Governor JB Pritzker’s health insurance bill is being considered in the House

Gov. J.B. Pritzker’s administration presented details of its sweeping health insurance reform plan to a state House committee on Wednesday, countering claims that it could raise costs for consumers.

Legislation to implement the governor’s plan, which aims to protect consumers from insurance practices that critics say delay or restrict access to needed care, already has the support of many Democrats and at least one Republican. Rep. Anna Moeller, an Elgin Democrat who chairs the Human Services committee and is the bill’s top House sponsor, said at Wednesday’s first hearing that the committee vote could come as soon as next week.

Pritzker and his allies in the legislature aim to overhaul the practices of a wide range of insurers. Among other things, the bill would ban step therapy, in which insurance companies require patients to try a different, often cheaper, alternative before the treatment doctors recommend. It would also prohibit prior authorization, as patients are sometimes required to obtain authorization from their insurance companies for inpatient mental health care before receiving treatment.

“I know insurance companies will fight us on this. But I’m not willing to play political games with the health of Illinois families,” the governor said during a separate appearance in Springfield on Wednesday.

Representatives and partners of insurance companies said at Wednesday’s hearing that they are generally willing to change some of the practices outlined in the legislation. But they said some of the provisions were unnecessary or could impose higher costs on consumers.

Pritzker dismissed the idea that the law could hurt patients’ wallets.

“Nobody here gets away with broad cost controls. “That’s not the point,” he said.

Other opponents argued that the law does not go far enough to protect low-income patients who receive Medicaid instead of private insurance.

Emily Miller, a senior adviser to the governor, told the committee the bill aims to balance the needs of insurers and consumers.

“The industry has a voice that has been well heard over the years,” Miller told lawmakers. He acknowledged there would be a cost to “cutting” the way insurance companies do business, but said efforts are focused more on the cost of care for families.

Other provisions, such as stricter standards for updating guidelines, are intended to increase transparency to consumers about which doctors are in-network. The legislation also addresses large group insurance price increases, seeking to expand some of the protections available to larger employers. A law Pritzker signed last year It includes small businesses and individuals.

It is also planned to ban short-term insurance plans that may be financially risky for consumers. So-called short-term limited-duration plans, which the governor called “junk” plans, provide coverage for a short period of time but can lead to high costs for treatment, witnesses said Wednesday.

Laura Minzer, president of the Illinois Life and Health Insurance Council, said in an interview after testifying before the committee Wednesday that she would prefer to see transparency requirements in these plans rather than a ban.

He also said eliminating stepwise treatment could increase costs because alternative prescription drugs offered by insurance companies often cost less than the treatment doctors initially recommend.

Lori Reimers, testifying on behalf of an association representing prescription drug price negotiators known as pharmacy benefit managers, said step therapy is not meant to be an “inappropriate or manipulative tactic.”

“These guidelines were not created just for the sake of price,” said Reimers, who represents the Pharmaceutical Care Management Association.

Among nearly a dozen witnesses who testified in favor of the legislation Wednesday, many shared personal stories about themselves or their patients who were harmed by insurance practices that would be restricted under the new bill.

Dr. from the Illinois Chapter of the American Academy of Pediatrics. Mary Dobbins said the law “literally deals with matters of life and death.”

State Sen. Patrick Joyce, a Democrat based in Essex, spoke at the hearing to share his personal experiences trying to get treatment for serious health problems for both of his children.

Joyce said her son was born with a rare condition that required open-heart surgery multiple times, including as a toddler.

Years later, when she believed her family was going through hard times, her daughter was diagnosed with leukemia, she said. Joyce lost her daughter Katelyn in 2011. Joyce said that during her daughter’s hospital stay, her family faced issues with their insurance company, including access to a nausea medication they knew would be effective.

“Our fight kept his spirits up,” Joyce said. “We stayed strong but were torn about what we needed to do between taking his medication and keeping his spirits up.”

“Who is defending Illinoisans? If you’re out alone, without family and friends, who is there? This law helps,” Joyce said.

Pritzker’s focus on insurance reform this session surprised many in Springfield. In his budget speech last month, the governor promised to spend significant political capital on legislation that prevents companies from dictating treatment decisions.

“There should never be a situation where an insurance company employee can deny coverage for something as serious as open-heart surgery,” Pritzker said at the time.

Minzer, who was recently appointed by Pritzker to a state committee on health benefits, said he was troubled by the governor’s negative characterization of the insurance industry, especially at a time when the industry is working with the state to implement other recently passed health laws. years.

“Is there friction between all these groups? One hundred percent. You will have that in health care,” Minzer said. Still, he added, saying that the industry in general is problematic is “a very broad, sweeping and inaccurate statement.”