Pritzker stops at OSF HealthCare in Rockford to tout health reforms targeting insurance practices

By Kevin Haas
Rock River Current
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ROCKFORD — Gov. JB Pritzker visited OSF HealthCare Saint Anthony Medical Center on Tuesday to tout a proposed law that targets insurance industry practices that he says delay and limit access to care.

The Healthcare Protection Act, which passed the state House 81-25 on Thursday with bipartisan support, is a series of insurance reforms intended to increase accountability for insurance companies and provide doctors and patients more control over their health care, Pritzker said.

“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.”

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Pritzker and Lt. Gov. Juliana Stratton stopped here as part of a weeklong tour to promote the bill ahead of a vote in the state Senate. They were in Belleville and Peoria on Monday. The bill now sits in the Senate Rules Committee. Both chambers return to Springfield on April 30.

The proposed law would make Illinois the first state in the nation to ban prior authorization for crisis mental health care in a hospital. It would also ban so-called step therapy, a process where insurers require a patient to try alternative medications before taking what is prescribed by their doctor.

“Prior authorization forces consumers to get approval from their insurance company before beginning treatment, even after their doctor has deemed the treatment medically necessary,” Pritzker said. “With step therapy, insurance companies can require patients to try and fail on often less effective treatment options and medications first before getting the actual care recommended by their doctor.”

The law is also intended to end unchecked rate increase and ban “junk insurance” plans, which are short-term policies that don’t meet the minimum standards of the federal Affordable Care Act. It’s also meant to improve network adequacy by requiring insurance companies to regularly update their provider directories to show the current availability.

“All of us who are providers or physicians chose to go to medical school, and when we made that decision a large driver of that was we wanted to help and to be good and be the best for the patients that we care for. What we didn’t realize was that we needed a crash course – advanced, super-advanced – in how you deal with insurance companies and how you deal with the red tape you experience,” said Dr. Lisa Davis, vice president and chief medical officer for OSF HealthCare Saint Anthony Medical Center. “I know my colleagues here will say that they spend a large portion of their days not doing that direct, hands-on patient care that they need to do, but fielding the land mines that encounter with trying to do what’s best for our patients.”

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The rules would not apply to self-insured plans, which are often offered by large companies and labor unions. Those plans are regulated under the federal Employee Retirement Income and Security Act. It also doesn’t apply to state-funded health care programs for immigrants.

The bill is expected to cost the state up to $50 million because of higher Medicaid and state employee health plan costs. That money was not in Pritzker’s original budget proposal, according to Capital News Illinois.

Critics point to that and say they expect it will lead to increased costs for taxpayers, many of whom are not covered under these reforms.

Pritzker said Tuesday in Rockford that he believes it will reduce health care costs because it will prevent insurance companies from prolonging treatments or requiring other types of treatments than the one prescribed by a doctor.

“That will help us cut costs in the long run,” he said. “This bill will save lives and lower health care costs for millions of Illinoisans.”

This article is by Kevin Haas. Email him at khaas@rockrivercurrent.com or follow him on X at @KevinMHaas or Instagram @thekevinhaas and Threads @thekevinhaas