Gov. Pritzker visits Silver Cross Hospital in New Lenox promoting health insurance reform

New Lenox — Gov. JB Pritzker and a group of state lawmakers visited Silver Cross Hospital in New Lenox on Wednesday morning to promote the Healthcare Protection Act, which is pending in the Illinois Senate.

The Healthcare Protection Act was introduced by Pritzker in the State of the State address in February and passed the Illinois House on April 18 with bipartisan support. The bill would take steps to regulate insurance providers, including Medicaid, in Illinois and to eliminate bureaucratic obstacles to receiving care, according to the bill’s supporters.

“This legislation will curb predatory insurance practices and empower patients and doctors,” Pritzker said.

Among the bill’s provisions are measures that improve “utilization management” by banning “step therapy,” which requires patients to undergo alternate – potentially less effective – treatments or procedures before insurance will pay for the treatment recommended by doctors, and prior authorization requirements for inpatient mental health care. These measures are meant to eliminate roadblocks that residents face to getting health care that is deemed appropriate for them.

“Too often, utilization management results in a denial of coverage,” Pritzker said, “simply because insurance companies want to boost profits. It’s an unhealthy and unfair system for patients. There is no question that medical professionals are better suited to make recommendations about treatment than insurance company bureaucrats, so with this bill we’re requiring insurance companies to use the same treatment criteria to determine medical necessity that doctors do. That way patients get what they need.”

The provision to ban prior authorization requirements for mental health services was hailed by the lawmakers and doctors present at the Wednesday event as groundbreaking and something that will save lives.

“We heard from a doctor who works in an emergency room that because of requirements for prior authorization before a patient can be admitted for a mental health crisis, he has seen time and time again people showing up at the hospital truly suffering an acute crisis having to be turned away because an insurance company would not allow them to be admitted,” said the bill’s House sponsor, state Rep. Anna Moeller, D-Elgin. “And the anguish that this doctor felt knowing that this person could end up hurting himself or hurting others because of the arbitrary rules put in place by an insurance company was eye-opening. This is going to prevent so many tragedies in our state.”

Under the bill, no patient can be turned away for admission for inpatient care while experiencing a mental health crisis, and insurance companies would be required to cover treatment.

Other steps the bill takes is requiring insurers to list on their plans what treatments do require prior authorization, and mandating that companies keep up-to-date lists of in-network providers on their websites to avoid the development of “ghost networks,” leading to provider lists seeming larger than they are.

The bill also would ban the sale of “junk” insurance plans that are short term and may not meet standards created by the Affordable Care Act.

If the bill passes, Illinois will be the first state in the country to ban insurance companies from requiring prior authorization for mental health care and the 13th state to ban “junk plans.”

The bill also builds on a law passed in 2023 that limited large rate hikes in the fully insured individual and small group insurance markets. The HPA will expand that protection by eliminating unchecked rate increases in large group insurance carriers as well.

“The Healthcare Protection Act is a set of consumer-focused health insurance reforms that will return a sense of autonomy and control to patients and their doctors,” Pritzker said.

The HPA passed the Democratic-controlled House by a vote of 81-25 with the support of 10 Republican lawmakers.

“Everyone, no matter who they are or where they live, deserves access to safe and effective care across all aspects of their health, maternal and mental health included,” said the bill’s Senate sponsor, state Sen. Robert Peters, D-Chicago.

Peters said he does not know exactly when the bill will come up for a vote in his chamber, but he is confident it will pass before the end of the Legislature’s session in May.

State Sen. Rachel Ventura, D-Joliet, said she left a career in the insurance industry because of what she described as its predatory business practices.

“I left that field because I felt I was selling parts of my soul away for somebody else to make trillions of dollars while we denied coverage to people who really needed it,” she said. “So, I am very in support of this bill. It’s time that insurance companies stop practicing medicine without a license, because that’s exactly what they’ve been doing.”

Silver Cross was one stop in a series of speaking engagements Pritzker, Peters, Moeller and Lt. Gov. Julianna Stratton made at hospitals throughout the state Wednesday promoting the legislation.