Illinois Gov. J.B. Pritzker and local lawmakers kicked off a weeklong statewide tour in Belleville on Monday to promote a key legislative initiative that will end some health insurance practices they say hurt patients.
The legislation, which passed the Illinois House last week and now awaits a vote in the Illinois Senate, is designed to curb insurance tactics used to control the amount and cost of care patients receive.
“For far too long, insurance companies — and not doctors — have been free to determine what treatment options patients should have and how quickly they can receive it,” Pritzker said at BJC's Memorial Hospital in Belleville. “With this bill, we’re putting power back in the hands of doctors and patients.”
Dubbed the Healthcare Protection Act, the legislation targets “utilization management” practices used by insurance companies that deny patients’ claims or direct them toward lower-cost options. Among other things, it bans “step therapy,” which requires a patient to prove a lower-cost drug is ineffective before the insurance company will cover a higher-tier drug prescribed by a doctor.
But health and pharmacy insurance representatives have said that step therapy and prior authorization are important to control costs.
The bill passed the House 81-25, including 10 Republicans in the Democratically dominated chamber. Rep. Kevin Schmidt, R-Millstadt, a chiropractor in the St. Clair County town, supported the bill.
“When I became a chiropractor, I swore an oath to do what's best for the patients,” Schmidt said. “Well, this is what's best for the patients.”
Passage of the bill would cost the state roughly $40 million to $50 million to cover higher Medicaid price tags and state employee health plans, Emily Miller, a senior adviser to Pritzker, told lawmakers during a committee hearing.
Rep. C.D. Davidsmeyer, R-Jacksonville, who voted against the measure, said the state employee health plan is already going to cost more. A recent report from the Commission on Government Forecasting and Accountability projected the state employee plan will cost 16.5% more next year.
“Ultimately, I think this is going to be a large increase to the State of Illinois,” Davidsmeyer said.
Rep. Katie Stuart, D-Edwardsville, who supported the bill, said Monday she’s heard that doctors’ offices in her district have hired an additional staff member to fight prior authorizations.
This bill prohibits insurance providers from requiring prior authorizations before covering the cost of in-patient psychiatric treatments.
Dr. Jennifer Neville, an internal medicine specialist based at BJC’s location in Shiloh, treats women with osteoporosis who have an increased risk of fracturing their bones. Often Neville prescribes a higher-tier medication to her patients, but it’s usually denied right away, she said.
“Unfortunately, this process is the norm,” Neville said. “I spend an inordinate amount of time and resources fighting with the insurers to get the patients the care they need.”
This process delays not only patient care, but it also bogs down the working time of nurses and doctors, said Jan Ernest, system executive director at BJC HealthCare.
“They spend those hours appealing and justifying what they know to be the best possible treatments against an insurance process designed toward the least expensive options — rather than what best meets patient needs,” Ernest said. “That delays and compromises care.”
The future of the legislation will be determined by the Illinois Senate, which is scheduled to reconvene April 30.
Capitol News Illinois' Peter Hancock contributed to this report.
