Illinois House Passes Healthcare Protection Act in Bipartisan Vote

A landmark legislative victory for Governor JB Pritzker, the Illinois House has just approved the “Healthcare Protection Act,” House Bill 5395, with an overwhelming bipartisan vote of 81-25. This legislation intends to stop some practices used by health insurance agency to control access and prices to medical coverage insurance for individual policyholders.

As an opening move, the bill initiated by Governor Pritzker in his State address last February is focused on a variety of “utilization management” methods that insurance firms use to cut costs, including the denial of claims and persuading patients to opt for low-cost alternatives for medical coverage insurance . Most importantly, it obliges insurers to follow “generally accepted standards of care” when determining coverage for doctor-prescribed treatments. In addition, it outlaws practices such as step therapy in which people have to demonstrate that a cheaper drug does not work before receiving a more effective but higher-priced medicine.

The legislation also ensures that insurance companies cannot impose prior authorization on covering the charges for hospital-based psychiatric treatment. All prior authorization requirements for medical coverage insurance should be made public on the websites of insurers. Moreover, the bill requires that all health insurance agency conduct internal audits of their provider networks to ensure adequacy and participation, and this is done regularly.

An additional provision of the act is that in Illinois, it prohibits the sale of short-term, limited-duration medical coverage insurance that do not comply with the federal minimum standards as stated in the Affordable Care Act. This law empowers the Illinois Department of Insurance to examine and affirm or deny rate hikes regarding large group insurance plans.

Governor Pritzker expressed optimism about the bill’s prospects in the Senate, predicting an easy passage. He emphasized the importance of the legislation in empowering doctors and patients by returning decision-making authority regarding treatment options to their hands.

However, it’s worth noting that the bill does not extend to self-insured plans regulated under federal law, nor does it apply to state-funded healthcare programs for noncitizens.

While the bill received widespread support, concerns were raised regarding its potential fiscal impact. Estimates suggest an additional $40-50 million in state expenditures, primarily towards higher Medicaid and state employee health plan costs. Representative C.D. Davidsmeyer highlighted the potential burden on taxpayers, particularly given the projected 16.5% increase in state employee healthcare costs next year.

With the House deadline met, the Senate now awaits the bill’s consideration. Governor Pritzker has announced plans to advocate for the legislation statewide, underscoring its potential to save lives and reduce healthcare costs for millions of Illinoisans.

Stay tuned for further updates as the Healthcare Protection Act progresses through the legislative process.

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