end of the press conference, the governor said that the Healthcare Protection Act will be passed during this current legislative session and that he will proudly sign it.

Subject expert hearing

Earlier that same day, the House Human Services Committee held a subject expert hearing led by Chair Representative Anna Moeller. Many testified, including obstetrician and gynecologist Leslie Dignan-Moore, M.D., of the Springfield Clinic.

Dr. Dignan-Moore referred back to 2021 when Springfield Clinic was removed as an in-network provider by a major commercial insurer in Illinois. Patients, who feared much higher out-of-network costs, began to look for alternative healthcare professionals. When Dr. Dignan-Moore began assisting patients by searching online directories, she discovered that the directories were “ghost networks.” Out of 99 options available to these patients, only four were accepting patients within the time and distance requirements of the ISMS-initiated Network Adequacy and Transparency Act (NAT Act).

ISMS will keep you informed about any developments pertaining to this legislation.

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